Oral health care to older adults
Linda C. Niessen, DMD, MPH
"I started thinking about our company from the customers` point of view. What I realized is that most people didn`t like doing business with car dealers. They looked forward to seeing us about as much as they did going to the dentist."
- Carl Sewell
With that introduction to his book, Customers for Life, Carl Sewell describes how he incorporated a customer service focus in his car dealership. The marketing and the customers followed.
People of all ages appreciate excellent customer service. Attention to patients` needs is the foundation for any marketing approach. Experts describe two types of marketing: external marketing designed to bring new customers to your practice; and internal marketing designed to improve relationships with patients already in your practice. This article discusses the concept of "customers for life" from the perspective of older adults.
Marshall McLuhan wrote "Perception is reality." Compared to Asia, Africa, and Europe, America is perceived as a young country. Its symbols reflect youth, energy, and activity. The culture does not value old age to the same extent as in Eastern cultures. As a result, U.S. attitudes toward aging may not always be positive, inadvertently sending the wrong message to older patients. The dental practice that can successfully meet the needs of older adults may reap unanticipated benefits.
Changing expectations: from life expectancies to oral health
Chances are your older patients are already in your practice. Since patients age with their dentists, you inherited a certain number of them when you purchased your practice from a retiring dentist. But even if you opened a practice in a newly developed city or suburb, the baby boomers in your office are well on their way to becoming older adults.
Half of all women in the U.S. who reach age 50 in 1999 will live to be age 80. Table 1 lists remaining life expectancy for African-American and Caucasian adults aged 50-85 years.
Because the people are living longer, their attitudes about health and oral health are changing. In fact, over a 30-year period, America`s older adults have gone from a generation that was predominately edentulous to a generation having an average of 20 teeth person. Just as the myths and stereotypes of American aging, ie sedentary, inactive, etc., are changing rapidly as the baby boomers reach 50, the expectations about oral health will continue to evolve. The "baby boom" generation - the cohort of Americans born between 1946-1964, currently number 76 million. An estimated 25 percent of them have a college education and they are poised to inherit $12 trillion from their World War II era parents.
The baby boomers are the first group of Americans to benefit from widespread water fluoridation and fluoride in toothpaste. As a result, they are reaching membership status (age 50) in the American Association of Retired Persons (AARP) with virtually an intact natural dentition. Their goals include straight, white natural teeth, along with general health and wellness.
Rowe and Kahn, in their book, Successful Aging, describe the results of a 15-year interdisciplinary research endeavor to identify predictors of successful aging. Their findings are exploding the myths of aging. "Choosing" your parents well is not the best predictor of successful aging; rather, lifestyle choices, more than genes, determine how well we age.
As a result, the new concepts, materials, products, and technologies available to prevent oral diseases, restore diseased teeth, and maintain oral health are of great interest to aging Americans. Research that links oral health with overall health - like the recent research linking periodontal disease to cardiovascular disease - will find an interested audience as older adults make healthy lifestyle choices that will include oral health care.
Welcome to the practice
Your practice`s first impression is as important as the first impression you make with any individual. How age-friendly is your dental office staff? Have you ever had a staff meeting to discuss aging and you and your staff`s attitudes toward aging, illness, and disability? Are older adults graciously welcomed to the practice during their initial phone conversation? Does the office staff fit the patient to your scheduling needs, or is the patient invited to provide a time that is most convenient for him or her?
Don`t assume retirees have a lot of free time. Many older adults may not know the actual life expectancies of Table 1, but they intuitively know that they don`t have as many years left at age 70 as they did when they were 50. And they don`t want to miss a tennis game or volunteer assignment for a dental appointment.
Does your reception area welcome people of all ages? Are there age-appropriate reading materials? Hard-back chairs, in addition to the softer living-room type furniture, offer patients with hip or knee replacements or generalized osteoarthritis an easier time going from standing to sitting. Area rugs can be hazardous for canes or walkers. Area rugs also make navigating a wheelchair more difficult. The reception area should have sufficient room to accommodate a wheelchair. The less disruption the patient in the wheelchair feels she or he causes the office staff, the more welcome she or he feels in the practice.
