Accommodating the Older Adult in the Oral Health Care Setting

Currently, seniors account for almost half of the total consumer demand for services. More than three-fourths of all assets in the United States are owned by persons aged 55 and older. The senior market is subdivided by age (younger than 65 and 65 or older); economic circumstances (working, retired with a fixed income, and comfortable or wealthy retired); level of activity (sedentary or active, and traveler or stay-at-home); and so forth. Marketing strategies are based on these factors. Seniors may experience physical limitations such as wheelchair dependency or vision impairment. The key to marketing is not to ignore that segment of society, but to adjust the marketing strategy to meet their needs. As the “baby boomers” are quickly approaching senior status, the markets are becoming more serviceoriented; health and fitness have become increasingly important to older adults. Consequently, seniors are seeking oral health care at a greater rate than ever before, but these visits vary based on race, level of education attained, and the existence of natural teeth.63

Office design
The dental office should include design features that consider the unique needs of older patients. The entire office should be climate controlled. controlled. If that is not feasible, light blankets should be made available in the operatories. If there is music, it should be pleasing and low volume. The waiting room should have good lighting and the reading materials should include large print selections as well as periodicals that are of interest to older adults. Chairs should be supportive and stationary to facilitate seating and rising. Loose rugs or mats and highly waxed floors should be avoided to prevent tripping or falling. Highly waxed floors can cause slipping and adversely affect sight in persons with vision problems.63

Entrances, doorways, restrooms, and operatories must be accessible to the disabled. The dental chair itself should possess a double-articulating headrest to permit adjustment of both the head and back. Pillows also should be made available to support the patient’s potentially painful muscles and joints. Hoses and foot petals should be neatly secured and out of the line of traffic.63

Staff behaviors
Respect for older adults by office staff is crucial to helping the elderly feel welcome.63 Numerous studies conducted to assess health care provider attitudes toward treating older adults revealed ageist attitudes that stemmed from a lack of knowledge and experience working with older adults, concern that older adults were too chronically ill or too old to treat optimally, and exposure to older adult patients on public assistance who could not pay for treatment rendered. Unfortunately, many of these attitudes do not appear to be changing.64,65 It is the responsibility of dental and dental hygiene educational programs to provide learning experiences that prepare practitioners to be competent and comfortable in assessing and managing the needs of older adults. Increasing reimbursement rates and expanding dental services through Medicaid is also critical to addressing this problem.66

Respect and awareness of the complex needs of older adults by all practitioners in the office is critical.63 The office manager should be knowledgeable about how to effectively communicate with older adults, particularly if hearing or vision impairment exists. In addition, the office manager must be able to offer creative and flexible financing options, such as senior discounts, since the vast majority of oral health care services received by older adults are out-of-pocket expenses. Familiarity with when to involve a patient’s family members or caregivers in scheduling or completing transactions is also important.

The dentist, dental hygienist, and dental assistant must be trained and able to assist the patient in wheelchair transfers. Certification in cardiopulmonary resuscitation and thorough reviews of the medical history must occur at each appointment to reduce the risk of medical emergencies. Simple courtesies such as recommending recommending patients taking diuretics use the restroom before going back to the operatory or suggesting patients stay seated for several minutes prior to rising from a supine position are important, too. Sending birthday cards, reminders for recall, and informational pamphlets about oral and systemic health to patients is advised, because older adults usually enjoy reading and appreciate the personal interest that has been taken in them. Oral cancer screenings and free dental consultations at local senior centers prove rewarding, while still reaching a broader segment of the older adult population.67