Currently, little is known about the oral health status, perceived oral health needs, or the extent of dental utilization among community-dwelling, functionally dependent elderly. The purpose of this study was to describe the dental health of functionally dependent elderly living at home and receiving community-based support services. The functional limitations experienced by these elderly living at home are comparable to functional limitations experienced by institutionalized elderly and these limitations impact on oral hygiene and access to dental care. Oral examinations and questionnaires were completed on 50 clients of an urban social service agency. Subjects had a mean of 8.8 teeth/person, with 44 percent completely edentulous. Two subgroups identified from the questionnaire--those who perceived themselves homebound (n = 30) and those who did not (n = 20), did not differ by age, gender, education level, or race. Respondents reported being homebound an average of 4.5 (+/- 2.9) years. The mean decayed, filled teeth for the perceived homebound group was 5.1, and 7.3 for the group that did not perceive themselves as homebound, with both groups averaging less than of one tooth/person with active root decay. Health care and social policy agendas must address the changing scope of oral health needs and limited access to dental care experienced by an aging population retaining more of their natural dentition.

Questionnaires and oral examinations were completed on 50 clients of a social service agency which provides home-based services to functionally dependent elderly. Nearly 61% of all respondents classified their oral health as frail/poor, and 82% reported a perceived need for some oral health care. When asked if they considered themselves homebound, 60% reported being homebound from 1-10 years (mean = 4.7 years). Two or more home services were received by 80% of the homebound group compared with just 45% of the not-homebound group. Paying for dental care, transportation difficulties, and poor health were the most frequently identified barriers that limited access to oral health care.

This study examines a low-income, urban elderly population of dental and medical, nondental users. A total of 1,378 medical, nondental users and 2,086 dental users were identified using longitudinal claims data (1983-1992) from a Medicare-waiver program that reimbursed for health care services at cost. Dental users were more likely to be from a younger age cohort (born after 1910, p = .0001) and were more likely to be black (63.3% vs 35.7%, P = .0001) than medical, nondental users. Medical, nondental users had more medical visits (p = .0001), higher medical and pharmacy charges (p = .0001), and more prescriptions (p = .0001) than did the dental users. These findings indicate that among this population of urban elderly, dental users were more likely to be black and have lower medical utilization than nondental users.

By the year 2000, it is likely that more than 66% of all US males will be veterans as a result of the large World War II cohort. This growing population of older veterans will have a major influence on the use of dental services at Veterans Administration facilities. The objectives of the project reported here were to identify and examine factors that explain use of dental services by noninstitutionalized veterans older than 55 years; this was a secondary analysis of a VA commissioned survey of 3,013 community-based veterans older than 55 years. A behavioral model developed by Anderson and Aday that identified predisposing, enabling, and need factors that determined use of health care services was adopted to analyze the data. A linear regression analysis showed that need factors accounted for the greatest degree of explained variance in use of dental services (R2 = .15), whereas enabling factors accounted for the least degree of variance (R2 = .02). Perception of dental problems, positive perception of physical health, perception of ability to meet expenses, and levels of education and income were significant predictors of use of dental services. The findings of this study show the use of dental services by noninstitutionalized veterans and other noninstitutionalized older populations is influenced by similar factors. The findings can be useful in discussing and formulating dental health care policy for older veterans.

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