Dolan T A, Atchison K A
University of Florida, College of Dentistry, Department of Community Dentistry, Box 100404 JHMHC, Gainsville 32610.
J Dent Educ. 1993 Dec;57(12):876-87.
Oral health is integral to an older adult's general health and quality of life, and basic oral health services are an essential component of primary health care. The elderly should receive special consideration in terms of their oral health care needs since they: 1) may have unique problems accessing the health care delivery system; 2) experience different patterns and prevalence rates of oral diseases; and 3) may have characteristics that affect the amount and types of dental treatment and the method by which it is performed. Older adults are maintaining their natural teeth into their later years, and epidemiologic trends suggest the increasing need for dental services by older adults. Yet dental utilization rates are lower for older adults than for younger age groups, and barriers to care include the cost of dental care, the lack of perceived need for care, transportation problems, and fear. Oral diseases and impairments are most commonly experienced by those segments of society least able to obtain dental care. Economically and socially disadvantaged older adults and the physically impaired are more likely to experience tooth loss and edentulism, untreated dental decay and periodontal diseases. Adults over the age of 65 years have the lowest proportion of dental expenses reimbursed by private dental insurance (10 percent), and the highest percentage of out-of-pocket dental expenses (79 percent), as compared to all other age groups. Of the two largest public programs, Medicare does not pay for most dental services, and Medicaid (Title XIX), does not offer dental benefits for adults in most states. Although the majority of older adults live independently in the community, there is a growing number of elders with special needs that require long term care either at home or in an institution. These frail and functionally dependent elders have significant dental needs, and experience greater barriers to receiving dental care as compared to the independent elderly. Additional research is needed to accurately characterize the oral health status and needs of the growing number of homebound and institutionalized elders. This will be of growing importance with the emergence of the vast array of home health care services available to older adults, and the changing emphasis on home care often seen as the preferred and lower cost alternative to nursing home care.
口腔健康是老年人总体健康和生活质量的组成部分，基本口腔健康服务是初级卫生保健的重要组成部分。鉴于老年人：1）在获得卫生保健服务系统方面可能有独特问题；2）经历不同的口腔疾病模式和患病率；3）可能具有影响牙科治疗数量和类型以及治疗方式的特征，因此在其口腔保健需求方面应给予特殊考虑。老年人在晚年仍保留着自己的天然牙齿，流行病学趋势表明老年人对牙科服务的需求日益增加。然而，老年人的牙科利用率低于年轻人群体，护理障碍包括牙科护理费用、缺乏对护理的认知需求、交通问题和恐惧。口腔疾病和损伤在社会中最无力获得牙科护理的人群中最为常见。经济和社会处境不利的老年人以及身体有残疾的人更有可能出现牙齿脱落和无牙症、未经治疗的龋齿和牙周疾病。与所有其他年龄组相比，65岁以上的成年人由私人牙科保险报销的牙科费用比例最低（10%），自付牙科费用的比例最高（79%）。在两个最大的公共项目中，医疗保险不支付大多数牙科服务费用，医疗补助（第十九条）在大多数州不为成年人提供牙科福利。尽管大多数老年人独立生活在社区，但越来越多有特殊需求的老年人需要在家中或机构接受长期护理。与独立生活的老年人相比，这些体弱且功能依赖的老年人有重大的牙科需求，并且在接受牙科护理方面面临更大的障碍。需要进行更多研究，以准确描述越来越多居家和机构养老老年人的口腔健康状况和需求。随着大量面向老年人的家庭保健服务的出现，以及对家庭护理的重视程度不断变化，家庭护理常被视为养老院护理的首选且成本较低的替代方案，这一点将变得越来越重要。
