Geriatric Dentistry

Caring for Our Aging Population

Paula K. Friedman

• Publisher: Wiley-Blackwell
• Year: 2014
• ISBN:
  9781118925454
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

Geriatric Dentistry: Caring for Our Aging Population provides general practitioners, dental students, and auxiliary members of the dental team with a comprehensive, practical guide to oral healthcare for the aging population. Beginning with fundamental chapters on the psychological, environmental, and social aspects of aging, the book approaches patient care from a holistic point of view. Subsequent chapters show the importance of this information in a practical context by discussing how it affects office environment, decision?-making and treatment planning, and the management and treatment of common geriatric oral conditions. Case studies and study questions are used to illustrate application of educational presentations to practice settings. Contributed by leaders in the field, Geriatric Dentistry will strengthen readers' understanding and clinical acumen in addressing this special population.

PART 1
Underlying Principles of Aging

Chapter 1
Aging: Implications for the Oral Cavity

Bei Wu

School of Nursing and Global Health Institute, Duke University, Durham, NC, USA

Aging of the US population

The US aging population is increasing. The US older population, that is individuals aged 65 and older, reached 40.3 million in 2010. This is an increase of 5.3 million compared to the 2000 census. The percentage of the US population aged 65 and older also increased from 2000 to 2010. In 2010, the older population represented 13.0% of the total population, an increase from 12.4% in 2000 (Vincent & Velkoff, 2010). In the USA, by 2030 it is projected that there will be about 72.1 million older people, more than twice their number in 2000. Individuals aged 65 and older are expected to grow to become 19% of the US population by 2030 (Administration on Aging, 2012). By 2050, it is projected that there will be about 88.5 million older adults, 20.2% of the US population (US Census Bureau, 2008a).

Ethnic diversity

The US population is becoming increasingly diverse, and this is true for the aging population too. In the USA, among those aged 65 and older in 2050, 77% of the elder population are projected to be White-alone, down from 87% in 2010. Within the same age group, 12% are projected to be Black-alone and 9% are projected to be Asian-alone in 2050, up from 9% and 3%, respectively, in 2010. The Hispanic proportion of the older population is projected to quickly increase over the next four decades. By 2050, 20% of the US population aged 65 and over are projected to be Hispanic, up from 7% in 2010. The smallest race groups are projected to see the largest growth relative to their populations. Among the population aged 65 and older, it is projected that in 2050, the American Indian and Alaska Native-alone population will be 918 000, up from 235 000 in 2010, and the Native Hawaiian and Other Pacific Islander-alone population will be 219 000, up from 39 000 in 2010 (Vincent & Velkoff, 2010). There is also a trend of increasing number of old-old (age 75 and older) and oldest-old (age 85 and older) populations in the USA. The old-old and oldest-old carry much of the chronic disease burden in the population.

In the USA, among those aged 65 and older in 2050, the White-alone population will comprise approximately 77% of the aging population, whereas in 2010 the racial composition of the elder population was 87% White-alone, 9% Black, 3% Asian-alone, 7% as Hispanics, and 0.6% American Indian and Alaska Native. Between 2010 and 2030, the percentage of minority elders will increase much faster than the White population. The White population aged 65 and older is projected to increase by 59% compared with an average increase of 160% for older minorities, including Hispanics (202%), African Americans (114%), American Indians, Eskimos and Aleuts (145%), and Asians and Pacific Islanders (145%) (Administration on Aging, 2012).

While an increasing number of studies have examined oral health disparities across race/ethnicity in the USA, a limited number of such studies have been conducted for older adults. Policy makers, public health officials, and other healthcare providers need to better understand how social factors, along with medical conditions, may contribute to racial/ethnic disparities in oral health with the demographic transitioning to a more diverse older population in the USA (US Census Bureau, 2008b).

A report from the Surgeon General (US Department of Health and Human Services, 2000) noted ongoing racial/ethnic disparities in oral health across all ages, and it stressed the need for research to explain these differences. The first step towards explaining the disparities is to know how oral health differs between the groups.

Trends in oral health in older adults

There is substantial evidence that oral health in the USA has significantly improved in the past four decades. Dye et al., using data from the National Health and Nutrition Examination Survey (NHANES, III, 1988–1994) and NHANES 1999–2004, found that the oral health of the USA has substantially improved during this period (Dye et al., 2007). Specifically, Dye et al. show that the rates of periodontal disease and caries have decreased for most age groups.

Edentulism, or complete tooth loss, is one of the most important indicators of oral health. Edentulism reflects both the accumulated burden of oral diseases and conditions and the result of dental extraction treatment (Sanders et al., 2004). Studies suggest that edentulism significantly affects quality of life, self-esteem, and nutritional status (Nowjack-Raymer & Sheiham, 2003; Slade & Spencer, 1994; Starr & Hall, 2010). In economically developed countries, the trend of edentulism has declined consistently. For example, in England and Wales, the prevalence of edentulism for the adult population declined from 37% in 1968 to 12% in 1998 (Kelly et al., 2000). In Australia, the prevalence of edentulism for the adult population declined from 20.5% in 1979 to 8.0% in 2002. Among Australian older adults aged 65 and older, the reduction for males was from 59.7% to 26.5%, and for females was from 71.5% to 40.3% (Sanders et al., 2004). Similarly in the USA, the few studies available on middle-aged and older adults have shown that edentulism in these age groups has been dropping for the past several decades. One study revealed that within the period of 1971 and 2001, for those in a low socioeconomic position (SEP), the prevalence of edentulism declined from 50% to 32% in adults aged 55–64 and from 58% to 43% in adults aged 65–74; the comparable declines for these age groups for individuals in a high SEP were from 22% to 6% and from 30% to 9%, respectively (Cunha-Cruz et al., 2007). A report conducted by the US National Centers for Health Statistics using the US National Health and Nutrition Surveys of 1988–1994 (NHANES III) and NHANES 1999–2004 found that the prevalence of edentulism declined in the USA over these two time periods from 34% to 27% among adults aged 65 and older (Dye et al., 2007).

In the USA, minority elders have been identified as a key demographic group at greatest risk for edentulism (US Department of Health and Human Services, 2000). Black elders, in particular, have higher rates of edentulism than non-Hispanic Whites and Mexican Americans (Dye et al., 2007; Schoenborn & Heyman, 2009; Wu et al., 2011a). One study reported that the rates of edentulism among Blacks were declining, even though they were still higher than other ethnic groups (Dye et al., 2007). This study reported that the rates of edentulism for Black elder...