Customers for Life: Marketing Oral Health Care to Older Adults

Respect for and awareness of the needs of older patients from dental office staff will help such patients feel welcome in a practice. Marketing to older patients is built upon this foundation. In addition, there are other strategies for internal and external marketing aimed at older people. This article addresses the concept of turning aging patients into "customers for life."

"I started thinking about our company from the customer’s point of view. What I realized is that most people didn't like doing business with car dealers. They looked forward to seeing us about as much as they did going to the dentist." -- Carl Sewell

With that introduction to his book, Customers for Life, Carl Sewell described how he incorporated a customer service focus into his car dealership. The marketing and the customers followed.

People of all ages appreciate excellent customer service. Attention to patients’ needs is the foundation for any marketing approach. Experts describe two types of marketing: external, which is designed to bring new customers to a practice, and internal, which is designed to improve relationships with patients already in a practice. This article discusses concepts for creating "customers for life" of older dental patients.

Marshall McLuhan wrote "Perception is reality." Compared with Asia, Africa, and Europe, America is perceived as a young country. Its symbols reflect youth, energy, and activity. The culture does not value old age to the same extent as do Eastern cultures. As a result, U.S. attitudes toward aging may not always be positive, inadvertently sending the wrong message to older patients. The dental practice that can successfully meet the needs of older adults may reap unanticipated benefits.

Changing Expectations: From Life Expectancies to Oral Health

Chances are the average dentist already has older patients in his or her practice. Since patients stay with a practice as they age, a dentist will generally inherit a certain number of older patients when he or she purchases a practice from a retiring dentist. But even dentists who open a practice in a newly developed area will have baby boomer patients who are well on their way to becoming older adults.

Half of all women in the United States who reach age 50 in 1999 will live to be 80.¹ Table 1 lists remaining the life expectancies for African American and Caucasian adults age 50 to 85 years.

As people are living longer, their attitudes about health and oral health are changing. In fact, during a 30-year period, America's older adults have changed from a generation that was predominately edentulous to a generation having an average of 20 teeth per person.² Just as the American myths and stereotypes about older people -- that they are sedentary, inactive, etc. -- are changing rapidly as baby boomers reach 50, the expectations about their oral health will continue to evolve. Baby boomers, the cohort of Americans born from 1946 to 1964, currently numbers 76 million. An estimated 25 percent have a college education, and they are poised to inherit $12 trillion from their World War II-era parents. The baby boomers are the first group of Americans to benefit from widespread water fluoridation and toothpaste with fluoride. As a result, they are reaching age 50 with a virtually intact natural dentition. Along with general health and wellness, their goals include straight white natural teeth.

Rowe and Kahn, in their book, Successful Aging, describe the results of a 15-year interdisciplinary research endeavor to identify predictors of successful aging.³ Their findings are exploding the myths of aging. "Choosing" parents well is not the best predictor of successful aging; rather, lifestyle choices more than genes determine how well people age. As a result, the new concepts, materials, products, and technologies available to prevent oral diseases, restore diseased teeth, and maintain oral health are of great interest to aging Americans. Studies that link oral health with overall health, like the recent research linking periodontal disease to cardiovascular disease, will find an interested audience as older adults make healthy lifestyle choices that include their approach to oral health care.

Welcome to the Practice

A practice's first impression is as important as the first impression a dentist makes with any individual. Awareness of the needs of older patients is a key to making a good impression. How age-friendly is the dental office staff? Has the dentist ever held a staff meeting to discuss the staff’s attitudes toward aging, illness, and disability? Are older adults graciously welcomed to the practice during their initial phone conversation? Does the office staff fit the patient into the dentist’s scheduling needs, or is the patient invited to provide a time that is most convenient for him or her? Office staff should not assume retirees have a lot of free time. Many older adults may not know the actual life expectancies in Table 1, but they do know that they don't have as many years left at age 70 as they did at 50. They don't want to miss a tennis game or volunteer assignment because of a dental appointment.

A dental office reception area should be welcoming to people of all ages. There should be a variety of age-appropriate reading material. Patients with hip or knee replacements or generalized osteoarthritis have an easier time getting out of hard-back chairs. Area rugs can be hazardous for canes or walkers and make navigating a wheelchair more difficult. The reception area should have sufficient room to accommodate a wheelchair. The less disruption a patient in a wheelchair feels he or she causes the office staff, the more welcome he or she will feel in the practice.

