Are we counseling our older patients?

Counseling the patient on eating habits and smoking are standard procedures for managing adult dental decay. Or at least they should be. A recent Swedish study reports that older patients did not receive the same level of counselling on eating or smoking, as younger patients (Chart 1) (Chart 2).

Chart 1

% of Swedish adults at high caries risk, receiving advice on eating habits from their dentist, 2008

Source: http://www.ncbi.nlm.nih.gov/pubmed/23230808

Chart 2

% of Swedish adults at high caries risk, receiving advice on smoking habit from their dentist, 2008

Source: http://www.ncbi.nlm.nih.gov/pubmed/23230808

Why the decline in counseling as the patient ages? One explanation might be the older patients do not recall professional counseling as well as younger patients. Another explanation is the dental professional simply differentiated his/her counseling by age – spending more time and effort on the younger at risk patients than on the older ones. The authors of this Swedish study believed the latter explanation, concluding that “Swedish dentistry has given up on the older age group where almost no information is provided regardless if the patient is experiencing problems or not.” And this may not be just a Swedish phenomenon. I recall from an online survey of Ontario adults that the use of in-office fluoride showed the same decline with age as in the above charts.

“Ageism” in any service is an issue but it presents particular difficulties in a very personal, health-related service like dentistry. Let’s face it. The Boomers are not generally amenable to receiving less information or less consultation or less preventive care than their children.

We continue to conduct surveys of patients in the waiting rooms of family dental practices in Canada and the UK. These surveys find the majority of patients are past mid-life and are very keen on becoming more involved in their dental treatment plan. The most preferred new service for these patients is a shared risk assessment (Chart 3). Almost half want this service.

Chart 3

I want my dentist to speak to me about this service, Small town, Ontario 2013

Source: Partners in Prevention

So on the one hand, there is evidence that older patients are offered less counseling services. And on the other, they clearly want to be engaged in their care. In this paradox, the Partners in Prevention program of shared diagnosis and more preventive care for adults, is a way of resolving this tension.

Source: Ross Perry