As global aging accelerates, a new study highlights how declining oral health affects older adults and calls for comprehensive healthcare solutions to improve their quality of life.
Review: Healthy aging and oral health: priority, policy and public health. Image credit: Drazen Zigic / Shutterstock
In a recent review published in the journal BDJ OpenRakhee Patel and Jennifer Gallagher of King’s College London reviewed the World Health Organization’s (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 world’s population is aging rapidly, with projections showing that by 2030, one in six people will be 60 or older, representing a major demographic shift, and will rise to 2.1 billion by 2050. This accelerating rate population aging presents complex challenges, particularly in how aging is defined in different regions and cultures. In addition, the need for personalized support is increasing as older populations diverge between regions. A more comprehensive understanding of the various biological, social, and psychological changes is essential for effective policymaking. Further research is critical to understanding these complexities and informing effective policies that address the unique needs of this expanding demographic.
The aging of the population
The aging of the world’s population is accelerating, with the WHO’s 2022 report predicting that by 2030, one in six people will be aged 60 or over, increasing from 1 billion in 2020 to 1.4 billion. By 2050, that number is expected to double to 2.1 billion, with those aged 80 and over 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 an “elderly person” varies worldwide. While the WHO and the United Nations (UN) define it as over 60, some countries, such as the UK, traditionally use 65, adjusted as life expectancy increases. These distinctions are increasingly important as the needs of people over 65 can vary significantly depending on their functional abilities.
Understanding the aging process
An aging population is often seen as a sign of improved health and longevity. Countries such as Japan, where a significant proportion of the population is aged 60 and over, demonstrate this trend. By 2050, it is expected that East and Southeast Asia will continue to be home to the largest share of elderly people at 37%, while Europe and North America will see their percentages decline from 29% to 19%. The global distribution of population aging presents unique challenges for regional health care systems, particularly in countries with low potential support ratios.
The potential support ratio, defined as the number of working-age adults (25-64) per older adult (65+), highlights the effects of an aging population. By 2050, many countries, particularly in Europe and Asia, will face support rates below two, indicating an increasing burden on health and social care systems. This trend highlights the urgent need for innovative public health strategies to manage the aging population.
Addressing Age and Diversity in Aging
As the population ages, negative stereotypes, often called “ageism,” arise that frame the elderly as a burden on society. However, there is considerable diversity among older people. WHO defines ageism as including age-based stereotypes, prejudice and discrimination, with global implications for both older and younger populations. In Europe, younger people report experiencing more age discrimination than older people. Age 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 is steadily increasing, with people aged 65 and over increasing from 16.4% in 2011 to 18.6% in 2021. Forecasts show that by 2066, one in four people in the UK Vasilei will be over 65 years old. Life expectancy has improved, disability free life expectancy (DFLE) remains a concern. Disability-free life expectancy (DFLE) for men is about 9.9 years and for women, about 9.8 years after age 65, indicating that a significant portion of older adults may be living with health problems.
The decade of healthy aging
The UN Decade of Healthy Aging aims to address the challenges of population aging through collective action in four areas: combating ageing, supporting communities for older people, providing integrated and person-centred care and ensuring access to quality long-term care. Healthy aging focuses on maintaining functional capacities for well-being, categorizing older adults as functionally independent, frail, or dependent. Two main factors influence aging: innate ability, which includes physical and mental health, and environmental factors, which include social and community support. Together, these factors determine the ability of older adults to function effectively and lead fulfilling lives.
The connection between oral health and aging
Deteriorating oral health is a major issue for the elderly, with high levels of dental disease prevalent in this demographic. The Global Burden of Disease Study ranks oral disorders as the leading cause of disability-adjusted life years (DALYs) worldwide, affecting millions of older adults. Recent estimates show that untreated dental disease affects over 57% of older adults. In particular, root caries, which is often untreated, is a significant burden, especially in institutionalized settings.
Oral health problems, especially tooth decay and periodontal disease, significantly affect the quality of life of the elderly. Despite the common belief that tooth loss is a normal part of aging, the aging process itself is not an independent risk factor for declining oral health. Instead, systemic conditions, medications, and access to dental care play critical roles in oral health outcomes.
Chronic diseases and oral health
The relationship between general health and oral health is increasingly recognized as a two-way street, with poor oral health exacerbating chronic conditions such as diabetes, cardiovascular disease and respiratory disorders. For example, poor oral hygiene can increase the risk of pneumonia in vulnerable populations, while periodontal disease can worsen diabetes management. Recent studies also highlight a link between cognitive decline and worsening oral health, with dementia patients facing greater challenges in accessing care.
In addition, diet is intricately linked to oral health. Seniors with compromised dentition may struggle with proper nutrition, leading to a cycle of declining health. Conversely, poor nutrition can increase the risk of dental disease, highlighting the need for a comprehensive approach to health that considers both oral and general health.
Case Study: Oral Health in the United Kingdom
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 teeth of their own. This change indicates a growing population that can benefit from preventive oral health strategies. However, disparities remain, particularly for those in nursing homes, where rates of missing teeth and untreated dental disease are significantly higher. Current policies in the UK, particularly in Scotland and Wales, emphasize the need for improved oral health in older populations, while the situation in England lags behind.
Policy recommendations for healthy aging and oral health
A multifaceted policy approach is needed to promote healthy aging and oral health. This should include early prevention strategies across the lifespan, improved training for care staff and greater integration between health and social care systems. Preventive strategies such as fluoride treatments, integrated health and social care, and improved access to dental services, particularly for vulnerable older populations, are critical.
conclusions
In summary, healthy aging is a critical global issue, requiring urgent attention to the effects of population aging on oral health and health care systems. Efforts to integrate oral health with broader health care policies will be vital to ensure that older people can live healthier, more fulfilling lives. Effective, patient-centred and prevention-focused services are essential to improve quality of life, address the interplay between oral and general health, and prioritize oral health in policy and research.
