The age distribution of the world’s population is changing. With advances in medicine and prolonged life expectancy, the proportion of older people will continue to rise worldwide. For example, there were 390 million people aged over 65 years recorded in the 1998 World Health Report, and this figure is estimated to double in 2025. The post-war baby boom generation will reach 65 years of age in 2011, significantly augmenting the number of older people.

In many developing countries, particularly in Latin America and Asia, increases of up to 300% of the elderly population are expected by 2025. By 2050, there will be 2 billion people over the age of 60, 80% living in developing countries. The growth in this population is staggering, posing tremendous challenges in caring for this ageing population.

As people age, their susceptibility to chronic and life-threatening diseases as well as acute infections increases, exacerbated by compromised immune systems. Cancer, cardiovascular diseases, diabetes, infections and poor oral health, most notably tooth loss and severe periodontal conditions, are more prevalent in this age group. The consequences of these diseases and conditions are significant, leading to disabilities and reduced quality of life.

Oral diseases are usually progressive and cumulative. The process of ageing may directly or indirectly increase the risk of oral diseases and tooth loss, compounded by poor general health, illnesses or chronic diseases. Among the elderly, high prevalence of co-morbidities and barriers to care are observed, together with oral health care challenges in relation to:

    * Changing dentition status
    * Caries prevalence with unmet need for care
    * Periodontal pocketing/loss of attachment and poor oral hygiene
    * Edentulousness and limited oral functioning
    * Denture related conditions, ill fitting removable dentures
    * Oral cancer
    * Xerostomia
    * Craniofacial pain and discomfort

The interrelationship between oral health and general health is particularly pronounced among older people. Poor oral health can increase the risks to general health and, with compromised chewing and eating abilities, affect nutritional intake. Similarly, systemic diseases and/or the adverse side effects of their treatments can lead to an increased risk of oral diseases, reduced salivary flow, altered senses of taste and smell, oro-facial pain, gingival overgrowth, alveolar bone resorption and mobility of teeth. The high prevalence of multi-medication therapies in this age group may further complicate the impact on oral health. Other relevant issues include high sugar content diets, inadequate oral hygiene due to poor dexterity, and alcohol and tobacco use, risk factors that are detrimental to oral health.

Barriers to oral health care among the elderly are considerable. Impaired mobility impedes access to oral health care, particularly for those who reside in rural areas with poor public transport. The situation is worsened in developing countries when oral health services and domiciliary care are not available. Given that some older people may experience financial hardship following retirement, the cost or perceived cost of dental treatment, together with poor attitudes to oral health, may deter them from visiting a dentist. The fear of violence may make them apprehensive of strangers, hindering good communications with oral health services providers.

In some countries, older people tend to live alone, away from friends and family. The lack of social support and feelings of loneliness and isolation may affect their mental health and well being. Clearly, there is unmet need among this group. It is important that health care service providers recognise these important psychosocial factors that underpin the health and well being of older people. There is a need to provide sensitive oral health services that are accessible, appropriate and acceptable to them. Their general health must be taken into account when planning complex treatment that may involve surgical procedures. Special needs diagnosis and advanced treatment planning are crucial. Finally, the implications for research and training are considerable.

The WHO Oral Health Programme intends to develop strategies for improved oral health of older people. Based on experiences from demonstration programmes in countries, national oral health planners are encouraged to integrate systematic oral health activities towards improved quality of life. The programme will effectuate these strategies in collaboration with the WHO Kobe Centre in Japan, the Regional Offices, WHO Collaborating Centres on Oral Health and NGOs.

Culled From:  World Health Organization.