[ISY-3] The Role of Gerodontology in the Centenarian Era- An USA Contribution to the International Consensus
【略歴】Dr. Marchini is an Associate Professor at the University of Iowa College of Dentistry and Dental Clinics, and his current research focus includes geriatric dentistry, and patient satisfaction with dental treatments. He is also interested on researching about the best way to teach dentistry, with particular interest to geriatric dentistry. Currently, Dr. Marchini is the Chair of the Special Care Dentistry Association Council of Geriatric Dentistry and the Councilor of the American Dental Education Association’s Gerontology and Geriatric Section.
In 2018., there were about 94,000 centenarians in the United States. This number is expected to grow to 589,000 in the year 2060, a 6-fold increase. In the most recent available report (2014) for an US centenarian cohort, it was shown that 36.5% of the centenarians were edentulous, 66.7% were denture wearers, and only 28.6% reported having excellent or very good health of teeth and gums. Although these oral health indicators of this sample of centenarians are better compared to their respective birth cohorts, these indicators clearly show the need for improving the way oral health care is delivered to older adults. It is even more important as the relationship between oral health and systemic health and wellbeing has received strong support from recent research efforts. However, persistent barriers to efficient oral health care delivery for aged populations have been reported in the USA for decades. Many barriers are related to socio-economic aspects, such as the lack of dental insurance after retirement (as dental insurance is traditionally tied to employment in the USA) and transportation issues. However, many barriers are related to the dental workforce and how future dentists are prepared to provide oral health care for an aging population. Currently, the USA has an insufficient number of dentists with advanced training in geriatric dentistry, and only a small number (five) advanced courses in this field. One of the main reasons for the reduced number of dentists with advanced training in geriatrics is the lack of interest on treating older adults. This negative attitude is rooted in the most common form of social prejudice: ageism. Ageism is the prejudice against a person based on age, and it usually translates into negative attitudes towards older adults. These negative attitudes have wide social repercussions, including but not limited to discrimination of older adults in the workplace, older adults’ loneliness, mistreatment of older adults, and discrimination of older adults in the health care system. Many reports have shown that discrimination based on age reflects in clinical practice and decision-making among health care providers, as well as health care policies. For instance, age-based disparities happen for diagnostic procedures and types of treatment offered in various fields of medicine, including cardiology, oncology, and stroke treatment. In dentistry, ageism seems to be prevalent among dental students, and the ability of dental education to change dental students attitudes toward older adults have been source of much debate. This lecture will present the basic demographics about centenarians in the USA, their oral health characteristics, the barriers for oral health care faced by USA older adults, and then will focus on current nationwide efforts to prepare the future USA dental workforce to provide appropriate oral health care for the growing population of older adults. The debate about these barriers and enablers might be useful for possible application in other national contexts, provided the much-needed adaptations are made.