Christine McGarrigle summarises findings from a recent study on ageing, and looks at the oral health and wellbeing of older adults in Ireland.
Published in 20 Year Anniversary edition of Irish Dentistry magazine (January 2018). Copy available to download at the bottom of the reference list at the end of this page.
A new study by the Irish Longitudinal Study on Ageing (TILDA) www.tilda.ie provides an overview on the oral health status of older adults in Ireland Sheehan, McGarrigle, O’Connell, 2017, http://tilda.tcd.ie/publications/reports/pdf/Report_OralHealth.pdf.
In this report, we examined the dental status of older adults in Ireland, whether they used dental services, and investigated how the quality of their oral health affected their mood, social participation and quality of life.
The report used data collected during the third wave of the Irish Longitudinal Study on Ageing (TILDA), a prospective study of 8,175 adults aged 50 years and older, representative of the community-dwelling middle-aged and older population.
Data for wave three was collected between March 2014 and October 2015, and included 6,425 adults aged 54 years and older who were interviewed in their own homes. The interview included detailed questions on socio-demographics, living circumstances, income and wealth, physical, mental and behavioural health, health care utilisation, social support and social participation.
We found that a large proportion of older Irish adults had no natural teeth (18%), and these were replaced with either full or partial dentures, although a small minority had neither teeth nor dentures.
There was a marked reduction in tooth loss among the younger elderly (54 to 64 years), with 40% of those aged 75 years and over having no natural teeth, compared to 7% of those aged 54 to 64 years, indicating improved oral health, possibly due to better dental services or the impact of fluoridation of water supplies since the 1960s. Older adults living in rural Ireland were twice as likely to have lost all their teeth as those resident in Dublin (22% versus 10%).
We found differences in health status by oral health. People who had lost all their teeth were more likely to rate their physical health negatively, particularly in the 54 to 64 age group, which could indicate either worse general health or stigma associated with tooth loss, which has become less common in younger cohorts.
Diabetes was also more common among edentulous adults aged 64 to 75 years, which has implications for ongoing management of their health as oral disease can have a negative impact on the regulation of diabetes.
Additionally, many older people with no teeth were also on multiple medications. This could be a sign of generally poorer health or indeed, polypharmacy could also be a contributory factor to tooth loss due to the side effect of reduced salivary flow. This highlights the need to ensure oral health is given greater priority amongst those with multiple health conditions.
An important finding to note was that adults aged 54 to 64 years with no teeth were much more likely to be current smokers than similar aged adults who had retained their own teeth, and the difference was particularly noted in those aged 54 to 64 years (40% versus 15%).
This indicates that smoking may be contributing to tooth loss in this younger cohort rather than the historic practice of widespread extractions, which will have been more common in the older generation.
Dental status was related to both quality of life and mood, and those who had not retained their own teeth had lower quality of life, higher depressive symptoms and more loneliness.
Older people who have lost their teeth were also less likely to participate weekly in active and social leisure activities than those with teeth – an important finding as previous research has shown that doing so is associated with higher quality of life (Ward, McGarrigle, 2017). They also experienced more loneliness, even in the younger (54 to 64 years) age group. This reduced social participation and wellbeing could be a result of worse physical health, but given that those who have full dentures enjoyed a better quality of life than those without them suggests that providing improved dental and denture care to this cohort could be important in helping them maintain social activity with all its attendant benefits.
Location and status
The use of dental health services is important to ensure oral health, and the Department of
Health has committed to improved oral hygiene and preventive measures in its Statement of Strategy 2016-2018. Indeed, early intervention and promoting oral hygiene have been targeted as key dental health goals.
Additionally, alongside commitments to extending its dental health programme for schoolchildren and extending dental treatment benefits for insured workers, there is a target in the current Programme for Government to introduce a preventive dental health package for medical cardholders, which includes a high proportion of older people (Department of the Taoiseach, 2016).
In this study, we found that among older people, there were wide discrepancies in the use of dental services by location and by dentition status. There was a particularly large discrepancy in the frequency of attending a dentist between people living in Dublin and in rural areas, suggesting services may be harder to access in the latter.
The fact that older people in rural areas were much more likely to have lost all their teeth could be a consequence of more limited availability of dental services, or it could be related to the fluoridation of public water supplies, given water supplies in rural areas are more likely to be from non-fluoridated, private sources (O’Sullivan, O’Connell, 2015).
In either case, it suggests greater accessibility to dental services is needed for this cohort.
A new era
The Department of Health has also made a commitment to introduce a new National Oral Health Policy (2014) following an in-depth review of existing services and needs. This review has highlighted concerns about oral health inequalities and the potential need for new measures to treat older adults in care settings and in the home (Kennedy, 2015).
While most dental services in Ireland are accessed privately, possession of a medical card entitles holders to the use of free state dental services. However, despite the fact that half of participants had a medical card rising to over 80% of the oldest group, the use of state dental services was low in this study and only 7% reported using them in the last 12 months. A majority of participants reported that they would attend a private dentist if they needed routine dental care. Use of state dental services was particularly low amongst those with no teeth, and even among those who would like to avail of them, the majority reported that they have never heard of them, did not know they were available, or believed they would be too costly.
This suggests more effort could be put into informing and assisting older people in how to access state dental services. It could also indicate variable availability in some areas, particularly given the discrepancies we found in dental care attendance and outcomes between Dublin and rural areas.
Department of the Taoiseach. 2016. A Programme for a Partnership Government. Pp55-56. http://www.taoiseach.gov.ie/eng/Work_Of_The_Department/Programme_for_ Government/A_Programme_for_a_Partnership_Government.pdf. Retrieved June 2016.
Department of Health. National Oral Health Policy. 2014. http://health.gov.ie/futurehealth/reforming-primary-care-2/national-oral-health-policy/. Retrieved June 2017.
Kennedy, C. National Oral Health Policy. Stakeholders Consultation Day. Summary Report. Department of Health. Dublin. 2015. Available at http://health.gov.ie/wpcontent/uploads/2015/10/Stakeholders-Consultation-Day_Summary-Report_FINAL.pdf. Retrieved June 2017
O’Sullivan V and O’Connell BC. Water fluoridation, dentition status and bone health of older people in Ireland. Community Dent Oral Epidemiol. 2015; 43(1):58-67.
Sheehan A, McGarrigle C, O’Connell B. Oral health and wellbeing in older adults in Ireland. 2017; Dublin: The Irish Longitudinal Study on Ageing. http://tilda.tcd.ie/publications/reports/pdf/Report_OralHealth.pdf
Ward M, McGarrigle C. The Contribution of Older Adults to their Families and Community. In McGarrigle C, Donoghue O, Scarlett S & Kenny RA (eds.), Health and wellbeing: active ageing for older adults in Ireland. Evidence from The Irish Longitudinal Study on Ageing. 2017; Dublin: The Irish Longitudinal Study on Ageing. http://tilda.tcd.ie/publications/reports/pdf/w3-key-findings-report/Chapter%202.pdf