Dental Health and Aging Population Quiz

Required Readings

• Pretty et al. (2014) - Seattle Care Pathways - Gerodontology - DOI: 10.1111/ger.12098 - https://frailty-guide.fdiworlddental.org/
• Mukherjee et al. (2017) - Informed consent in dental care and research for older adults - JADA - https://doi.org/10.1016/j.adaj.2016.11.019
• Metcalf et al. (2011) - A systems perspective for dental health in older adults - AJPH - DOI: 10.2015/AJPH 2011.300321
• Foley et al. (2017) - Systematic Review of oral health status for people with dementia - JDR Clin Transl Res - DOI: 10.1177/2380084417714789

Geriatrics-Focus on Person-Centered Care

• Focus on Geriatrics (10/30/2024) with Judith Jones, DDS, MPH, DScD, [email protected]

Geriatrics Objectives

• Describe the demographics of aging and its impact on dental practice.
• Describe the prevalence of chronic diseases in older adults.
• Describe oral health disparities in the aging population.
• Describe the principles of geriatric medicine.
• Describe functional declines in older adults.
• Describe goals for long-term oral health care.
• Explain Seattle Care Pathways.
• Discuss communication with other providers, including caregivers.

Why I Went Into Geriatrics

• Humorous cartoon about wrestling with screamers not being compatible with long hair

The Wave of Baby Boomers

• Image of a large wave, representing the large generation of Baby Boomers.

Total Population by Age and Sex

• Graph depicting total population by age and sex: 1900, 1950, and 2000
• Shows a change in population distribution across different age groups over time

Percentage of Americans Aged 65+ and 85+

• Graph displaying percent change from 1900-2060 in the population aged 65+ and 85+
• Data reveals significant and continuous growth for both age groups

Why Showing These Graphs

• Graphs explain demographics of aging.
• There are more older people than ever before.
• There are more older adults with teeth than ever before.
• Older adults are more complex due to various factors.
• Discuss four reasons for the increasing complexity among older adults.

Average Life Expectancy Increased Since 1900

• Table illustrating the increased average life expectancy at birth, age 65 and age 85, (1900-2018).

Average Life Expectancy Varies by Sex, Race, and Ethnicity, 2015

• Table showing average life expectancy varies by: Sex, Race (non-Hispanic Black, non-Hispanic White, Hispanic), and ethnicity (F/M).

Common Chronic Conditions for Adults 65+

• Chart summarizing the presence of 10 common chronic conditions in adults above 65.

Percentage of US Adults with One or More Chronic Conditions, 2008

• Graph showing increasing trend in chronic conditions across different ages (55-64, 65+,1-3+ chronic conditions)

Percent of People with Depression by Age, US, 2014

• Graph displaying percentage of people with depression by age group (85+, 80-84, etc), comparing men and women.

Hearing and Vision Problems Common in Older Age Groups, USA, 2016

• Bar graph showing percent of hearing and vision impairments among different age groups (45-64, 65-74, and 75+).

Visual and Hearing Impairments

• Tips for communicating with people who have visual or hearing impairments
• Speak slowly and lower in pitch.
• Don't backlight.
• Ask if the individual can hear/read.

Diabetic Retinopathy

• Discusses leaking of retinal blood vessels, advanced/long-term diabetes, macula/entire retina and vitreous.
• Emphasizes that not all diabetics experience this.

Glaucoma

• Discusses chronic elevated eye pressure
• Early detection and close medical monitoring can help reduce complications
• In more advanced cases print will appear faded, and words will be hard to read

Cataracts

• Discusses opacity of the lens reducing acuity.
• No scotoma.
• Vision is hazy, especially with bright light.

Macular Degeneration

• Discusses deterioration of the macula
• Visual distortions in print
• Peripheral vision largely unaffected.

Visual Impairments

• Illustration of visual impairments, focusing on the aspects that affect everyday life.

Older Patients and Sensory Impairments, USA 1999-2006

• Chart illustrating the growing trend of sensory impairment in older people(70-79, 80+), comparing vision, hearing, balance and loss of feeling in their feet

Feb 2011: 59-Year-Old Male Patient

• Patient case study with identified demographics, chief complaints, medical history, and social history.

April 2011: 59-Year-Old White Male Patient

• Patient case study with patient's history, treatment details, and associated expenses.

