Jessamin E. Cipollina, M.A.
Concerns are growing about how poor oral health of older adults, aged 65 and older, negatively impacts physical and mental health as well as overall quality of life. According to the CDC, 1 in 5 adults is reported to have untreated tooth decay or have lost all of their teeth, while 2 in 3 adults have gum disease.1 Tooth loss can further affect nutritional health and ability to enjoy most foods. Gum disease, including gingivitis and periodontitis incur infection, increased tooth and gum pain, and tooth loss associated with reluctance to smile and issues with speech.1,2
The CDC also cites various systemic factors that increase risk for poor oral health among seniors including one or more chronic conditions such as diabetes, cardiovascular disease, or cancer. Chronic mobility disorders such as arthritis, Parkinson’s disease, stroke, and dementia contribute to limitations in self-care including oral hygiene.3-5 Social factors including, but not limited to: loss of dental insurance related to retirement, no Medicare dental benefit, isolation due to loss of spouse and/or peer group, depression, disability or institutionalization are also barriers to seeking dental care or carrying out effective oral hygiene.1,3 National data on oral health also shows significant disparities among older adults by race/ethnicity and income.6 It is estimated that one third of older adults living in poverty have untreated decay and 36% are endentulous; this is four times the rates for older adults with annual household incomes at or above $47,000.4,6 The vast array of factors that affect oral, physical, and social well-being can dramatically affect the quality of life (QOL) of this population.
Isolation and loneliness are of particular concern related to older adults’ QOL. Studies on ageing and social support networks describe loneliness as both a cause and a consequence of negative overall health; loss of connections over time reduces the social network of older adults which further increases the likelihood of depressive symptoms, cognitive decline, inadequate nutrition, and poor self-care, including oral hygiene.3,7,8 In addition to the stressors of sustaining social support in older age, many older adults struggle with maintaining oral health, that is, obtaining preventive and/or restorative dental care and performing oral hygiene. This situation comes with its own set of problems that impact this group’s willingness to socialize with others and maintain a sort of independence that promotes self-confidence.8 This notable relationship between insufficient dental care and loneliness represents a need for further exploration and understanding about how good oral health can improve older adults’ overall QOL and well-being.
One recent study assessed differences in self-reports of oral health and QOL among seniors with varying fraility, including those with remaining teeth and/or dentures and those who were edentulous.2 Seniors with remaining teeth reported better QOL than those who were edentulous, supporting a connection between good oral health care and overall positive QOL.2 Another study by Rouxel and colleagues, described the link between oral health and loneliness and sought to define oral health-related QOL. Their findings support the notion that those with oral health issues, such as dental disease and tooth loss, are more likely to report feeling lonely and reluctant to socialize.8 Future research could continue to explore oral health-related QOL as a means of combating loneliness and improving social well-being.
Maintaining good oral hygiene practice and self-care is a surprisingly important part of socializing and enjoying life. Our favorite social activities – dining out, laughing with friends, engaging in rich conversation – all necessitate being confident in ones’ appearance and being comfortable with smiling and engaging with others. Older adults that struggle with tooth loss, mouth pain and oral diseases struggle to enjoy tasteful and nutritional food or may be reluctant to engage with others because they lack self-confidence in their appearance.
In addressing oral health as an essential component of overall health, particularly for older adults, there needs to be greater awareness about the negative impact poor oral health practices and care can have on physical, mental and social health. Recent studies postulate implications for changing healthcare and education policies by proposing integration of oral health into all aspects of health care, as well as providing community-based programming and education for seniors on good oral health and preventing dental disease.2,6,8 Oral health is present and pertinent over the entire life span and rooted in many aspects of day-to-day health and functioning. Although the promotion of access to care and importance of oral health for older adults is often neglected in education, practice, research and policy, there appears to be growing interest in attending to best practices for improving this population’s quality of life and understanding how to successfully address their needs.3,5
- CDC. Oral Health for Older Americans | Adult Oral Health | Basics | Division of Oral Health | CDC. https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm. Accessed August 14, 2018.
- Hoeksema A, Spoorenberg S, Peters L, et al. Elderly with remaining teeth report less frailty and better quality of life than edentulous elderly: a cross-sectional study. Oral Dis. 2017;23(4):526-536. doi:10.1111/odi.12644
- Catalanotto F, Koppelman J, Haber J. Emerging Models of Dental Practice Aim at Addressing Needs of the Aged. Compend Contin Educ Dent. 2017;38(9):606-610; quiz 613. http://www.ncbi.nlm.nih.gov/pubmed/28972385. Accessed August 15, 2018.
- Tomar S. Changes in disparities in dental caries status in the Inited States. 2017.
- Haber J, Hartnett E, Allen K, et al. Putting the mouth back in the head: HEENT to HEENOT. Am J Public Health. 2015;105(3):437-441. doi:10.2105/AJPH.2014.302495
- Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health. 2012;102(3):411-418. doi:10.2105/AJPH.2011.300362
- Chen Y, Feeley TH. Social support, social strain, loneliness, and well-being among older adults. J Soc Pers Relat. 2014;31(2):141-161. doi:10.1177/0265407513488728
- Rouxel P, Heilmann A, Demakakos P, Aida J, Tsakos G, Watt RG. Oral health-related quality of life and loneliness among older adults. Eur J Ageing. 2017;14(2):101-109. doi:10.1007/s10433-016-0392-1