Access to Dental Care for Older Americans
Are We Making Progress?
Teresa A. Dolan, D.D.S, M.P.H.
THE GRAYING OF AMERICA has been a topic of discussion among demographers, policymakers, gerontologists and geriatric health care professionals for many years. The literature is replete with studies describing the importance of oral health to the healthy aging process and challenges associated with ensuring appropriate access to care for older adults in the United States. This paper summarizes key trend related to access to care, the demand for and use of dental services by older patients, and dental workforce challenges associated by the changing needs of older patients. This paper also highlights recent “calls to action” by the dental community and other aging advocates and questions our progress in addressing the oral health needs of older adults, with particular concern about vulnerable subgroups of older adults. Finally, the paper highlights opportunities for action to improve access to care for older Americans.
What Do We Mean by Access to Dental Care?
The Institute of Medicine defined access to care as “the timely use of personal health service to achieve the best possible health outcomes.” The report further explained that “Access is a shorthand term for a broad set of concerns that center on the degree to which individuals and groups are able to obtain needed services from the medical care system. Often, because of difficulties in defining and measuring the concept, people equate access with insurance cover age or with having enough doctors and hospitals in the geographic area in which they live. But having insurance or nearby health care providers does not guarantee that people who need services will get them.” Timely and appropriate access to health care is considered important to reduce premature morbidity and mortality, preserve function and enhance overall quality of life.
Concern about older adults and their access to appropriate dental services in the United States have been reviewed several times in recent years. For example, the Public Health Services’ Bureau of Health Professions supported the Iowa Oral Health Care Reform Workshop in 1993 and commissioned a series of white papers, including one focused on access to care for older adults. More recently, the Elder’s Oral Health Summit was convened in Boston, MA, to “examine the state if science in access to and outcomes of care for elders and to formulate a “Research Agenda and Plan of Action for the Future of Elder’s Oral Health.” The conference included an updated literature review about access to care among older adults in the United States.
The current status of older adults’ access to care can be described as “the best of times and the worst of time.” In general, many older adults living independently in their communities have no difficulty obtaining dental care. Research suggests that those who can afford care, have dental insurance, are dentate and have a pattern of regular care-seeking behaviors, believe they need care, have a regular source of care, can get to the office, can effectively communicate with the dentist and the office staff, and do not belong to ethnic or minority groups generally do not have difficulty accessing dental services.