Chapter 23

Older people

WHO ARE OLDER PEOPLE?

A generation ago, nobody over 50 years old in the United Kingdom would have objected to being classified as old.

Things have changed rapidly and dramatically over the last few decades. Diagnosis and treatment of many illnesses have vastly improved. People are living longer, eating more healthily and are keen to improve or maintain their health. Today, many people over 70 years old would not consider themselves as old.

Until recently in dentistry, older people were associated with being edentulous (having no natural teeth), or partially dentate (having some natural teeth), although of course both can apply to people of any age. It is now increasingly common for dental professionals to treat patients in their 80s and 90s who have natural teeth.

British Dental Association classification of older people

The British Dental Association (BDA) describes older people as falling into three groups [1]:

Of course, transition through these stages is relative, and one person may be active and independent at 85, whilst another may be frail at a much younger age.

UK adult dental surveys

In the United Kingdom, adult dental surveys take place approximately every 10 years. The following comparison between the last three UK adult dental surveys shows that dental treatment and its uptake by older people in the UK population have improved considerably:

• 1988 survey [2] – 80% of over 75 year olds had no natural teeth.
• 1998 survey [3] – 58% of over 75 year olds had no natural teeth.
• 2009 survey [4] – 30% of 75–84 year olds had no natural teeth (47% of adults over 85).

Benefits of a healthy mouth

The benefits of a healthy mouth in the older patient include:

• Allows enjoyable eating of regular, nutritious meals.
• Promotes confidence in appearance, eating and speaking in public.
• Permits clear speech.
• Prevents oral infection that may affect general health – denture wearers are prone to denture stomatitis, angular cheilitis and oral candidiasis (see Chapter 8).

Diet and nutrition (see also Chapter 9)

Healthy eating at any age is vital to good health and fitness. Older people generally have slightly lower energy requirements than younger adults, but still require a balanced diet, but with greater emphasis on:

• Vitamin C (fruit and vegetables).
• Vitamin D (from sunlight or supplements).
• Calcium-rich foods to help avoid osteoporosis (low-fat dairy products).
• Carbohydrate (pasta, rice and cereals).

Some older people have a greatly reduced appetite and should be encouraged to eat well, while others may be overweight which may restrict their mobility and should be encouraged to lose weight. Some find that they can no longer eat large meals and tend to opt for small, frequent snacks, in which case healthy snacks should be promoted.

Barriers to a good diet

Changes in the following circumstances can result in a poor diet for the older person in particular:

• Death of a spouse.
• Reduction in physical activity/mobility.
• Failing health or eyesight.
• Illness.
• Xerostomia – drug- or age-related (see Chapter 7).
• Deterioration of smell or taste senses.
• Physical disability (unable to shop and go out).
• Poverty.
• Discomfort from ill-fitting dentures.
• Lack of up-to-date information on oral health and nutrition.

Any of these circumstances may cause older people to skip regular, well-balanced meals and snack on easy-to-prepare alternatives which are often high in sugar. Also, many older people grew up in an era when adding sugar to tea and coffee was the norm and find it difficult to break this habit. Those who were young when World War II was in progress may recall that many foods were difficult to obtain. Sweet thin/>