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The health of the nation
C O M M E N T A R Y
E D I T O R I A L
EDITORIAL
The health of the nation Why you should care All health trends suggest that now is the time to define and prepare our profession for our role in caring for an aging and more medically complex patient population.
Michael Glick, DMD Editor E-mail “[email protected]”
144
JADA, Vol. 138
he National Center for Health Statistics (NCHS) recently released a detailed report on the state of health in the United States.1 There are several clear trends that permeate this report: dwe are getting older; dwe retain our dentition into an older age; dwe have more chronic diseases; dwe take more medications. As a nation, we are aging while enjoying more years of healthy living than ever before. The life expectancy at birth in 1950 was about 68 years.2 Today, it is approaching 78 years. There are several reasons for this longevity. More people today have more and better access to health care than ever before; effective public health measures are in place to prevent and diminish microbial infections; healthier lifestyles are becoming more of a norm; and technological and medical breakthroughs have improved both diagnostic and treatment capabilities. All of these considerations also affect oral health. In past centuries, the main threats to human life were infectious diseases. Today, chronic diseases are the major causes of death, with heart diseases, neoplasms, cerebrovascular diseases, chronic lower respiratory diseases and diabetes mellitus leading the way. The age-adjusted death rates for these diseases are plummeting, which would suggest that people are surviving longer while still experiencing these diseases. However, significant disparities exist among racial and ethnic groups. In 2004, the age-adjusted death rate for African-Americans exceeded that of whites by 32 percent for heart disease, 24 percent for cancer, 45 percent for stroke, 114 percent for diabetes and more than 750 percent for HIV disease. Older people are much more affected by chronic diseases than are younger people, and as the number of older Americans increases, the absolute number of people with chronic diseases will rise accordingly. In 1950, there were just more than 12 million Americans older than 65 years. Now, 55 years later, more than 36 million people are older than 65 years, with almost 5 million people living beyond the venerable age of 85 years. The first baby boomer will turn 65 years old in 2011, an occasion that will usher in a new demographic era never before experienced in the United States. When the last baby boomer reaches this milestone in 2030, about 20 percent of all Americans—more than 71 million people—will be older than 65 years.
T
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
C O M M E N T A R Y
EDITORIAL
Today, the average 65-yearold has two or more chronic conditions, and more than one-half take three or more prescription medications each day. Unfortunately, the price we pay for longer survival is more chronic conditions, along with polypharmacopeia. These are relevant characteristics germane to future dental patients. Longevity, together with the narrowing gap in life expectancy and health care utilization between the sexes, result in interesting new disease patterns. While 30 percent of men and 33 percent of women aged 45 to 54 years have hypertension, these percentages increase dramatically with age. Among people 75 years or older, almost 70 percent of men and more than 80 percent of women have hypertension. While more than 25 percent of women aged 65 to 74 years have elevated serum cholesterol levels above 240 milligrams per deciliter, only 11 percent of men reach the same cholesterol level at the same age. To accommodate these types of changes, innovative preventive and treatment strategies must be introduced, and current models of access to health care must change. The NCHS report also shows that about 39 percent of adults aged 18 to 64 years visit a physician’s office or a hospital
146
JADA, Vol. 138
outpatient or emergency department annually. A slight increase to 45 percent is noted among people 65 years of age or older. In contrast, 64 percent of adults younger than 65 years visit a dentist, while slightly more than 56 percent of people 65 years and older have an annual dental visit. If oral health care providers see patients more frequently than physicians do, then it would appear that dentists are
The participation of nonphysicians in detecting risk factors for chronic diseases with high morbidity and mortality could be part of a new health care model for disease prevention.
in a position to help improve their patients’ health by screening for nonoral diseases. A recent study suggested that oral health care providers could alert patients to the presence of risk factors for cardiovascular disease of which they were not aware.3 The participation of nonphysicians in detecting risk factors for chronic diseases with high morbidity and mortality could be part of a new health
care model for disease prevention. The present oral health trends in the United States indicate that, even without any major breakthroughs in the prevention and treatment of caries or periodontal diseases, patients will enjoy a lifetime use of their natural dentition with a reasonable level of periodontal health. The same success cannot be assumed for overall health. Research in geriatric medicine needs to be enhanced and rapidly translated into clinical practice. At the same time, substantial educational efforts and resources need to be implemented and allocated to address the oral health needs of a graying society and the impact of this particular patient population’s overall health on the provision of oral health care. All health trends suggest that now is the time to define and prepare our profession for our role in caring for an aging and more medically complex patient population. Tomorrow is too late. ■ 1. National Center for Health Statistics. Health, United States, 2006: With chartbook on trends in the health of Americans. Hyattsville, Md.: National Center for Health Statistics; 2006. 2. Miniño AM, Heron MP, Smith BL. Deaths: Preliminary data for 2004. Natl Vital Stat Rep 2006;54(19):1-49. 3. Glick M, Greenberg BL. Primary cardiovascular risk screening by dentists. JADA 2005;136:1541-46.
