The utilization of dental services and dental expenditures by older adults has increased in recent decades. For example, in comparing National Health Interview Survey data, only 16.2% of people over 65 in 1957 reported having a dental visit in the previous year as compared to 54% in 2002. Mean expenses per person age 65 and older with a visit increased from $348 in 1996 to $620 in 2004. Approximately 70% of these dental expenditures were paid out of pocket, about 24% from private insurance, and about 6.3% from Medicaid. A report by Oral Health America noted the lack of public support for dental care for senior stating: “There are significant structural problems in our oral health care system, and the problems are getting worse due to demographic trends, workforce trends, public health infrastructure inadequacies, and the increasing number of children, adults, elderly and special populations not covered by Medicare or Medicaid.”
What procedures did older adults receive? In 2004, 16 millions older adults received about 74 million dental procedures. Among those with a dental visit, 85% receives a diagnostic service, 75% received a preventive service, and 29.7% had a prosthetic service. A report comparing trends from 1996 to 2004 are mixed, with a slight increase in the use of diagnostic and preventive services, but a slight decrease in the use of restorative and prosthetic services. What about vulnerable elder? Vulnerable elderly patients have been defined as patients over age 65 who have any or all of the following: limited mobility, limited resources or complex health status. Numerous studies have described the inadequacies of our dental delivery system in meeting with the oral health needs of subpopulations of elders, including the homebound and those living in long-term care facilities.
Federal legislation passed in 1987 was intended to improve access to dental care within nursing homes through the required use of minimal data set (MDS) and follow-up using resident assessment protocol (RAP). However, an Inspector General report in 2001 cited dental care as a “top 3“ area for which RAPs did not trigger a care plan. Model programs such as the Apple Tree Dental have refined delivery system issues, including the effective use of portable dental equipment, communication with patients and families, obtaining informed consent and billing for services. However, much work is needed to ensure adequate access to care for this subgroup of elders.