Elder care Overcoming barriers focus of efforts

Results from a new ADA survey on the oral health care of vulnerable elderly patients shows that the overwhelming majority of U.S. dentists treat patients in this population group, but they see serious barriers to care and would like more information to better serve them.

The ADA Survey Center conducted the survey on behalf of the Council on Access, Prevention and Interprofessional Relations in response to Resolution 5H-2006, a resolution that called for 26 different initiatives related to the oral health of vulnerable elders.

“This survey has helped give support and direction to CAPIR and its workgroups in moving forward with other initiatives related to 5H-2006 and the vulnerable elderly,” said Dr. Jerald Boseman, a council member from Salt Lake City. “As we learn more about the oral-systemic relationship of disease, and as our population ages, we as a council are increasingly concerned about the quality of life faced by those elderly who have dental needs and little or no ability to have them addressed. We are committed to finding solutions that will not only lessen, but hopefully solve any pending crisis in oral health care facing our vulnerable elderly population.”

The 2007 Oral Health Care of Vulnerable Elderly Patients Survey found that 92.6 percent of all dentists provided care during that year to vulnerable elderly鈥攑atients who are over age 65 and have limited mobility, limited resources or complex health status. Those dentists reported that an average of 9 percent of their patients were vulnerable elderly.

Most dentists (98.3 percent) provided care in their offices and 13.8 percent reported providing care in a nursing home or long term care facility.

About one-quarter of patients (24.9 percent) required dentists to consult with dental specialists and more than a third (37.4 percent) required dentists to consult with physicians. The most common referral by dentists was for transportation services, with 39.5 percent of dentists reporting such a referral. More than a third of established dentists (38.6 percent) and a quarter of new dentists (25.3 percent) said they were “very comfortable” treating vulnerable elderly patients.

Yet, many dentists reported needing more information on managing patients with complex medical histories (68.5 percent); managing xerostomia (63.6 percent); managing dementia patients (49.1 percent); managing caries (48.7 percent); and developing home care plans for patients with functional or mental impairments (41.5 percent and 35.6 percent, respectively).

Dentists surveyed also reported that more than half of vulnerable elderly patients (56.6 percent) were not covered by insurance, 57.4 percent of patients received discounted care and 14.3 percent received free care. Only about a third of dentists (35.8 percent) were familiar with the National Foundation of Dentistry for the Handicapped Donated Dental Services Program and 42.9 percent of those familiar with the program participated in it. A third of dentists (33.5 percent) said vulnerable elderly had a problem obtaining dental care in their community. Among the barriers identified were inability to pay for care (88.7 percent); lack of transportation (68.4 percent); inadequate financial support from local, state or federal programs (65.5 percent); lack of perceived need (61.5 percent); and not knowing where to go (51.3 percent).

The complete survey is available online at ADA.org. For more information, contact Barbara J. Smith, manager, Geriatric and Special Needs Populations for CAPIR, by calling toll-free, Ext. 2697 or e-mailing smithb@ada.org.