Percentage 65+ Year Olds with Unfilled Caries

• Report details including demographics(NH White, NH Black, Mexican American, <200% FPL, >=200% FPL) percent of 65+ year olds with unfilled tooth cavities from 2011-2016

Complete Tooth Loss, 2011-2016 U.S.

• Results of studies of complete tooth loss in certain demographics(NH White, NH Black, Mexican American, ages 65-74, and 75+)

Percent Aged 65+ who Report 6+ or complete tooth loss, By Income, U.S., 2014

• Relationship between income and the occurrence of tooth loss in persons aged 65+ (incomes range from less than $15,000 per year to greater than $50,000)

Percent Aged 65+ who Report 6+ or complete tooth loss, By Education, U.S., 2014

• Relationship between education level and the occurrence of loss of 6 or more teeth or complete tooth loss in adults aged 65+

Why Is This Important?

• Tooth loss and dental carries are linked with poor general health.
• Relationship between dental problems and poor self-reported health

Oral Impacts more Common in Seniors with Poor General Health

• Presentation on how oral health issues affect and are affected by senior general health.

How Much Pain and Distress?

• Graph demonstrating degree of pain and distress based on number of teeth (25+, 11-24, 0-10)

Found it Difficult to Relax

• Graphic demonstrating different levels of difficulty relaxing during dental procedures based on the number of teeth remaining (25+, 1-24, 0)

Percent avoiding foods

• Report demonstrating a decreased ability to eat specific foods across different age demographics based on the number of remaining teeth (25+, 11-24, 0-10)

Avoid Going Out

• Graph displaying the degree of avoidance of social outings due to oral health issues (25+ teeth, 11-24 teeth plus dentures, 0-24 teeth, no denture)

Periodontal Disease

• Image showing signs of periodontal disease.

Periodontitis Prevalence, 2009-2014, U.S.

• Results identifying the prevalence of periodontitis among different demographics (65+, men, Mexican Americans, low-income, tobacco users)

Prevalence of Severe Periodontitis among 65+ Year Olds USA, 2009-2014

• Graph displaying the prevalence rates of severe periodontitis in older adults, differentiated by demographics, focusing on smoking status and income levels (Mexican, other, non-hispanic white, non-hispanic black, <100% FPL, >= 100% FPL, smoker, non-smoker)

Oral Cancers

• Images illustrating different types of oral cancer.

Oral and Pharyngeal Cancer

• Graph comparing oral and pharyngeal cancer incidence and death rate in different demographics (White males, Black males, Black females, White females, ages 65-69, 65+), (2011-2015).

Oral CA Screening

• Data on Oral Cancer Screening in Michigan, highlighting Wayne County having the highest incidence rates, focusing on the demographics of NH White, NH Black, NH Other, Hispanic , and the relationship to their adjusted rate per 100,000, which varies from "Suppressed" rates of 7.1-8.9 to rates above 25.2 .

So What!

• Summary that inequities are present in oral health disparities and access, dental problems decline seniors' health
• Dental issues lead to negative health outcomes, impact social/mental well-being, and lead people to avoid certain foods, socialize less, and experience shame.

Questions

• Inquiry about the reasons oral health inequities are happening.
• Inquiry about potential solutions to address oral health inequities
• Inquiry about the ways in which one can help others involved in oral health inequities
• Inquiry about interventions that can be applied to the oral health inequities issue

Social Determinants of Health

• Definition of social determinants of health as factors that influence health outcomes.
• Factors including: income, working conditions, literacy, and access to healthcare.

World Health Organization

• Conceptual framework illustrating how social determinants influence health and health inequalities, with a focus on socioeconomic, political and intermediary factors, along with the role of health care systems

Our "Urban Context"

• Presentation of statistics and demographics for the city of Detroit, compared to the entire US population (2011-2016 data)

Cost per Beneficiary by 65+ year Olds

• Chart showing costs associated with health care services by demographics (by source)

Policy Implications

• Suggest that funding for dental care should be supported for all elders.
• Proposed Medicare policy changes to include dental coverage for eligible individuals.
• Suggest Part B physicians services, making that all elders are eligible for oral care services

Objectives: Geriatrics

• Objectives regarding the demographics of aging, the impact on their practice, the epidemiology of chronic diseases in older adults, and oral health disparities in the aging population

Objectives: Next Time

• Future objectives to be addressed regarding geriatric medicine principles, functional and oral health declines, goals for long-term oral health care.
• Including communication between providers and caregivers.