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Undergraduate Training
Although most dental schools have some undergraduate didactic training in geriatrics, most have limited clinical training, particularly in providing care to the functionally dependent elderly. Over the past 27 years, the University of Iowa has developed a model program of didactic and clinical training for their dental undergraduates. The adoption of this model by other schools of dentistry would vastly improve the level of experience and confidence of graduating dentists. The components of the Iowa program include:
• Required didactic course for junior dental students during spring semester
• Required 5-week clinical program (Special Care Program) for senior students split between the school-based and nursing home-based clinics.
Graduate and Residency Training
The University of Minnesota has been providing graduate-level training in geriatric dentistry since 1981 in a program called Oral Health Services for Older Adults. One of the strengths of Minnesota’s program is that it has established clinical training sites in environments that provide the full spectrum of aged individuals, from the relatively well elderly to the functionally dependent nursing home patient. Currently, the program offers two tracks: a 1-year advanced clinical training program and a 2-year didactic and clinical program that results in an M.S. degree. This program has served as a leadership-training program for the country. Previous graduates currently hold positions in several dental schools, within the Veteran’s Administration, and in the private sector.
Continuing Education for Dental Professionals
Opportunities exist for intensive training at various U.S. locations. An example of one such program is a 5-day course, “Miniresidency in Nursing Home Care for the Dental Team” directed by University of Minnesota School of Dentistry faculty. This program draws on the expertise of individuals delivering dental care, both fixed and portable, in several long-term care settings. The program is designed specifically to teach dentists, dental hygienists, and dental assistants how to deliver care more effectively in nursing homes. Several other long-standing training programs exist. Additional information about these offerings can be obtained from Special Care Dentistry (formerly the Federation of Special Care Organizations in Dentistry) at (312)440-2660 or www.scdonline.org.
Recommendations for Title VII and VIII Programs
merica ages, more of us are on the gray side of the picture. In 30 years, the U.S. Census Bureau projects that one out of every five Americans will be 65 or older. The population age 85 and older is currently the fastest growing segment of the elderly. When we look ahead 50 years from now, we can expect that over 20 million people in this country will be 85 or older. The size of this group is especially important for the future of our health care system because it includes most of the frail elderly, people who tend to have lower income, poorer health, and require more health care services. This population group has extensive oral disease, medical problems that complicate their oral care, and unique dental treatment challenges. What can health policy makers do to assure that there are enough trained health professionals for America’s future? Based on the dental needs of frail elderly adults discussed the authors of this paper recommend the following: Work to Change Perceptions Regarding Oral Health and Disease So that Oral Health Becomes an Accepted Component of General Health
• Include oral health services in all health promotion, disease prevention, and care delivery programs. Develop training programs for nondental health professionals to emphasize how they can and should work to enhance oral health.
Accelerate the Building of the Science and Evidence Base and Apply Science Effectively to Improve Oral Health
• Survey dental needs among older adults living in a variety of settings, including senior housing, board and care homes, assisted living facilities, nursing homes, and other long-term care facilities.
• Develop community-based dental care delivery systems at regional and state levels to reduce gaps in prevention and care for low-income older adults, nursing home residents, and elderly people with disabilities.
• Increase the number of dental professionals who are trained to provide mobile, on-site dental care for frail elderly adults and other groups with special dental access needs.
• Provide oral health benefits in all public health programs, especially those for elderly adults.
• Increase the number of dental, medical, and nursing programs with active partnerships or cooperative working agreements with public and private community-based organizations that serve people with special access needs, such as frail elderly adults.
REFERENCES
1. Administration on Aging. Profile of Older Americans: 2000. 54S Helgeson et al. Spec Care Dentist 22(3) 2002
2. Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key indicators of well-being. Available at:
3. National Center for Health Statistics. Nursing home care.
Accessed February 1, 2001.
4. Gabrel CS. An overview of nursing home facilities: Data from the
1997 national nursing home survey . Hyattsville, MD: National Center for Health Statistics. 2000; DHHS Publication No. (PHS) - 2000 - 1250 - 0 - 0169 (Advance data no . 311) .
5. Ettinger RL, Beck JD. Geriatric dental curriculum and the needs of the elderly. Spec Care Dentist 1984;4:207-13.
6. Leon J, Lai RT. Functional status of the non-institutionalized elderly: Estimates of ADL and IADL difficulties. Rockville (MD): U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. 1990. DHHS Publication No. (PHS) 90-3462.
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