Jessamin E. Cipollina, MA
Older adults often struggle with maintaining proper nutrition, which can lead to many adverse health outcomes. Chronic health problems contribute to changes in appetite, taste and smell, which contribute to decreased food intake and lack of motivation to cook and prepare food. Trouble chewing related to ill-fitting dentures and loose or missing teeth, as well as oral pain from tooth decay, abscesses or xerostomia, also make it difficult to enjoy eating. The COVID-19 pandemic has exacerbated many of the challenges older adults already face including, but not limited to: food shopping, enjoying meals with friends, or have food preparation help from a home aide, who may be at risk for spreading the virus. It is clear to see that for older adults, nutrition, oral health and COVID-19 are inextricably linked!
The important relationship between oral health and nutrition for older adults is minimized in our health culture, but a healthy mouth and teeth are vital to the idea that nutrition contributes to a healthy body. The majority of adults 65 and older have one or more chronic conditions, many of which have an oral-systemic connection. There is a great need for more awareness about the links between inflammation, infection and the chronic conditions that have related to oral health problems that can affect a person’s nutritional status and overall health. Chronic conditions, including diabetes, cancer, heart disease and depression, impact older adults’ ability to maintain both proper oral hygiene and nutrition Older adults are at risk for oral infections related to tooth decay, gum disease and tooth loss, all of which make chewing and swallowing difficult.1-3 Poor oral hygiene is a prominent and harmful barrier to getting adequate nutrition.
There are many physiological and metabolic changes in aging that put older adults at risk for nutrient deficiencies. Day-to-day activity and energy needs decline significantly, along with muscle mass, senses and overall ability to absorb nutrients. These declines can be associated with a total lack of appetite, along with inspiration to cook and eat healthful food.2 Behavioral and mental health issues are often neglected in health care across the lifespan, especially the connections between behavioral, oral and nutritional health.1,4-7 Older adults are particularly susceptible to feelings of hopelessness and loneliness due to losing their partners, friends and family in old age. The grief or loss that this group experiences related to illness and death of friends and family is often related to or can lead to depression, addiction and substance abuse. As a result, the symptoms that older adults experience impact their ability and motivation to shop for food and eat alone or in the company of others as these activities become less interesting.5-7 Similarly, oral health issues like tooth loss or poor dentition can greatly affect older adults’ self-esteem, making them reluctant to socialize due to their appearance. Social support from family, friends and the community are greatly important in improving older adults’ quality of life, and positive mental health is a hugely important factor in promoting positive health outcomes in this age group.4-7
When thinking about nutrition and oral health with this age group, the social determinants of health (SDOH) need to be considered. Age-related changes associated with oral health impede ability to eat and drink. Those older adults who experience economic disadvantages, lack of insurance, and are in racial/ethnic minority communities are shown to have the most oral health complications. Those older individuals with disabilities or who are homebound or institutionalized are also at increased risk for poor oral health, especially in the midst of a global pandemic where access to care is limited for this age group.2-3 Food insecurity is common among older adults in the US: approximately 5 million adults over 60 rely on SNAP benefits, and households with older adults have only $125 per month for their food budget.8 Food insecurity, being on a fixed income, and other related social and environmental factors are often overlooked in the health care system. Due to the COVID-19 pandemic, vital food delivery service programs have been halted and older adults may no longer receiving regular hot meals. With a limited budget and necessary social distancing precautions, access to healthy food is greatly restricted for this age group. Without the motivation and financing to buy, cook and eat healthy foods, older adults’ poor nutrition can lead to serious physical health complications.2,4
Promoting accessible, affordable and available oral health care is a responsibility that falls on the entire health care system. This age group has complex care needs that benefit from an interprofessional team of health care professionals to effectively address nutritional, oral health and overall health issues. Connecting students and clinicians across the health professions to provide effective whole-person care is a must, yet dentists and nutritionists are often left out of this team! Interactive classroom, simulation, case study, and live clinical experiences provide opportunities for interprofessional teams of students and clinicians who collaborate to develop management plans that address the spectrum of physical, behavioral, dental, nutritional, and social support interventions needed by this complex patient population.9-10 Oral health and nutrition education can also be integrated by faculty using web-based curricula integration tools that weave nutrition, oral health and overall health and interprofessional competencies. These types of experiences prepare students to promote interprofessional teamwork and care in clinical practice, providing comprehensive whole-person care to their patients.9-10 Health professions educators, students, and clinicians are equally responsible for promoting another important intervention, health literacy, to educate patients and providers alike about the links between oral health, nutrition, and overall health. Oral health and nutrition are inseparable key components of older adults’ health and play a vital role in influencing their ability to eat and get the nutrients they need to thrive.
- The Gerontological Society of America. Oral Health: An Essential Element of Healthy Aging. 2017. Retrieved from https://www.geron.org/images/gsa/documents/gsa2017oralhealthwhitepaper.pdf.
- The Gerontological Society of America. What’s Hot: A Newsletter of the Gerontological Society of America. 2020. At: https://www.geron.org/images/gsa/documents/whatshotnutritionoralhealth.pdf.
- CDC. Oral Health for Older Americans. CDC, 2020. https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm. Accessed August 14, 2018.
- 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
- Cipollina JE. Eating, Chatting and Laughing: Oral Health Improves Social Support and Quality of Life of Older Adults. 2020. At: https://all4oralhealth.wordpress.com/2018/08/21/eating-chatting-and-laughing-oral-health-improves-social-support-and-quality-of-life-of-older-adults/
- National Council on Aging. SNAP and Senior Hunger Facts. At: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/senior-hunger-facts/
- Haber, J., Hartnett, E., Cipollina, J., Allen, K., Crowe, R., Roitman, J., Feldman, L., Fletcher, J., & Ng, G. Attaining Interprofessional Competencies by Connecting Oral Health to Overall Health. Journal of Dental Education. Published in Early View. doi: 10.1002/jdd.12490
- Greenberg SA, Hartnet E, Berkowitz GS et al. Senior oral health: A community-based interprofessional educational experience for nursing and dental students. 2020, Journal of Gerontological Nursing;46(8):37-45. doi: 10.3928/00989134-20200527-03