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J Dent Educ. 69(9): 957-960 2005
© 2005 American Dental Education Association
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Summit Proceedings

The Elders’ Oral Health Summit: Introduction and Recommendations

Judith A. Jones, D.D.S., M.P.H., D.Sc.D.; Carolyn J. Wehler, R.D.H., M.P.H.

Key words: elders, geriatric oral health, health policy, health planning

Disparities in oral health and access to dental care among older Americans will become more critical with the aging of the seventy-six million baby boomers—a generation that will begin to retire in 2006 and start reaching age sixty-five in 2011.1 At a time when the elderly are an ever-larger proportion of Americans, the greatest percentage-wise increases within the oldest age groups will occur among minority elders.1 However, minority elders have not shared gains in oral health status and access to dental care.2,3

The Elders’ Oral Health Summit, held September 13–14, 2004 in Boston, Massachusetts, critically examined determinants of elders’ access to dental care and oral health in the United States, as well as compared financing and other options for improving oral health care and outcomes in elders over the next decade. Our goal was to develop a research agenda defining what we need to know in order to improve oral health and access to and financing of oral health care among elders. This article describes the summit, its specific aims, and its outcomes.


   Aims and Outcomes
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 Aims and Outcomes
The summit and its...
 Next steps
 References
 
The specific aims of this summit were to:

  1. Systematically review national (U.S.) data on access to dental care among community dwelling, frail, and institutionalized elderly;
  2. Examine what we know and decide what we need to know about the determinants of access to dental care and oral health among the elderly, particularly regarding health literacy;
  3. Critically examine disparities in oral health and access to dental care among the poor and racial and ethnic minorities;
  4. Compare the access to dental care in the United States to access in other developed nations with aging populations;
  5. Systematically review the financing of dental care among the elderly, including the frail, the poor, and minority groups in the United States and around the world;
  6. Describe what we know and need to know about improving access to oral health care among elders, including a variety of financing options:
    1. Extending dental insurance into retirement,
    2. Prepaid dental insurance plans for retirement,
    3. HMO models: The First Seniority Experience,
    4. Development of statewide Elders’ Oral Health Insurance Programs for the poor and near poor, similar to the State Children’s Health Insurance Programs, at least for basic care, and
    5. Development of an optional Part "D" (for Dental) in Medicare, similar to the optional Part B for physicians’ services for elders and the disabled; and

  7. Identify gaps in the knowledge base on access to dental care that are amenable to further research.

Three immediate, tangible outcomes were expected from the workshop. The first is the Research Agenda: what do we still need to know about disparities in oral health and access to oral health care for the elderly? This was developed during the conference and is presented as Table 1Go.


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  		Table 1. Research Agenda: what do we need to know?
 
The second outcome is a set of articles published in this issue of the Journal of Dental Education. These articles summarize in detail what we know and point to what we need to know about disparities in oral health and access to dental care among the elderly. Specifically they summarize access to oral health care,4 determinants of access,5 disparities in health care,6 and, in particular, oral health and disease among elders.7 Of particular note is the article by Rudd and Horowitz8 that focuses on health literacy and its critical impact on health and disease among the elderly. Several articles describe current models for financing dental care for the elderly9,10 and future financing,10,11 particularly for minority elders, the poor, and the frail, homebound, and institutionalized.

The third product is an Implementation Plan. All plenary speakers, breakout session leaders, and participants were asked to make specific recommendations to improve access to care among older Americans. These were collected and collated, and redundancies were eliminated. The resulting Implementation Plan, organized around the surgeon general’s National Call to Action,12 is shown in Table 2Go. The plan has and will be distributed with the Research Agenda at a number of national meetings and in consumer publications.


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  		Table 2. Plan of Action: what we need to do...
 

   The Summit and Its Recommendations
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 Aims and Outcomes
 The summit and its...
Next steps
 References
 
The two-day workshop was held September 13–14, 2004 at the Boston University School of Management. The workshop began with a summary of the "state of the science" on oral health outcomes, access to, and financing of dental care for the elderly, as well as an examination of ways to improve access for elders in the decades ahead. The focus was on the overall population, as well as the identification of special groups of elders, including the poor, persons of color, the frail, the homebound, and the institutionalized.

