As global aging accelerates, a new study highlights how oral health deterioration affects older adults and calls for integrated healthcare solutions to improve their quality of life.
Review: Healthy ageing and oral health: priority, policy and public health. Image Credit: Drazen Zigic / Shutterstock
In a recent review published in the journal BDJ Open, Rakhee Patel and Jennifer Gallagher of King’s College London examined the World Health Organization (WHO) public health framework for healthy aging and global policies. They proposed an integrated model that addresses the impact of aging on oral health and healthcare systems, using the United Kingdom (UK) as a case study.
Background
The global population is aging rapidly, with projections indicating that by 2030, one in six people will be 60 years or older, representing a significant demographic shift and rising to 2.1 billion by 2050. This accelerating pace of population aging presents complex challenges, particularly in how aging is defined across different regions and cultures. Moreover, the need for tailored support grows as older populations diversify across regions. A more comprehensive understanding of the varied biological, social, and psychological changes is essential for effective policy-making. Further research is critical to understand these complexities and inform effective policies that address the unique needs of this expanding demographic.
The Aging Population
Global population aging is accelerating, with the WHO's 2022 report projecting that by 2030, one in six people will be 60 or older, an increase from 1 billion in 2020 to 1.4 billion. By 2050, this number is expected to double to 2.1 billion, with those aged 80 and older tripling to 426 million. Aging involves complex biological, social, and psychological changes that occur at different rates for different individuals, resulting in a highly diverse older population. The definition of "older person" differs globally; while the WHO and United Nations (UN) define it as over 60, some countries, like the UK, traditionally use 65, adapting as life expectancy increases. These distinctions are increasingly important as the needs of individuals over 65 can vary significantly depending on their functional abilities.
Understanding the Aging Process
Population aging is often seen as a sign of improved health and longevity. Countries like Japan, where a significant proportion of the population is aged 60 and over, illustrate this trend. By 2050, it is anticipated that Eastern and South-Eastern Asia will continue to house the largest share of older adults at 37%, while Europe and Northern America will see their proportions decrease from 29% to 19%. The global distribution of aging populations presents unique challenges to regional healthcare systems, particularly in countries with low potential support ratios.
The potential support ratio, defined as the number of working-age adults (25-64 years) per older adult (65+), highlights the implications of an aging population. By 2050, many countries, particularly in Europe and Asia, will experience support ratios below two, indicating a growing burden on health and social care systems. This trend underscores the urgent need for innovative public health strategies to manage aging populations.
Addressing Ageism and Diversity in Aging
As the population ages, negative stereotypes, often termed "ageism," arise, framing older adults as burdens to society. However, there is considerable diversity among older adults. The WHO defines ageism as including stereotypes, prejudice, and discrimination based on age, with global implications for both older and younger populations. In Europe, younger individuals report experiencing more age discrimination than older adults. Ageism also intersects with other forms of disadvantage, such as those related to gender, race, and disability, further exacerbating inequality.
In the UK, the aging population has been steadily increasing, with those aged 65 and over rising from 16.4% in 2011 to 18.6% in 2021. Projections suggest that by 2066, one in four people in the UK will be over 65. While life expectancy has improved, disability-free life expectancy (DFLE) remains a concern. Disability-free life expectancy (DFLE) for men is around 9.9 years, and for women, about 9.8 years post-65, indicating that a significant portion of older adults may live with health issues.
The Decade of Healthy Aging
The UN's Decade of Healthy Ageing aims to tackle the challenges of population aging through collective action in four areas: combating ageism, supporting communities for older adults, providing integrated and person-centered care, and ensuring access to quality long-term care. Healthy aging focuses on maintaining functional abilities for well-being, categorizing older adults as functionally independent, frail, or dependent. Two key components influence aging: intrinsic capacity, encompassing physical and mental health, and environmental factors, which include social and community support. Together, these elements determine older adults' ability to function effectively and lead fulfilling lives.
The Link Between Oral Health and Aging
Oral health deterioration is a significant issue for older adults, with high levels of dental disease prevalent among this demographic. The Global Burden of Disease Study ranks oral disorders as a leading cause of disability-adjusted life years (DALYs) globally, affecting millions of older adults. Recent estimates indicate that untreated dental conditions affect over 57% of older adults. In particular, root caries, which often goes untreated, poses a significant burden, especially in institutionalized settings.
Oral health problems, particularly dental caries and periodontal disease, significantly impact the quality of life for older adults. Despite the common belief that tooth loss is a normal part of aging, the aging process itself is not an independent risk factor for oral health decline. Instead, systemic conditions, medications, and access to dental care play critical roles in oral health outcomes.
Long-Term Conditions and Oral Health
The relationship between general health and oral health is increasingly recognized as bidirectional, with poor oral health exacerbating chronic conditions such as diabetes, cardiovascular disease, and respiratory disorders. For instance, poor oral hygiene can increase the risk of pneumonia in frail populations, while periodontal disease can exacerbate diabetes management. Recent studies also highlight a link between cognitive decline and deteriorating oral health, with dementia patients facing greater challenges in accessing care.
Furthermore, nutrition is intricately connected to oral health. Older adults with compromised dentition may struggle with proper nutrition, leading to a cycle of health decline. Conversely, poor nutrition can increase the risk of dental diseases, highlighting the need for an integrated approach to health that considers both oral and general health.
Case Study: Oral Health in the UK
In the UK, epidemiological data reveal that the number of older adults retaining their natural teeth is increasing. For example, 53% of adults aged 85 and over reported having some of their own teeth. This shift indicates a growing population that can benefit from preventative oral health strategies. Nonetheless, disparities remain, particularly for those in care homes, where rates of edentulism and untreated dental conditions are significantly higher. Current policies in the UK, particularly in Scotland and Wales, emphasize the need for improved oral health among older populations, while the situation in England lags behind.
Policy Recommendations for Healthy Aging and Oral Health
A multifaceted policy approach is essential for promoting healthy aging and oral health. This should include early prevention strategies throughout life, improved training for care staff, and greater integration between health and social care systems. Preventative strategies like fluoride treatments, integrated health and social care, and improved access to dental services, particularly for vulnerable older populations, are critical.
Conclusions
To summarize, healthy aging is a critical global issue, necessitating urgent attention to the effects of an aging population on oral health and healthcare systems. Efforts to integrate oral health with broader healthcare policies will be vital in ensuring that older adults can lead healthier, more fulfilling lives. Effective, patient-centered, and prevention-focused services are essential to enhance quality of life, address the interrelationship between oral and general health, and prioritize oral health in policy and research.