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
E D I T O R I A L
EDITORIAL
The health of the nation Why you should care All health trends suggest that now is the time to define and prepare our profession for our role in caring for an aging and more medically complex patient population.
Michael Glick, DMD Editor E-mail “[email protected]”
144
JADA, Vol. 138
he National Center for Health Statistics (NCHS) recently released a detailed report on the state of health in the United States.1 There are several clear trends that permeate this report: dwe are getting older; dwe retain our dentition into an older age; dwe have more chronic diseases; dwe take more medications. As a nation, we are aging while enjoying more years of healthy living than ever before. The life expectancy at birth in 1950 was about 68 years.2 Today, it is approaching 78 years. There are several reasons for this longevity. More people today have more and better access to health care than ever before; effective public health measures are in place to prevent and diminish microbial infections; healthier lifestyles are becoming more of a norm; and technological and medical breakthroughs have improved both diagnostic and treatment capabilities. All of these considerations also affect oral health. In past centuries, the main threats to human life were infectious diseases. Today, chronic diseases are the major causes of death, with heart diseases, neoplasms, cerebrovascular diseases, chronic lower respiratory diseases and diabetes mellitus leading the way. The age-adjusted death rates for these diseases are plummeting, which would suggest that people are surviving longer while still experiencing these diseases. However, significant disparities exist among racial and ethnic groups. In 2004, the age-adjusted death rate for African-Americans exceeded that of whites by 32 percent for heart disease, 24 percent for cancer, 45 percent for stroke, 114 percent for diabetes and more than 750 percent for HIV disease. Older people are much more affected by chronic diseases than are younger people, and as the number of older Americans increases, the absolute number of people with chronic diseases will rise accordingly. In 1950, there were just more than 12 million Americans older than 65 years. Now, 55 years later, more than 36 million people are older than 65 years, with almost 5 million people living beyond the venerable age of 85 years. The first baby boomer will turn 65 years old in 2011, an occasion that will usher in a new demographic era never before experienced in the United States. When the last baby boomer reaches this milestone in 2030, about 20 percent of all Americans—more than 71 million people—will be older than 65 years.
T
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.
C O M M E N T A R Y
EDITORIAL
Today, the average 65-yearold has two or more chronic conditions, and more than one-half take three or more prescription medications each day. Unfortunately, the price we pay for longer survival is more chronic conditions, along with polypharmacopeia. These are relevant characteristics germane to future dental patients. Longevity, together with the narrowing gap in life expectancy and health care utilization between the sexes, result in interesting new disease patterns. While 30 percent of men and 33 percent of women aged 45 to 54 years have hypertension, these percentages increase dramatically with age. Among people 75 years or older, almost 70 percent of men and more than 80 percent of women have hypertension. While more than 25 percent of women aged 65 to 74 years have elevated serum cholesterol levels above 240 milligrams per deciliter, only 11 percent of men reach the same cholesterol level at the same age. To accommodate these types of changes, innovative preventive and treatment strategies must be introduced, and current models of access to health care must change. The NCHS report also shows that about 39 percent of adults aged 18 to 64 years visit a physician’s office or a hospital
146
JADA, Vol. 138
outpatient or emergency department annually. A slight increase to 45 percent is noted among people 65 years of age or older. In contrast, 64 percent of adults younger than 65 years visit a dentist, while slightly more than 56 percent of people 65 years and older have an annual dental visit. If oral health care providers see patients more frequently than physicians do, then it would appear that dentists are
The participation of nonphysicians in detecting risk factors for chronic diseases with high morbidity and mortality could be part of a new health care model for disease prevention.
in a position to help improve their patients’ health by screening for nonoral diseases. A recent study suggested that oral health care providers could alert patients to the presence of risk factors for cardiovascular disease of which they were not aware.3 The participation of nonphysicians in detecting risk factors for chronic diseases with high morbidity and mortality could be part of a new health
care model for disease prevention. The present oral health trends in the United States indicate that, even without any major breakthroughs in the prevention and treatment of caries or periodontal diseases, patients will enjoy a lifetime use of their natural dentition with a reasonable level of periodontal health. The same success cannot be assumed for overall health. Research in geriatric medicine needs to be enhanced and rapidly translated into clinical practice. At the same time, substantial educational efforts and resources need to be implemented and allocated to address the oral health needs of a graying society and the impact of this particular patient population’s overall health on the provision of oral health care. All health trends suggest that now is the time to define and prepare our profession for our role in caring for an aging and more medically complex patient population. Tomorrow is too late. ■ 1. National Center for Health Statistics. Health, United States, 2006: With chartbook on trends in the health of Americans. Hyattsville, Md.: National Center for Health Statistics; 2006. 2. Miniño AM, Heron MP, Smith BL. Deaths: Preliminary data for 2004. Natl Vital Stat Rep 2006;54(19):1-49. 3. Glick M, Greenberg BL. Primary cardiovascular risk screening by dentists. JADA 2005;136:1541-46.
http://jada.ada.org February 2007 Copyright ©2007 American Dental Association. All rights reserved.