Ageing in the United Kingdom - what does this mean for dentistry?

/Home/Specific Dental and Oral Health Concerns/Seniors and Dental Care

Ageing in the United Kingdom - what does this mean for dentistry?
Received 3.22.03; Accepted 5.3.03
A. Tinker1
British Dental Journal

1Professor of Social Gerontology, Institute of Gerontology, King's College London, Franklin-Wilkins Building (WBW), Waterloo Road, London SE 9NN

Correspondence to:
E-mail: anthea.tinker@kcl.ac.uk

In Brief
When considering the future demand for dental services the effects of an ageing population need to be taken into account.
The impact of a growth both in numbers of older people, and especially the very old, are examined.
Account is taken of differences in gender and ethnic origin.
The likely effects of an ageing workforce and changes in attitudes, living conditions and technology are also considered.
They all lead to the conclusion that older people are currently disadvantaged and policy needs to take this into account.

Abstract

When considering the future demand for dental care and the consequent provision of services for the older population there are two key demographic issues that need to be discussed. The first concerns the older population itself and the second concerns the workforce. This paper focuses on the former but discusses the latter briefly.

The current focus of interest of the British Dental Association is the effect of an ageing population in twenty years time. Projections by the Government Actuary's Department (GAD) now go up to 2070 but this is in response to demand for such data and using current assumptions.1 The United Nations (UN) is prepared to make projections to 2050 However, any projections need a health warning because many factors could alter them. In particular assumptions about declining fertility rates may have to be revised in the light of increased migration. Similarly there is need for caution about medical advances. For example anything, such as the development of drugs, that would improve the position of people with dementia would reduce the burden of care. Nor do we know what resources older people will have in the future. At the moment the evidence is that the gap between the rich and poor is growing.2

AGEING IN THE UNITED KINGDOM - THE OLDER POPULATION
There are a number of elements when considering the older population. These include:

An increase in overall numbers and percentages of older people.
An increase in numbers and percentages of very old people.
A continued preponderance of older women.
An increase in numbers and percentages of older people from black and ethnic minority groups.
When drawing conclusions about these groups it is tempting to examine the position of older people in that group now and project it to the future. However, cohort differences are important. People who are 50 now and will be 70 in 20 years are likely to be substantially different from those who are 70 now.

a. An increase in overall numbers and percentages of older people
Table 1 shows that while the total population of the United Kingdom (UK) will grow from 588 million in 2001 to 622 million in 2020 a substantial number will be accounted for by the rise of those aged 65 and over from 94 million to 12 million. Even more striking is the rise in the percentage of those aged 65 and over in the population from 159% to 193%.

It is important to take account of short-term effects within these overall figures. For example 1920 saw the highest number of babies born in the last century. This large group, which experienced some deaths in World War 2, are now aged 82 Similarly there will be the short-term effect of the baby boomers of the 1940s who are now entering retirement. Another group are the baby boomers born in the mid 1960s which will lead to a further rise in numbers of older people in 30 years time.

The reasons for the increases in numbers of older people is partly that people are living longer and, in the developed world, mainly due to falls in mortality at older ages. But what must also be taken into account in looking at percentages of older people compared with other ages is the effect of the fall in the birth rate. Table 2 shows the dramatic drop in total live births per 1000 women aged 15-44 in the UK.3 From a rate of 91 per 1,000 in 1961 the rate fell to 55 in 2000.

What is relevant in looking at population figures is the likely effects. While generalisations are dangerous one of the obvious effects is on health and health services. For example there is a strong association between age and disability as Table 3 shows. This shows that for some indicators of self reported health this was worse at older ages. Figures from the 1998 General Household Survey (GHS) show that comparing those aged 65-74 with those aged 75 and over 37% of the former reported limiting long-standing illness compared with 48% of the latter and the former reported 52 days with acute sickness compared with 72 of the latter.4 In 1998 over half (58%) of people aged 75 and over had no natural teeth.5 But even in very old age there is evidence of good health (see the next section).

There is evidence that older people are disadvantaged in dentistry. Access to NHS Dentistry, the first report of the House of Commons Health Committee found that certain groups, including older people and those with dementia (one in five over the age of 80) suffer particular problems over access to dental services.6 They also argued that there should be greater clarity about the availability of NHS treatment.

When looking at these figures, differences between groups must always be taken into account. Gender and ethnic differences will be considered later but other likely variations should also be noted. Geographical variations will mean differences in the kinds of patients that dentists treat. For example in 1997 Conwy had the highest percentage of people over pension age with 25%.7 There are also clusters of areas around the south coast including Dorset, Isle of Wight and Sussex where there are above average percentages. London has a lower than average proportion.

Resources is another area where generalisations are dangerous. 'Pensioners' incomes have risen, but so has the gap between the richest and the poorest' is the conclusion of a recent study by Curry and O'Connell.7 These authors also found that a quarter of pensioners are in relative poverty and that 'The make up of pensioners' incomes will change but there are no signs that future pensioners will be relatively better off than the pensioners of today'.2 The ability to pay for health services will be severely jeopardised by evidence about low incomes. In NHS Dentistry: Options for Change, the Department of Health (DH) stated 'Fear of cost, made worse by lack of information on cost, is a major barrier to older people accessing care'.

The British Dental Journal is published by Nature Publishing Group for the British Dental Association.
© 2005 British Dental Association

Complete article may be viewed online.