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Dental professionals face challenging dilemmas in providing oral healthcare to older adults-from assessing competency and treatment options, to ascertaining elder abuse or neglect.
ABSTRACT The use of dental services by older adults is increasing, and a variety of ethical and moral dilemmas may arise not only because of a lack of financial resources and insurance, but also due to a higher prevalence of chronic diseases and disabilities that may complicate informed consent and selection of appropriate treatment options. Behavior management can also be a concern for older adults with neuropsychiatric disorders-and questions may surface about oral health-related manifestations of potential abuse and neglect. This article reviews key ethical issues in providing oral healthcare for older adults and offers strategies to address them. | key words: ethics, informed consent, oral health, dental care
The use of dental services in the older population is ever increasing, due to greater public knowledge and expectations about the significance of oral health to overall health, declining rates of tooth loss, and technical advances in oral healthcare delivery, among other factors.
Along with the many challenges associated with caring for an aging population, a variety of ethical concerns and moral dilemmas frequently arise in oral healthcare, as they do in other health services, and are a matter of growing concern to both dental and non-dental health professionals (Scheunemann and White, 2011; Silveira, Kim, and Langa, 2010; Appelbaum, 2007).
When providing care for older adults, the higher prevalence of chronic diseases, functional impairments, and resource limitations can create challenges around people's access to dental care, the scope of care, and the choice of treatment options. The lack of access to care is particularly disturbing for older adult residents of nursing facilities who are at the highest risk for poor oral health. Chronic conditions, especially those affecting cognition, frequently raise questions about the informed consent process and appropriate surrogate involvement.
Finally, behavioral difficulties related to neuropsychiatric problems provoke concerns about appropriate behavior management strategies, while dependence upon others might lead to questions about potential abuse or neglect. This article reviews these key ethical concerns in the dental care of an aging population and how dental and other health professionals can address them to improve the oral and overall health of older adults.