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Edi tor ia l

Population ageing and the implications for oral health in

Africa

A myriad of oral health challenges presentlyconfront the elderly population in Africa. Reports

from the continent have found oral health

impairment and poor oral hygiene to be more

common in older adults and that many elderly

people perceive oral health to be less important

when compared with their general physical

health14. In fact, the attention given to the oral

health needs of the older people has been grossly

inadequate, especially considering the changing

demographic profile on this continent, with its

enormous welfare and cost implications. The

elderly population in Africa, like elsewhere, con-stitutes a substantial proportion of the general

population, and it is increasing very rapidly.

More than one-tenth (11.9%) of the African

population are older than 60 years and this will

continue to escalate with the increasing life

expectancy in Africa from the current 50 years or

so to about 65 years by 20505. Only about one-

fifth (20.6%) of the earths 810 million persons

aged 60 years or over are from developed regions6,

and about one-tenth (10.6%) of these (i.e. about

215 million) live in Africa. Moreover, whilst age-

ing populations are expanding rapidly every-

where, they seem to be expanding even morerapidly in less-developed regions6. For example,

between 2012 and 2050, current estimates suggest

that this age-group will increase by about 260%

in East, Middle, Northern and Western Africa,

and about 150% in Southern Africa. Unfortu-

nately, most African governments have been pre-

occupied with other concerns and have not given

their ageing populations the serious consider-

ations they deserve; nor are they adequately pre-

pared to meet the emerging challenges. There are,

for example, very few preventive oral healthcare

programmes for elders compared with other age-groups on the continent.

When compared to previous generations, older

Africans today are better educated, more aware of

health needs, more hopeful of retaining their

natural teeth and seek care that includes where

possible sophisticated restorative procedures, aes-

thetic dentistry and implants7. However, whilst

most countries in North America, Europe and

Asia provide social supports for their elderly

populations, there are few statutory social insur-

ance and retirement programmes in Africa. Social

insurance programs in most African countries donot have universal coverage, and they are often

available only to government employees who

constitute a very small proportion of the popula-

tion and very few elderly persons draw pensions

from government. Indeed, most people have to

keep working to pay for the ever-rising cost of

food, housing, transportation and healthcare. Pay-

ment for dental services is still based on fee-for-

service in most African countries and where

health insurance exists, it usually does not cover

most oral health-related services.

The family which has traditionally been themajor source of support for most elderly Africans

is going through a very rapid transformation, and

its ability to support elderly members is fast

diminishing. The African extended family system

with its statutory role of caregiving to elderly

members is now substantially altered and weak-

ened by social change, driven by migration,

urbanisation and industrialisation. The African

family is no longer in a position to fulfil the eco-

nomic, cultural, and social functions for which it

was previously renowned. There is also reluctance

to use residential nursing homes because of a

widespread belief that residents lose their respectand self-esteem. Strategically planned governmen-

tal, societal and professional efforts are therefore

needed to complement family caregiving.

Feminization of the aged, when combined with

a poorer social and economic status for women,

has been identified as a major issue in African

geriatrics8. This may present a challenging trend

in planning oral health-services for older people.

Health insurance programmes, for example, may

have to be gender sensitive by taking into consid-

eration the special needs of elderly women.

HIV/AIDS poses a very major challenge to mostAfrican societies, and the oral manifestations of

this infection offer dental personnel an important

role in its prevention and management. Of the

estimated 33.3 million adults with HIV/AIDS at

the end of 2009, an estimated 22.5 million

(67.6%) were in sub-Saharan Africa9. However,

most of the attention to HIV/AIDS on the conti-

nent has focused on youth, commercial sex work-

ers and pregnant women, although there have

been recent attempts to extend our attention to

include elderly population8.

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Most societies see the loss of teeth or edentu-

lousness as a veritable sign of ageing, akin to grey

hair. Hence, the African aphorism only those that

are not old enough to lose their teeth need to

cover their gapped teeth. A report from Nigeria

noted poor oral hygiene amongst elderly people

and a preference generally for traditional oralcleansing methods1, although there is little infor-

mation about the effectiveness of these methods.

In Africa, a greater percentage of the popula-

tions reside in rural communities, whereas den-

tists and dental facilities are concentrated in

urban settings10. This is due to resource con-

straints on the part of governments and also to

the greater financial and professionally rewards

for private dental practice in urban locations. Pov-

erty amongst elders complicates their access to

care even further and especially in rural areas.

The imbalance and maldistribution may be ame-liorated by integrating oral healthcare into the

Primary Health Care services which currently

constitute the anchor and basis for the national

health policies of most African countries11.

The current situation of neglect for the aged por-

tends grave danger for the continent. There is an

urgent need to introduce focused policies that will

strengthen both the formal and informal welfare sys-

tems and improve oral health access. The oral health

needs of elders should be a shared responsibility

between the governments, not-for-profit non-gov-

ernmental organizations and the business communi-

ties as partners. Such arrangements should alsoinclude persons who may be chronologically young

but biologically old because they are medically com-

promised or developmentally disabled7. It is unfortu-

nate that no reliable data currently exist for the

population of this latter group on the continent.

Geriatrics is not yet a major component of the

curriculum of dental schools in Africa. It has been

reported that, even in the advanced countries of

Europe and North America, there are significant

perceived barriers to teaching geriatric dentistry

and that these have remained the same in the last

three decades7

. One major obstacle is the paucityof trained faculty to teach the discipline. African

dental schools must rise up to this challenge and

join the global initiative aimed at improving

research, teaching and services in gerodontology.

Eyitope O. Ogunbodede1,2

1Department of Oral Health Policy and Epidemiology, Harvard

School of Dental Medicine, Boston, MA, 02115, USA2Department of Preventive and Community Dentistry,Faculty of

Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria

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2013 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2013; 30: 12

2 E. O. Ogunbodede