Oral health is an integral component of age-friendly care.

Abstract

We congratulate the authors of “Clinician Knowledge and Behaviors Related to the 4Ms Framework of Age Friendly Health Systems” for conducting such an important study of the implementation of the 4Ms framework.1 While the findings of the study clearly indicate the need for wider implementation, the 4Ms remain a valuable tool for all areas of health care, including oral health. Although dental literature may not have directly informed the 4Ms framework at its inception,2 it is becoming increasingly evident that oral health is a critical component of geriatric care. We believe healthcare professionals and policymakers should explicitly include oral health as an essential component of the Age-Friendly Health Systems movement. As healthcare professionals (a dentist, a family physician, and a geriatrician), we recognize that age-friendly care is ideally provided by interprofessional teams. We have noticed that the mouth is often neglected in primary care. Nearly 70% of adults over the age of 65 suffer from periodontal disease.3 Periodontal disease has been associated with chronic conditions affecting older adults including diabetes,4 heart disease,5 and even Alzheimer's disease.6 This makes caring for the mouth an essential aspect of healthy aging. So closely tied are oral and systemic conditions such as periodontal and heart disease that the risk factors for both are nearly indistinguishable. Enlisting oral health providers early in the process of caring for older adults could be an asset in our arsenal to mitigate the impact of chronic illness and also aligns with the 4Ms. For example, polypharmacy is common in this age group and can lead to xerostomia,7 which increases the incidence of caries and often leads to tooth loss. Tooth loss creates significant challenges for patients already struggling with social isolation and nutritional deficits. Denture-wearing compliance also becomes an issue as adequate salivary flow is needed for denture retention and prevention of oral mucositis. Because eating and drinking are important social activities, ensuring that older adults can maintain their teeth has the added benefit of reducing isolation. Dental health professionals can encourage older adults to talk to their primary care providers about addressing polypharmacy. Attention to oral health considerations may also help our patients' mentation, as periodontal disease is associated with Alzheimer's disease. Dental health professionals can help encourage older adults to seek treatment earlier, as periodontal disease may be present prior to the appearance of neurological symptoms.8 Additionally, dentists are able to facilitate early intervention by sending electronic alerts and other communications to primary care providers. The mouth also comes into play when considering therapeutic options related to mobility, particularly in older adults at high risk of falling. Intravenous and oral anti-resorptive agents are commonly used in this age group and carry a risk of medication-related osteonecrosis of the jaw. Collaboration with dental health professionals prior to initiating therapy can help prevent this outcome.9 This enhanced focus on the mouth aligns with what matters most. When older adults are able to receive comprehensive oral care, they may have additional options for therapeutic plans that improve their overall health and quality of life, thus leading to more successful therapeutic outcomes.10 The inclusion of “the mouth” in the 4Ms framework may not necessitate the inclusion of an additional “M.” Rather, oral health can be incorporated seamlessly when asking older adults what matters most to them, thus yielding meaningful and effective collaboration between dental and other health professionals while maintaining the elegant simplicity of the 4Ms framework. We call upon healthcare providers and policymakers to consider oral health when implementing the 4Ms of Age-Friendly Health Systems. Alberto Enrique Varela, Jose E. Rodriguez, and Timothy W. Farrell were equally involved in the preparation of this manuscript. The authors declare no conflicts of interest. None.