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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