Ed i to r ia l

Health priorities and barriers to care of the older adult

One of the key issues associated with the care of the

older adult arises from a lack of understanding as to

what are the actual needs, what is required to

address these needs and how they may be

achieved. A paper published in this issue, partic-

ularly related to people in long-term care facilities,

highlights the fact that many dentists have little or

no contact with severely or terminally ill older

patients and therefore they have very little

experience in providing palliative dental care for

this group. Other research highlighted in this study

also indicates that there is a lack of mobile dental

units, unfavourable working conditions, increasing

economical pressure in dental practice and a lack of

information and understanding regarding gerod-

ontology. As far as the dentists themselves were

concerned, many have stated that they would only

carry out home visits if the level of financial sup-

port were appropriate and only if it was close to

their dental practice so that the treatment could be

completed within 30 minutes. A key factor in all

this relates to the fact that domiciliary care is no

longer the treatment of the edentulous individual

but the provision of potentially complex oral care

for large numbers of retained teeth, many of which

have received advanced restorative procedures.

Therefore, the availability of suitable equipment

becomes increasingly important to meet the treat-

ment needs of these patients. It has been suggested

that long-term care facilities should incorporate

dental surgeries specially equipped to treat the el-

derly residents and this might motivate dentists to

provide oral care. In addition, many dentists feel

inadequately prepared to treat this group of

patients, particularly with regard to the appropriate

care decisions for frail patients on multiple medi-

cations. Therefore, the conclusions of the study by

Nitschke et al. is that practitioners should be made

more aware of the dental health needs of this group

of the population with the need to establish more

postgraduate training programmes to increase

clinical and ethical competence. Health politicians

also have to be made aware of the need for meeting

the infrastructural and financial aspects involved

and the restructuring of consultancy services for

this group of patients.

There are also concerns, from noted care groups,

regarding the overall health of the elderly popula-

tion. Figures quoted by governments, such as the

United Kingdom, predict that the population of

over 80s is set to double in the next 20 years, but

that quality of life of this group is likely to be poor.

It has been stated that the amount of time women

spent living in poor health increased between 1981

and 2001 by 15% to 11.6 years and for men the

equivalent time increased more rapidly by 34% to

8.7 years. It has been suggested that spending on

long-term care would have to rise significantly as

the demand for residential and nursing home pla-

ces is expected to triple in the UK to 1.1 million.

Some governments at least appear to be listening to

older people and their care organisations in allow-

ing more elderly care to take place in people’s own

homes. This has been identified as particularly true

of people in their 50s and 60s but much less true of

those in their 80s who feel more comfortable with

the support of a residential care environment. It is

important that older people can choose just in the

same way that 20 and 30 year olds have plenty of

choice. As far as cost is concerned, in Scotland, the

decision has been taken by the Scottish parliament

to provide free long-term care as opposed to

means-tested provision in many other countries.

It is important for the population as a whole that

people remain active into their 70s and 80s and

studies in America have suggested that healthier

lifestyles mean that people will live longer. One

way that this could be achieved would be to ensure

that relatively basic surgical procedures such as hip

replacements were completed with minimum delay

as this would enable the older patient to return to

normal daily life as quickly as possible. Doubt has

been cast on whether caring for the older popula-

tion would put a strain on overall healthcare ser-

vices. It has been suggested that, apart from birth

and during childhood, most of the costs of caring

for a person comes during the last 6 months and

therefore whether this happens at 50 or 80 makes

little difference to the healthcare costs.

Another major issue with regard to the health of

the older adult is that governments need to pro-

mote healthier food by better education and, if

possible, make it cheaper. It has been suggested in

the UK, that 0.5 million older people are under-

nourished, one in five live in poverty and many

find it hard to afford the basics such as food and

heating. Age Concern estimate that 15% of over-

85s are unable to prepare a main meal for them-

selves, with 38% of these denied regular help or

access to hot food. The obvious effect of this is that

the old elderly are more prone to infections and

take longer to recover from illnesses, with many

� 2005 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2005; 22: 121–122 121

likely to die from cold-related problems. It is

therefore important that friends and neighbours

keep a close eye on elderly people they know by

helping with the shopping and staying in contact.

Another factor in the well-being of the older

adult has been identified by Age Concern who state

that, in the UK, 3.5 million live alone without

regular visitors or opportunities to go outside their

own home and other studies have shown that this

is a widespread phenomenon throughout the

world. Many over-65 year olds spend more than

12 hours every day alone, some as much as

21 hours and 25% have no close friends.

Many elderly are being denied basic check-ups

and others are prescribed medication they do not

need. Researchers have found that out of those

who would benefit, only three out of four have

been offered flu vaccine, only two out of five have

been prescribed the recommended beta-blocker

drug and only two-thirds prescribed aspirin.

It is sad to say that older people living in nursing

homes were less likely to have had their blood

pressure checked during the previous 12 months,

less likely to have had their diabetes assessed and

more likely to be prescribed tranquillisers and lax-

atives. The care of elderly women is also a concern

with many being denied potentially life-saving

surgery because of their age. It has been suggested

that women over 70 years are more likely to miss

out on surgery for breast cancer as doctors believe

they are too old for the operation. They tend to

prescribe tamoxifen instead of surgery but studies

have indicated that without surgery, these patients

are less likely to survive. Another study by Help the

Aged found that terminally ill younger people

received much better care than their older coun-

terparts. Only 8.5% of older cancer sufferers are

able to die with dignity in a hospice compared with

20% of all cancer patients. Similarly, while 50% of

the old would like to die at home, younger mem-

bers of the population are more likely to be given

the opportunity. They also reported that older

people in hospital endure poor support from staff

already overstretched, receive little in the way of

specialist care and often feel unable to articulate

their concerns and wishes about how they would

like to die. The whole issue is compounded by the

fact that woman over the age of 50 receive regular

breast screening but that stops at 70. Approxi-

mately 60% of women over the age of 70 do not

realise that they have a higher chance of develop-

ing breast cancer compared with other age groups.

Age is a major risk factor for the development of

most cancers, meaning that 50% of breast cancers

occur in women over the age of 65 years and 60%

of deaths from breast cancer occur in this age

group.

However, the problem facing all academics and

doctors is that:

‘People may live longer, or they may not. They may be

in good health, or they may not. Unfortunately, we

will not know precisely until it happens’

Ruth Hancock, 2004.

James P. NewtonEditor

� 2005 The Gerodontology Association and Blackwell Munksgaard Ltd, Gerodontology 2005; 22: 121–122

122 Editorial