CHARACTERISTICS OF OLDER ADULTS IN THE UNITED STATES
Older adults today are better educated than in the past. In 1965, 24% of older adults had graduated from high school and only 5% had earned a bachelor’s degree or higher. By 2018 , 86% of adults age 65 and older were high school graduates, with 29% having earned a bachelor’s degree or higher (Federal Interagency Forum on Aging Related Statistics, 2020). The median household income for American householders age 65 and older in 2019 was $27, 398 with a median income for men at $36, 921 and $21,815 for women (Administration for Community Living, 2021). Approximately 39% of individuals age 65 or older report some functional limitation (Federal Interagency Forum on Aging-Related Statistics, 2020). However, 39% report difficulty with one or more of the six basic activities of daily living – transferring from bed/chairs, eating, toileting, bathing, dressing, and walking (Federal Interagency Forum on Aging-Related Statistics, 2020).). Older women are more likely to report a functional limitation than older men. However, the most common functional limitation for both genders involves mobility such as walking or climbing stairs. (Federal Interagency Forum on Aging-Related Statistics, 2020). According to the U.S. Administration on Aging approximately 40% of noninstitutionalized adults in the U.S. population age 65 and older rate their health as very good or excellent (American Dental Association, 2021a) However, most people in this age range have at least one chronic health condition while some have multiple systemic health conditions The most common chronic condition in older men and women is hypertension , followed by arthritis, heart disease, cancer, and diabetes (American Dental Association, 2021a).
According to Census data, in 2018 non-Hispanic Whites constituted 77% of the U.S. older adult population. However, older adults are becoming increasingly diverse. It is estimated that by 2060, the percentage of Hispanics in the older population will increase from 8% to 21% the percentage of Blacks will increase from 9% to 13% and the percentage of Asians will increase from 5% to 8% of the older adult population (Federal Interagency Forum on Aging-Related Statistics, 2020). The life expectancy for a U.S. woman reaching age 65 today is approximately 2.3 years greater than that for a U.S. man reaching age 65 today (U.S. Social Security Administration, n.d.). It is not surprising, then, that older adult women outnumber older adult men, with women accounting for 56% of adults age 65 and older and 64% of adults age 85 and older. More men age 65 to 74 are married (71%) compared to women in the same age group (46%). Women 65 years old and older are much more likely to be widowed than men (32% versus 11% (Federal Interagency Forum on Aging-Related Statistics, 2020). A common misconception is that a large number of people over 65 reside in nursing homes, yet in 2019 only 1% of those aged 65-74, 2% of those 75-84 and 8% of those 85 years of age and older were long-term residents of these facilities (Administration for Community Living, 2021). A greater number of older women live alone than older men. Interestingly, there is a significant difference in the living arrangements of older women by race. A higher percentage of older non-Hispanic women (33%) and Black women (35%) live alone compared to older Asian women (16%) and for older Hispanic women (22%) (Federal Interagency Forum Aging Related Statistics, 2020).
GERIATRIC DENTISTRY
● Medications. ● Cognition. ● Functional status. ● Socioeconomic status. ● Lifestyle. ● Medical history, and ● Dental and denture history.
Geriatric dentistry is largely about safely managing patients with common chronic diseases. Risk assessment is therefore extremely important. The type and magnitude of the planned dental procedure (invasive versus noninvasive) must be carefully weighed in light of the nature, severity, and stability of the patient’s medical conditions. The original rational treatment planning model for geriatric patients was created by Ettinger and Beck in 1984 who proposed that the elderly patients could be classified as functionally independent older adults, frail older adults and functionally dependent older adults (Catapano, et al., 2021). and encompassed decisions about care for geriatric dental patients included in this model and should be informed by factors that include:
These factors influence diet, oral hygiene, saliva production, and fluoride use – all of which figure into the risk of decay, periodontal disease, and tooth loss. Modifications to the original model reflect a consideration of a plethora of new medications that can have drug-drug interactions and adverse oral and systemic side effects.
NORMAL BIOLOGICAL CHANGES RELATED TO AGING: IMPLICATIONS FOR DENTAL PROFESSIONALS
Aging changes in skin Skin thins and loses elasticity with aging, resulting in increased risk of tears and breaks. Wounds heal more slowly in older adults than in their younger counterparts. As humans age, there is decreased vascularity in the skin. The ability of skin to adapt to heat and cold (thermo- regulation) also decreases with age (National Institute on Aging, 2017; Nigam & Knight, 2017). Dental professionals should be aware of, and sensitive to, these normal changes in the skin of their older patients and alter the treatment of older patients accordingly. Strategies would include being cautious not to tear the corners of the mouth when providing dental care and offering a blanket or adjusting the room temperature to ensure that the older patient is comfortable.
Older adults are more prone to dehydration than their younger counterparts and have been found to take in less water each day than younger adults (Taylor & Jones, 2022). The stratum corneum is a non-vital layer of cells that forms the external layer of the epidermis and is essential in maintain cutaneous hydration (Tobin, 2017). Older adults with cognitive difficulties may forget to drink. For some older adults, mobility problems, impaired thirst mechanisms, diabetes, falls and renal disease can increase the risk of dehydration (Taylor & Jones, 2022). Dental professionals should be aware of the increased risk of dehydration in their older patients and may evaluate dehydration by assessing skin turgor. This simple test evaluates the skin’s elasticity and its ability to return to its normal shape after distortion.
EliteLearning.com/Dental
Page 54
Powered by FlippingBook