This article is from the archives of the UB Reporter.

Barriers to dental care

Seniors cite cost as major reason for not seeing a dentist

Published: June 30, 2005

Contributing Editor

To say that health-care professionals have to fight tooth-and-nail to provide dental services to senior citizens is not much of a stretch.

A survey of 415 senior citizens in Western New York, conducted by researchers in the School of Dental Medicine, found that more than half faced barriers to seeing a dentist. Not surprisingly, the most serious barrier reported was cost.

Respondents also named lack of dental insurance, anxiety about going to the dentist and not having transportation among the several barriers to receiving dental care that seniors face.

The study provides a snapshot of dental care to the elderly that could be relevant anywhere there are high concentrations of low-income older citizens. Kimberley Zittel-Palamara, director of the Counseling, Advocacy, Referral, Education and Service (CARES) program in the UB dental school, is lead author.

Seniors participating in the study, accessed through senior-citizen centers and nutrition centers across the eight counties of Western New York, were 71 percent female, 88 percent Caucasian and 66 percent rural. The data revealed that barriers affect different age groups of seniors in different ways.

Participants were categorized as "early seniors" (ages 60-74), "middle seniors" (ages 75-84) and "late seniors" (ages 85 and older). The researchers combined the barriers that were named most often into three categories: anxiety/depression, transportation/weather and finances.

Analysis showed that anxiety/depression was the most significant barrier named by early seniors, accounting for more than half the barrier effect. However, as age increased, the impact of anxiety decreased and eventually disappeared, while the importance of transportation/weather increased. Transportation issues accounted for nearly 85 percent of dental-care barriers listed by late seniors, with finances accounting for the remaining 15 percent.

For the middle seniors, the three categories of barriers were nearly equal in importance.

Of the major differences between age groups, Zittel-Palamara said, "It may be that younger seniors have more apprehension about spending a significant amount of money on dental treatment because they may have retired recently and now are living on a fixed income. This generation of seniors also remembers a time when going to the dentist was associated with painful procedures without anesthesia, resulting in more anxiety about going to the dentist.

"As wearing dentures increases with age," said Zittel-Palamara, "the likelihood of needing more complex procedures often associated with pain will inevitably decrease. Further, transportation needs by young seniors may be less frequent than the other senior age groups because they still are able to drive. As the loss of driving ability increases with age, so too does the need for transportation assistance to the dentist. And in rural areas, the dentist may be more than an hour away. Distance, coupled with difficult winters, may make it even more difficult to get to the dentist."

A breakdown of the data showed that of the 415 persons surveyed, 402 reported having no dental insurance. In light of that piece of data, it was surprising that only 207 people reported they had no barriers to dental care.

Zittel-Palamara theorizes that a substantial portion of those reporting no insurance were denture wearers who didn't think they needed dental care because they had no natural teeth. Therefore, the lack of insurance was not perceived as a barrier for these people.

"I think this difference is due to lack of knowledge that you need dental care, and by extension, dental insurance, even if you wear dentures and have been wearing them for many years," she said. "Denture wearers need to be checked for periodontal disease, which we now know is a risk factor for heart disease, and for cancerous lesions."

Of the 208 seniors who did report barriers to receiving dental care, 191 named finances, 92 named not having a dentist, 52 named transportation and the weather, and 34 named anxiety/depression.

Zittel-Palamara said the results of the study may help dentists identify barriers seniors face and to feel comfortable discussing them with their patients.

"For seniors who do not have a dentist, Offices for the Aging staff may assess access to dental care needs. In fact, we are expecting to start another project in the summer, training Offices for the Aging staff in Erie and Niagara counties on how to assess access to dental-care needs in semi-dependent seniors living at home.

"Knowing that senior patients of different ages face different barriers will help guide these conversations and keep seniors in the dental-health-care system," she said.

Additional UB researchers on the study were Elaine L. Davis, associate professor of oral diagnostic sciences; Meelin D. Chinkit-Wells, clinical assistant professor of pediatric and community dentistry; James A. Wysocki, clinical manager of the CARES program; Jude A. Fabiano, director of the dental school's Advanced Education in General Dentistry Program; and Frank Scannapieco, professor and chair of the Department of Oral Biology.

The research was funded by a grant from the National Institutes of Health.