While older adults are less likely to access dental services after age 80, this trend is more evident amongst blacks and Hispanics than whites, according to a new study by researchers at New York University (NYU) Rory Meyers College of Nursing and the University of Hawai’i at Manoa. The findings highlight barriers to care for older adults, as well as disparities in dental visits for racial and ethnic minorities and immigrant populations.
“Assessing disparities in dental service utilization is particularly important in the context of the United States, as it reflects the most salient challenges faced by disadvantaged social groups with regard to the lack of dental insurance, lack of access to dental care, racial discrimination, and language barriers,” explains the study’s senior author Bei Wu, PhD, Dean’s Professor in Global Health, professor of nursing at NYU Rory Meyers College of Nursing, affiliated professor at NYU College of Dentistry and director for research at Hartford Institute for Geriatric Nursing.
The study analyzed how people utilize dental services as they age by using data from the Health and Retirement Study, a longitudinal study from the University of Michigan that consists of interviews with a national sampling of middle-aged and older adults. The study included 20,488 patients of various ages and ethnicities, including 17,661 U.S.-born and 2,827 foreign-born respondents. Investigators focused on U.S. adults age 51 and older, and variations by race and country of birth.
The findings revealed that 70% of adults had visited a dentist within the last two years. The rate of dental visits declined beginning at age 80, with 71% of U.S.-born adults of all races and ethnicities were more likely to see a dentist than immigrants (62%). The rates of decline for whites were slower than others. Findings also show that whites had higher rates of service utilization than blacks and Hispanics, regardless of birthplace. However, the gap between U.S.-born adults and immigrants decreased as people aged.
“The disparity by birthplace was found to be closing as respondents became older, regardless of race/ethnicity. These findings suggest that acculturation may play an important role in increasing and decreasing oral health disparities over time,” says Wu. She adds that as people get older, particularly after age 80, both immigrants and native-born older adults face similar challenges that could affect their use of dental care. These challenges may include frailty, comorbidity issues, giving up driving, and diminishing income.
Several ideas have been floated to improve access to dental care for these patient populations, including the expansion of Medicare coverage to include preventive care visits. According to the Kaiser Family Foundation, almost two-thirds of Medicare beneficiaries, or nearly 37 million people, do not have dental coverage. An NCHS Data Brief reports in 2017 the percentage of adults who had dental insurance was higher among those ages 65–74 (34.3%) compared with those aged 75–84 (22.3%), and 85 and older (19.9%). 1
Failure to visit the dentist can have adverse effects on a senior’s overall health. Older adults commonly experience caries, xerostomia, loss of taste, or food avoidance due to oral pain, which can result in lower nutritional intake.
Cost is also a factor as older adults may be on a fixed income, and oral health may compete for priority alongside chronic health conditions or illnesses. According to a Journal of the American Dental Association report, high-income seniors visit the dentist more often and report better overall health compared with low-income seniors.2
Additional approaches to help expand access to oral health care include states considering legislation that would allow dental therapists to provide routine preventive and restorative care to patients in their homes.
The study’s findings that U.S.-born individuals had higher rates of service utilization than foreign-born for all racial/ethnic groups suggest developing culturally competent programs are important to meet the dental needs of diverse populations.
In their role, oral health professionals can continue to educate patients about appropriate oral hygiene techniques, encourage patients to stick to regular checkups, and the link between oral health and systemic diseases. Dental teams should also recommend products and product modifications to help older adults perform more effective self-care.
“The practical implications of these findings are that we need to develop public health programs nationally and globally that aim to educate middle-aged and older racial/ethnic minorities to improve oral health outcomes, improve access to dental care, and increase levels of cultural and linguistic competency among care providers,” says Wu.
Findings from the study, “Racial/Ethnic Disparities in Dental Service Utilization for Foreign-Born and U.S. Born Middle-Aged and Older Adults,” have been published in Research on Aging.
- Kramarow EA. Dental care among adults aged 65 and over, 2017. NCHS Data Brief, no 337. Hyattsville, MD: National Center for Health Statistics. 2019. Available at: https://www.cdc.gov/nchs/data/databriefs/db337-h.pdf. Accessed August 6, 2019.
- Yarbrough C, Vujicic M. Health Policy Perspectives: Oral Health trends for older adults. J Am Dent Assoc. 2019;150:714–716.