What we commonly think of as “health care” is not the only Issue Seniors grapple with. According to the Centers for Disease Control and Prevention (CDC), older Americans with the poorest oral health tend to be those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized (e.g., seniors who live in nursing homes) also increases the risk of poor oral health. Adults 50 years and older who smoke are also less likely to get dental care than people who do not smoke. Many older Americans do not have dental insurance because they lost their benefits upon retirement and the federal Medicare program does not cover routine dental care.
Oral health problems in older adults include the following:
- Untreated tooth decay. Nearly all adults (96%) aged 65 years or older have had a cavity; 1 in 5 have untreated tooth decay.
- Gum disease. A high percentage of older adults have gum disease. About 2 in 3 (68%) adults aged 65 years or older have gum disease.
- Tooth loss. Nearly 1 in 5 of adults aged 65 or older have lost all their teeth. Complete tooth loss is twice as prevalent among adults aged 75 and older (26%) compared with adults aged 65-74 (13%). Having missing teeth or wearing dentures can affect nutrition, because people without teeth or with dentures often prefer soft, easily chewed foods instead of foods such as fresh fruits and vegetables.
- Oral cancer. Cancers of the mouth (oral and pharyngeal cancers) are primarily diagnosed in older adults; median age at diagnosis is 62 years.
- Chronic disease. People with chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) may be more likely to develop gum (periodontal) disease, but they are less likely to get dental care than adults without these chronic conditions. Also, most older Americans take both prescription and over-the-counter drugs; many of these medications can cause dry mouth. Reduced saliva flow increases the risk of cavities.
That’s why Kaiser Health News and National Public Radio have teamed up and begun a yearlong investigative project that explores “the scale, impact, and causes of the health care debt crisis in the United States.”
About 4 in 10 adults report having medical or dental debt, a Kaiser Family Foundation poll has found, a share that roughly translates into an estimated 100 million adults. Many expect repaying the debt to take years, and about 1 in 5 say they do not expect to ever pay it all off.
The problem drives millions of Americans from their homes or into bankruptcy, but the consequences are not just financial. About 1 in 7 people with health care debt say they have been denied access to a hospital, doctor, or other provider because of unpaid bills. The toll of medical debt tends to fall most severely on the poor, the sick, and people of color, the investigation reveals.
Besides cutting spending on food and other essentials, millions are being driven from their homes or into bankruptcy. And medical debt is piling additional hardships on people with cancer and other chronic illnesses.
In addition, much of the medical debt is hidden as monthly installments paid via credit card, loans from family, and payment plans arranged directly with hospital and doctor’s offices.