Medicare Part Zero

ZERO.

That’s the Medicare dental benefits for its recipients. You heard right: ZERO!

There are over 49 million adults receiving Medicare (Medicare Trustees Report, 2012) and the population is only growing older!  Most do not have dental benefits and it is projected by 2030 the number of Medicare recipients will grow to 72 million (Administration on Aging, 2013).

Payment for dental services is generally out-of-pocket for seniors. Senior citizens aged 65 and over need dental care more than ever, yet 34% of seniors have income less than or equal to 200% of the poverty level (Levinson et al, 2013). 70% of seniors don’t have dental insurance (Dolan 2005) and 80% of the uninsured seniors can’t afford a major dental procedure (Henry J Kaiser Foundation). It is no surprise then that older adults with the poorest oral health are those who are economically disadvantaged and those who lack insurance. The risk for poor oral health is further augmented in those who are homebound, institutionalized or disabled.

Those who cannot afford dental health premiums, risk the preventative health protection that could avoid many negative outcomes. Tooth decay is almost completely avoidable, yet when people are unable to see a dental provider, they do not get the preventive services, such as early diagnosis. Many older adults take medications that have the complicating side effect of reducing salivary flow. This results in dry mouth, which contributes to dental decay. Intervention can halt or slow the progression of most oral diseases.

While many older adults are fortunate enough to have their teeth, many, due to aging teeth and gums along with deteriorating bone structure have major tooth issues. These teeth have more extensive (and older) restorations. The following are the dental health issues & exposure related to seniors:

  • 50% have untreated caries
  • 23% have severe gum disease
  • 30% lose their teeth
  • 30,000 oral cancers diagnosed annually.

Statistics from: Advance for Nurse Practitioners and Physicians Assistants

The avoidance of procedures to detect and prevent tooth problems due to lack of adequate dental health coverage leads to lower quality of life and poor additional non-dental health outcomes. For instance, left untreated cavities lead to pain and infection, loose or missing teeth causing trouble chewing and nutritional deficiencies. Studies continue to show a possible link between oral infections and systemic diseases such as diabetes, heart disease and respiratory infections. The incidence of oral and pharyngeal cancers is higher among older adults than for other age categories and late diagnosis leads to high mortality.

Primary care providers can play an important role in partnering with dental colleagues to improve the oral health of older adults by including oral health assessments, education and preventive interventions with their older adult patients so that many of the oral health problems, which are preventable are addressed. Advocating for dental care for the elderly population is an important health equity priority. An increased push for interprofessional education of dental, medical and nursing students will accomplish just that – equipping medical professionals, who traditionally do not include oral health assessment into their practice, with skills to competently educate, assess and manage senior patients and refer them for oral care should a dental issue arise.

Do you know a senior with oral health problems? Share your thoughts with us or with the White House Conference on Aging! http://www.whitehouseconferenceonaging.gov/submissions/register.aspx

References:

Advance for Nurse Practitioners and Physicians Assistants. Oral Care in Elderly Patients.http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/Oral-Care-in-Elderly-Patients.asp

Administration on Aging. (2013). Aging Statistics. http://www.aoa.gov/Aging_Statistics

Centers for Disease Control and Prevention.The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 201

Dolan, T. A., Atchison, K., & Huynh, T. N. (2005). Access to Dental Care Among Older Adults in the United States.Journal of Dental Education, 69(9), 961-974. Retrieved from http://www.jdentaled.org/content/69/9/96

Henry J. Kaiser Family Foundation. Oral Health in the US: Key Facts. http://www.kff.org/uninsured/upload/8324.pdf.

Levinson, Z., Damico, A., Cubanski, J., Neuman, T. (2013). A state-by-state snapshot of poverty among seniors: findings from analysis of the supplemental poverty measures. Henry J. Kaiser Family Foundation. http://kff.org/medicare/issue-brief/a-state-by-state-snapshot-of-poverty-among-seniors/

Medicare Trustees Report, 2012, Table V.B3 (p.209),https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads//tr2012.pdf

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