Prevention as internal marketing
Although adults are living longer and healthier, they are managing multiple chronic diseases. On average, adults over age 65 see their physicians more than four times as often (5.5 office visits per person) than they see their dentist (1.2 office visits per person). Arthritis, cardiovascular disease, diabetes, psychiatric illnesses, and cancer are among the most common chronic diseases seen in older adults. These medical conditions may result in dependency in adults over age 80, causing them to spend some time in a nursing home.
Additional time by the dental team will be needed to review a medical history with significant positive findings. Older adults will be taking multiple medications to treat the chronic diseases. The medical history must include a review of medications and over-the- counter medicines, vitamins, supplements, and herbal remedies. Patients often don`t perceive vitamins, supplements, and herbs as medicines and therefore don`t think to tell the dental teamthey are taking them. Yet, these products can interact with other medications patients are taking or with medications dentists may prescribe.
The principles of diagnosis and treatment planning remain consistent throughout the life cycle. An extensive interview, thorough medical and dental history, and comprehensive examination are essentials in the development of a treatment plan that meets the patient`s needs. Older adults remain interested in the latest advances in oral health care and, having provided for their children`s oral health, are now ready to invest in themselves. Just like younger patients, older adults` decisions to accept a treatment plan may be related more to their belief or interest in improving their overall health, increasing self-esteem, or adding self-confidence rather than purchasing an implant supported prosthesis or anterior veneers.
Baby boomers and older adults are looking for methods to stay healthier longer. For many adults, oral health care is an important element in the formula for health and wellness. As a result, preventive dental measures are as important for older adults as they are for children. Including a preventive component in the overall treatment plan implicitly tells an older adult that you care about his or her future. It also says you want that future to be healthy.
A risk assessment approach will assist in helping patients identify the factors that increase their risk for oral diseases. Patients may be unaware that the multiple medications they take can decrease salivary flow and thus increase their risk of root caries. Diabetes may increase a patient`s risk of periodontal disease. Individuals who use inhalants for asthma or steroids for their rheumatoid arthritis will have an increased risk for oral candidiasis infections. Patients with dementia who cannot remember how to use a toothbrush or those who have suffered a stroke and lost the use of their dominant hand are at increased risk for plaque related oral diseases. New oral-health products that assist patients in maintaining oral health abound. Tobacco cessation at any age remains one of the best methods to improve an individual`s oral and overall health. The dental team can assist patients who are ready to quit.
Traditional external marketing includes many activities, including advertising, patient newsletters, and direct mail. Today, e-commerce is taking shape and more and more patients are searching the World Wide Web for oral-health information. Community activities such as health fairs, PTA meetings,and civic club participation have served to increase dental professionals` visibility in their communities. Have you considered extending your visibility to assisted living centers, adult day care centers, or senior citizens centers?
Have you ever viewed your ability to answer an adult son or daughter`s request to perform a dental consult on Mom or Dad in a nursing home as a form of marketing? It`s true that answering a nursing home consult will take additional time in your already busy life. Keep in mind, however, that you and your dental team will be viewed as caring, committed professionals when you answer that request. And once in the nursing home, you have the opportunity to educate the health- care staff, physicians, nurses, nurses aides, occupational therapists, etc, on the importance of oral health throughout life.
The aging of America offers new opportunities for marketing the value of oral health care and your dental practice. External marketing opportunities may find dental professionals in senior centers, assisted- living facilities, or nursing homes. Internal marketing may result in improved customer service and patient satisfaction for all patients, including older adults.
Oral health was designed to last a lifetime. More and more people - particularly baby boomers - will enter older adulthood with their natural dentition. Their view of aging will be one of health and wellness. Oral health care will become an increasingly important component.
With improved techniques, concepts, and home-care products, oral health shouldn`t have to decline with aging or illness. As leaders in the field of dental science, we have a responsibility to share our knowledge and expertise to improve the oral health of the public.
This article originally appeared in the CDA journal, vol. 27 No. 9, September 1999, and was reprinted with permission. References available upon request.