As global aging accelerates, a new study highlights how deteriorating oral health is affecting older adults and calls for integrated healthcare solutions to improve their quality of life.
Judgement: Healthy aging and oral health: priority, policy and public health. Image credits: Drazen Zigic / Shutterstock
In a recent review published in the journal BDJ openedRakhee Patel and Jennifer Gallagher from King’s College London examined the World Health Organization’s (WHO) public health framework for healthy aging and global policy. They proposed an integrated model that addresses the impact of aging on oral health and healthcare systems, using the United Kingdom (UK) as a case study.
Background
The world’s population is aging rapidly, with forecasts indicating that one in six people will be aged 60 or over by 2030, representing a significant demographic shift and rising to 2.1 billion by 2050. This accelerating pace of aging poses complex challenges especially in terms of how aging is defined in different regions and cultures. Furthermore, the need for tailored support is growing as older populations diversify across regions. A more comprehensive understanding of the diverse biological, social and psychological changes is essential for effective policymaking. Further research is critical to understand these complexities and develop effective policies that meet the unique needs of this growing demographic.
The aging population
The aging of the world population is accelerating. The 2022 WHO report predicts that one in six people will be aged 60 or over by 2030, up from 1 billion in 2020 to 1.4 billion. By 2050, this number is expected to double to 2.1 billion, while the number of people aged 80 and over will triple to 426 million. Aging involves complex biological, social and psychological changes that occur at different rates in different individuals, resulting in a highly diverse older population. The definition of “older person” varies globally; while the WHO and the United Nations (UN) define it as over 60, some countries, such as Britain, traditionally use 65, adapting as life expectancy increases. This distinction is becoming increasingly important because the needs of people over 65 can vary significantly depending on their functional capabilities.
Understanding the aging process
The aging of the population is often seen as a sign of better health and longer lifespans. Countries such as Japan, where a significant portion of the population is 60 years or older, illustrate this trend. It is expected that by 2050, East and Southeast Asia will continue to house the largest share of elderly people at 37%, while in Europe and North America this share will decrease from 29% to 19%. The global distribution of aging populations poses unique challenges for regional healthcare systems, especially in countries with low potential support rates.
The potential support ratio, defined as the number of working-age adults (25-64 years) per older adult (65+), highlights the consequences of an aging population. By 2050, many countries, especially in Europe and Asia, will face support rates of less than two, indicating increasing pressure on health and social care systems. This trend underlines the urgent need for innovative public health strategies to control the aging population.
Addressing ageism and diversity in aging
As the population ages, negative stereotypes, often called “ageism,” emerge where older adults are viewed as burdens on society. However, there is great diversity among older people. The WHO defines ageism as including stereotypes, prejudices and discrimination based on age, with global implications for both older and younger populations. In Europe, younger people report experiencing more ageism than older adults. Ageism also intersects with other forms of disadvantage, such as those related to gender, race and disability, further exacerbating inequality.
In Britain, the aging population has been steadily increasing, with the number of over-65s increasing from 16.4% in 2011 to 18.6% in 2021. Projections predict that one in four people in Britain will be over 65 by 2066. 65 years. Life expectancy has improved, but life expectancy without disability (DFLE) remains a concern. Life expectancy without disability (DFLE) for men is about 9.9 years, and for women about 9.8 years after age 65, suggesting that a significant proportion of older adults may live with health problems.
The decade of healthy aging
The UN Decade of Healthy Aging aims to address the challenges of population aging through collective action in four areas: combating age discrimination, supporting communities for older adults, providing integrated and person-centered care, and ensuring access to high-quality long-term care. Healthy aging focuses on maintaining functional skills for well-being, with older adults being categorized as functionally independent, frail, or dependent. Two major components influence aging: intrinsic capacity, which includes physical and mental health, and environmental factors, which include social and community support. Together, these elements determine the ability of older adults to function effectively and lead a fulfilling life.
The link between oral health and aging
The deterioration of oral health is a major problem for older adults, with high rates of dental disease in this target group. The Global Burden of Disease Study ranks oral diseases as one of the leading causes of disability-adjusted life years (DALYs) worldwide, affecting millions of older adults. Recent estimates indicate that untreated dental disease affects more than 57% of older adults. In particular, root caries, which often remains untreated, poses a significant burden, especially in institutionalized settings.
Oral health problems, especially dental caries and periodontal disease, significantly impact the quality of life of older adults. Despite the common belief that tooth loss is a normal part of aging, the aging process itself is not an independent risk factor for oral health decline. Instead, systemic conditions, medications, and access to dental care play a critical role in oral health outcomes.
Long-term conditions and oral health
The relationship between general health and oral health is increasingly recognized as bidirectional, with poor oral health exacerbating chronic conditions such as diabetes, cardiovascular disease and respiratory disorders. For example, poor oral hygiene can increase the risk of pneumonia in vulnerable populations, while periodontal disease can worsen diabetes management. Recent studies also highlight a link between cognitive decline and worsening oral health, with dementia patients facing greater challenges in accessing care.
Moreover, nutrition is closely linked to oral health. Older adults with compromised teeth may have difficulty with proper nutrition, leading to a cycle of health decline. Conversely, poor nutrition can increase the risk of dental disease, highlighting the need for an integrated health approach that considers both oral and general health.
Case study: oral health in Britain
In Britain, epidemiological data shows that the number of older adults retaining their natural teeth is increasing. For example, 53% of adults aged 85 and older reported having some of their own teeth. This shift indicates a growing population that can benefit from preventive oral health strategies. Nevertheless, disparities remain, especially in care homes, where rates of edentulism and untreated dental disease are significantly higher. Current policies in Britain, especially in Scotland and Wales, emphasize the need for better oral health among older populations, while the situation in England is lagging behind.
Policy recommendations for healthy aging and oral health
A multifaceted policy approach is essential to promote healthy aging and oral health. This should include early prevention strategies across the lifespan, better training for healthcare staff and greater integration between health and social care systems. Preventive strategies such as fluoride treatments, integrated health and social care and improved access to dental services, especially for vulnerable older populations, are crucial.
Conclusions
In summary, healthy aging is a critical global issue that requires urgent attention to the impact of population aging on oral health and healthcare systems. Efforts to integrate oral health with broader health care policies will be critical to ensuring that older adults can live healthier, more fulfilling lives. Effective, patient-centered and prevention-oriented services are essential to improve quality of life, address the interrelationship between oral health and general health, and prioritize oral health in policy and research.