Connecting Older Adults to Needed Dental Care

For months Mrs. M., an 80-year-old widow living in western Queens, was suffering from mouth pain and sore gums, and was having difficulty chewing her food. But it wasn’t until a group of fourth-year students from the New York University College of Dentistry visited her senior center at the Jacob A. Riis Neighborhood Settlement House that the source of the problem was discovered: ill-fitting dentures.

Mrs. M. had lost a lot of weight after an illness, but it didn’t dawn on her that her weight loss had completely changed the way her dentures fit. And she wasn’t alone in missing the impact of everyday changes on her dental health. One of her neighbors had a similar problem—his dentures were causing problems after he’d put on 20 pounds. Mrs. M. and her neighbor learned something else from the NYU students as well—their Medicaid coverage would pay for a refitting of their dentures, and a new pair every five years.

INCREASING ACCESS

The visit from the NYU dental students—along with a supervising faculty member—was part of a United Hospital Fund grant-supported project to increase access to oral health prevention and treatment services among older adults.

The dental teams visited eight naturally occurring retirement communities, or NORCs—neighborhoods or housing developments with large populations of adults over 60—throughout the city, providing almost 200 seniors with education on oral health, dental screenings, and exams. They also assisted in arranging follow-up care—offering to schedule a dental appointment and consultation at an NYU College of Dentistry clinic or with a senior’s own dentist, and providing seniors with lists of neighborhood dentists who either accepted Medicaid or were willing to offer discounted fees to seniors not eligible for Medicaid.

“Older adults see their physicians for a multitude of chronic illnesses but their doctors generally do not ask about oral health, even though oral health problems may affect or complicate their illnesses, and their illnesses—and the medications used to treat them—may in turn affect oral health,” says Donna Shelley, MD, MPH, the project’s director and the director of interdisciplinary research and practice at the NYU College of Dentistry, as well as a clinical associate professor. “As a result, many oral health problems are undiagnosed and untreated. And many seniors suffer in silence.”

Indeed, a 2000 Surgeon General’s Report, Oral Health in America, called oral disease affecting older adults a “silent epidemic.” Barriers to adequate care include lack of insurance: Medicare doesn’t cover dental care and only some states’ Medicaid programs do. While New York’s Medicaid program is one that does, a recent survey of adults who attend senior centers in New York City found that 20 to 40 percent of them did not know that Medicaid covered these services.

Almost all of the 184 seniors screened by the NYU project (89 percent) needed some form of follow-up care, and 35 percent reported oral pain. “Those percentages speak volumes about unmet need,” says Deborah Halper, vice president of education and program initiatives at the Fund.

BARRIERS TO CARE

While many of the seniors participating in the project went on to receive the dental services they needed, the project staff also made efforts to learn more about those who chose not to receive needed care. When interviewed, the seniors listed “lack of financial resources,” “lack of adequate transportation,” “other medical problems,” and “lack of social support” as the lead reasons for not seeking care.

“The good news is that this feedback helps the dental community and the NORC community understand where we should focus our future efforts, research, and advocacy,” says Dr. Shelley. “Dental providers, communities, and seniors working together can make great strides in addressing some of these barriers.”

This article was originally published in the summer 2011 issue of Blueprint.