Compounding barriers to accessing oral healthcare among older adults has become a large issue in dentistry that many people may not be paying enough attention to, according to two leaders in the field.
Caitlin Walker, manager of the Delta Dental Community Care Foundation, and Rebecca Cornille, DDS, the chief dental officer at Vista (Calif.) Community Clinic, recently joined Becker’s Dental + DSO Podcast to discuss the importance of enhancing oral healthcare for seniors in the U.S.
Note: Responses were lightly edited for clarity and length.
Question: What are some of the biggest issues that you both are following in the dental industry this year?
Caitlin Walker: First and foremost, oral health is overall health, and this is really the foundational principle of our work. Our senior population in the U.S. is growing, and they generally are a group that really lacks access to quality oral care, and that is something we’re finding is really impacting their overall well being.
By 2030, 1 in five Americans will be over the age of 65, but what we’re finding at Delta Dental is over 80% of those folks are not going to the dentist as much as recommended, and about half of the older adult population lacks dental coverage at all. Our goal is for all older adults to have access to affordable, quality oral healthcare so they can age with dignity. The foundation especially is focused on low income older adults and communities of color that we know experience more barriers to care and worse oral health outcomes throughout their lives. As an example, a quarter of older adults living in poverty have lost all of their natural teeth across the U.S. That’s compared to just 10% overall, so that’s a huge overlooked population. We know this impacts people’s lives beyond their oral health. It’s affecting their nutrition, their chronic conditions, and the ability to engage in a social life, which really impacts mental health and wellbeing. We have an opportunity as a foundation, and [with] our partners, to alleviate some of this pain and pressure through our impact work, and we’re really looking to do so.
In 2022, the foundation launched the Senior Oral Health Partnership. This program is investing in building partnerships that both assess and address the most important barriers to oral healthcare in their communities, and our partners, including Dr. Cornille through organizations like the Vista Community Clinic, are really doing this work on the ground. We have four active partnerships across the country that are now bringing care to seniors who otherwise would not have it. We’re in four communities, including Washington, D.C., Santa Cruz County, San Diego County, and most recently, the Mississippi Delta region.
Dr. Rebecca Cornille: As part of the San Diego partnership, I’m one of nine partners in the area that’s really looking to address the oral healthcare needs of seniors. We’re really focusing on the integration of dental and medical care as a critical component of advancing health equity and creating innovative models across patients lifespans. We’re really looking at making sure we’re providing and creating a model we can replicate across the country in the various partnerships.
What we’re able to do specifically at Vista Community Clinic is, for example, work with patients who have diabetes and make sure we’re connecting them to appropriate medical care or optometry since diabetes can impact both oral health and eye health. We’re also connecting patients to mental health resources if they need it, transportation, food insecurity, etc. We find that this is particularly challenging for seniors who might fall into various areas where they’re not able to access oral healthcare or even primary healthcare due to coverage or transportation or the other things I’ve mentioned.
Access to dental care is a primary barrier for underserved communities, yet the dental clinic can sometimes be the most accessible entry point for the wider healthcare system. Unfortunately, pain can be a very, very powerful driver in that patients might access our clinic first through our dental department, but then we learn they have other primary care needs that need to be met, and we’re able to connect them to those resources through our organization.
Q: How did senior oral healthcare become such an overlooked issue?
CW: Speaking from the philanthropic lens, we know from national stats that less than 1% of philanthropic giving is going to any cause related to aging. That was a really striking thing to learn about, [that] we’re not paying attention to issues related to aging, and I think, in general, our culture is not very good about recognizing folks’ needs as they age. Oral care is an even more niche area in which we talk a lot about prevention for young people, which is great and of course really important, but as people age, they’re not covered by traditional Medicare, so we have half of the population that has no coverage after the age of 65 when a lot of issues are compounding right at the moment where they really need care. We’re hoping the conversation can be elevated to include oral health. There’s a robust conversation nationally about aging and health, but oftentimes oral healthcare is missing from that conversation.
RC: In my experience, 20 years in this setting, there are often opportunities to work with the youngest in our population for prevention, which is very important, but when the focus shifts strictly to our youth, we aren’t paying attention to those needs of the seniors or the older adults in our communities who oftentimes didn’t have access to the same prevention models that are currently existing or have been developed, and that can be compounded, especially in low income populations where access and affordability are a real issue. I [often] see and hear senior patients who want to access oral healthcare, but there’s a lot of financial restrictions there. Being on a fixed income, it can be incredibly challenging if they’re on Medicare and there’s no oral health component of Medicare. There’s no way to pay for the care they need, and oftentimes that requires making decisions between food on the table, rent, etc., versus going to the dentist, and it just shouldn’t be that way. We need to care for our seniors who have been overlooked for this period of time. While we work to continue to prevent oral health disease, it’s really important we do everything we can to bring a voice to those who are voiceless, who are voiceless, or those who have been overlooked.
Q: What are you most excited about when it comes to dentistry right now, and is there anything that makes you nervous?
CW: There are plenty of both exciting things and things that make me nervous, but truly the most exciting thing is seeing our community partners have the impact they’re having. In the last four years, our partners have served over 22,000 older adults, and that’s not just with one visit, that’s establishing a dental home, so we’re really proud and energized about that.
Just two weeks ago, leaders from all four of our Senior Oral Health Partnership communities met up in Washington, D.C., at the Senior Oral Health Summit, which is our annual convening event. We were really focused on our collective learning and action to reduce barriers to care for this population. We also brought our partners and providers directly to lawmakers on Capitol Hill, which was our first time doing something like that as a group, and we were able to really make a powerful case for expanding access to oral care for seniors and expanding medical-dental integration models that are working well, and just elevating those two things as public health priorities.
The biggest concern is just how urgent the need is, and what we’re seeing on the ground as far as the need our older adults have in this area. It’s a complex issue. There are entrenched barriers around affordability [and] accessibility that we’re really trying to learn more about and put our efforts toward overcoming, but we’re going to need to engage across sectors on this. We really can’t do it alone, and we don’t have all the answers at this point, but what we’re doing now is just actively listening, trying to pull more partners in from across sectors and fields, and really using our platforms to tell the stories of older adults and their needs.
I’ll just share one thing from one of the visits we had on Capitol Hill a couple weeks ago. We were sharing just the importance of oral health when it comes to older adults’ overall health, and we shared with a health staffer of a senator that Medicare doesn’t cover dental, so a large portion of older adults in the U.S. don’t have any coverage at all. The health staffer was shocked to learn that. There are people making decisions about our healthcare who don’t know how this population is impacted, so it’s really an incumbent on us to be a voice for the voiceless.
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