Staging in Gerodontology: A Framework

Comprehensively, systematically and reproducibly assessing and describing the (oral) health status and care needs of older adults is challenging. We aimed to provide a framework for evaluating and reporting older adults' oral health, capturing general and oral function and disease, as well as oral, systemic and socio-economic/social risk factors determining oral care complexity and capability, care needs and levels, and clinical management, including prevention, active and supportive therapy, as well as informing education, research, surveillance and health services. The present paper describes the first aspect, staging of oral health in this population.

Eight reviews were conducted to identify risk factors for deterioration of oral health in older adults; existing systematic reviews were further considered during the framework development. A 2.5-day workshop with 31 international researchers and stakeholders was held and a structured consensus process implemented to come to an agreed, internationally applicable framework. A 75% level of agreement was achieved after two rounds of voting.

A case definition based on staging and grading, reflecting the current general and oral health and function, care complexity, and the risk of deterioration of oral health due to local, systemic, and socio-economic and social factors, was developed. Staging includes person-level (based on clinical frailty), function-level (based on clinical and subjective evaluations reflecting oral function, such as tooth loss and oral impacts), and disease-level (including caries, periodontal disease, and oral mucosa assessments) domains.

Oral health staging in older adults can allow clinicians, carers, and policymakers to systematically and comprehensively define and classify patient cases in order to derive appropriate and adequate care. Staging should be used in combination with grading, and both may allow capturing the overall health status and care needs of older patients for health surveillance, research, and education purposes. Next steps will include validation, dissemination, and implementation of the framework.