Functionally dependent veterans. Issues related to providing and improving their oral health care

This article discusses issues related to the quality and effectiveness of new, emerging, and existing oral health delivery mechanisms and models for the functionally dependent veteran. It describes the particular needs and unique qualities of functionally dependent veterans and enumerates the clinical dental interventions and delivery systems available to this group. Barriers specific to The Department of Veterans Affairs (VA) regarding this population and suggestions for improved access to care are summarized. Suggestions for further research are proposed with the intent that limited resources be utilized so that maximum benefits are provided to the functionally dependent veterans who need care most. What we know: Among the veteran population and the general population, the oldest cohort of elderly (those age 85 and older) are growing faster than any other age group. The rate of functional dependency increases dramatically with age, from about 10% at age 65 to 69 to about 57% after age 85. Functionally dependent elderly are the most likely group to be home-bound or in nursing homes. Compared with independent elderly, the oral status of functionally dependent elderly tends to be poorer. Functionally dependent elderly have higher rates of tooth loss, greater prevalence of denture-related problems, greater prevalence and severity of dental caries, higher prevalence of gingival and periodontal disease, and typically not seen a dentist in at least 5 years. The Department of Veterans Affairs has several advantages over non-VA settings in delivering dental care to the functionally dependent including the presence and availability of dental clinics at VA medical centers and outpatient facilities, the fact that they are free to eligible VA patients, and the greater knowledge base of the dentists. Although VA is effective in delivering oral care to a small percentage of the total population, it is likely that demand will increase and resources exhausted if certain anticipated changes occur (eg, greater demand for dental care and/or changing dental status, such as more elderly with teeth). Questions that need to be answered: What quality of oral care is VA providing to the functionally dependent veteran? What delivery systems are the most effective in providing care to the functionally dependent elderly? Is there a difference in oral health outcomes when dental personnel serve on patient care teams? What barriers exist for delivering quality oral care for the functionally dependent elderly? How can we eliminate or minimize these barriers?