After the informational review, there were six breakout groups. Five groups examined the details of specific reimbursement mechanisms, chosen because they are models that have or could be developed for reimbursing care. Each group brainstormed lists of advantages, disadvantages, and the applicability of the mode of financing for special population groups among the elderly. The sixth group focused on health literacy issues. On day two, the workshop reconvened its plenary session, allowing the breakout groups to report their findings, followed by a discussion on options for financing. During the afternoon of day two, a final panel of representatives of the Older Women’s League, organized dentistry (American, National, and Hispanic Dental Associations and the American Dental Hygienists’ Association), the public sector (United States Public Health Service and the Centers for Disease Control and Prevention), and a dentist in private practice considered cross-cutting issues and suggested recommendations for further research and action. Details of the agenda are available on the summit’s website at dentalschool.bu.edu/elder-summit/.

Review of the recommendations for further research and action reveals several cross-cutting themes. These include advocating for dental care coverage for the most vulnerable, including legislation and appropriations, and increasing educational opportunities to improve and diversify the workforce. Other important themes include encouraging private insurers and Medicare to develop self- and employer-funded benefit plans for retirees and the need for further information on how we can best prevent and treat oral diseases in the elderly.


   Next Steps
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 Aims and Outcomes
 The summit and its...
 Next steps
References
 
For the Elders’ Oral Health Summit to make a difference, the ideas generated need to be disseminated widely and serve as a starting point for further research and action. The fifteen papers from the summit are published in this issue of the Journal of Dental Education. The Research Agenda and Plan of Action are complete and being disseminated. Presentations on the Recommendations to national meetings have occurred, and more are planned. Lay summaries will be timed with the publication in the JDE.

Readers with any questions or comments should contact Dr. Judith Jones. Once the materials are disseminated, it is up to the professions, policymakers, and the public to determine and take the next steps to ensure oral health for all elders in the decades ahead.


   Footnotes
 
Dr. Jones is Associate Professor in the Boston University Schools of Dental Medicine and Public Health, Chair of the Department of General Dentistry, and Convener of the Elders’ Oral Health Summit; Prof. Wehler is Assistant Professor in the Boston University School of Dental Medicine, Department of General Dentistry. Direct correspondence and requests for reprints to Dr. Judith A. Jones, Chairwoman, Department of General Dentistry, Boston University School of Dental Medicine, 100 East Newton St., Boston, MA 02118; 617-414-1060 phone; 617-414-1061 fax; judjones{at}bu.edu. For further information on the summit, visit dentalschool.bu.edu/elder-summit.

The summit was funded by NIH R13DE 14703 01A1; corporate sponsors included DENTSPLY International, GlaxoSmithKline, and Brasseler USA.


   REFERENCES
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 Aims and Outcomes
 The summit and its...
 Next steps
 References
 

  1. Kinsella K, Velkoff V. An aging world: 2001. U.S. Census Bureau, Series P95/01-1. Washington, DC: U.S. Census Bureau, 2001:128–9.
  2. Oral health in America: a report of the surgeon general. Rockville, MD: National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.
  3. Jones JA, Fedele AJ, Bolden A, et al. Gains in dental care use not shared by minority elders. J Pub Health Dent 1994; 54:39–46.
  4. Dolan T, Atchison K, Huynh T. Access to dental care among older adults in the United States. J Dent Educ 2005; 69(9):961–74.[Abstract/Free Full Text]
  5. Kiyak H, Reichmuth M. Barriers to and enablers of older adults’ use of dental services. J Dent Educ 2005;69(9):975–86.[Abstract/Free Full Text]
  6. Kressin N. Racial/ethnic disparities in health care: lessons from medicine for dentistry. J Dent Educ 2005; 69(9):998–1002.[Abstract/Free Full Text]
  7. Gilbert G. Racial and socioeconomic disparities in health from population-based research to practice-based research: the example of oral health. J Dent Educ 2005; 69(9):1003–14.[Abstract/Free Full Text]
  8. Rudd R, Horowitz A. The role of health literacy in achieving oral health for elders. J Dent Educ 2005;69(9):1018–21.[Abstract/Free Full Text]
  9. Compton R. Expansion of dental benefits under the Medicare Advantage Program. J Dent Educ 2005;69(9):1034–44.[Abstract/Free Full Text]
  10. Jones J. Financing elders’ oral health care: lessons from the present, innovations for the future. J Dent Educ 2005;69(9):1022–31.[Abstract/Free Full Text]
  11. Anderson M. Prepaid dental annuity for retirement. J Dent Educ 2005;69(9):1032–3.[Abstract/Free Full Text]
  12. A national call to action to promote oral health. NIH Publication No. 03-5303. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and the National Institutes of Health, National Institute of Dental and Craniofacial Research, May 2003.



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