Internal Marketing

Although adults are living longer and healthier lives, they are also managing multiple chronic diseases. On average, adults older than 65 see their physicians more than four times as often (5.5 office visits per person) as they see their dentist (1.2 visits).⁴ Arthritis, cardiovascular disease, diabetes, psychiatric illnesses, and cancer are among the most common chronic diseases seen in older adults.⁵ These medical conditions may result in dependency in adults older than 80, causing them to spend some time in a nursing home.

Additional time by the dental team will be needed to review a medical history with significant positive findings. Older adults may be taking multiple medications to treat chronic diseases. The medical history must include a review of prescription medications and over-the-counter drugs, vitamins, supplements, and herbal remedies. Patients often don't perceive these over-the-counter items as medicine and, therefore, don't think to tell the dental team about their use of them. Yet, these products can interact with other medications patients are taking or that a dentist may prescribe.

The principles of diagnosis and treatment planning remain consistent throughout a patient’s life. An extensive interview, thorough medical and dental history, and comprehensive examination are essentials in the development of a treatment plan that meets a patient's needs. Older adults remain interested in the latest advances in oral health care and, having finished providing for their children's oral health, are ready to invest in their own. Just as with younger patients, older adults’ decisions to accept a treatment plan may be related more to their belief or interest in improving their overall health, increasing self-esteem, or adding self-confidence than to just purchasing an implant-supported prosthesis or anterior veneers.

Baby boomers and older adults are looking for methods to stay healthier longer. For many adults, oral health care is an important element in the formula for health and wellness. As a result, preventive dental measures are as important for older adults as they are for children. A dentist who includes a preventive component to the treatment plan implicitly tells an older adult that the dentist cares about that patient’s future.

A risk assessment approach will help the patient identify the factors that increase his or her risk for oral diseases.⁶ Patients may be unaware that the medications they take can decrease salivary flow and thus increase their risk of root caries. Diabetes may increase a patient's risk of periodontal disease, and people who use inhalants for asthma or steroids for their rheumatoid arthritis will have an increased risk for oral candidiasis infections. Patients with dementia who cannot remember how to use a toothbrush or those who have suffered a stroke and lost the use of their dominant hand are at increased risk for plaque-related oral diseases. New oral health products to assist patients in maintaining oral health abound. Tobacco cessation at any age remains one of the best methods to improve an individual's oral and overall health. The dental team can assist patients who are ready to quit.

External Marketing

Traditional external marketing includes activities such as advertising, patient newsletters, and direct mail. E-commerce is taking shape, and more patients are searching the World Wide Web for oral health information. Community activities such as health fairs, PTA meetings, and civic club participation have served to increase dental professionals’ visibility in their communities. A dentist should consider extending his or her visibility to assisted living centers, adult day care centers, or senior citizen centers.

Answering an adult son or daughter's request to perform a dental consult on his or her parent in a nursing home is a form of marketing. While performing that nursing home consult will take additional time in a dentist’s busy life, that dentist and dental team will be viewed as caring, committed professionals when they answer that request. And once in the nursing home, a dental professional has the opportunity to educate the health care staff, physicians, nurses, nurse’s aides, and occupational therapists on the importance of oral health throughout life.

Conclusion

The aging of America offers new opportunities for marketing the value of oral health care and a dental practice. External marketing opportunities may find dental professionals in senior centers, assisted living facilities, or nursing homes. Internal marketing may result in improved customer service and patient satisfaction for all patients, including older adults.

Oral health was designed to last a lifetime. Future cohorts of older adults, particularly the baby boomers, will reach older adulthood with their natural dentition intact. Their view of aging will be one of health and wellness, and oral health care will become an increasingly important component.

With improved techniques, concepts, and home care products, oral health need not decline with aging or illness. As experts and leaders in the field of dental science, dentists have a responsibility to share their knowledge and expertise to improve the oral health of the public.

Author/

Linda C. Niessen, DMD, MPH, is vice president of clinical education with DENTSPLY International and a clinical professor at Baylor College of Dentistry in Dallas.

References/

1. US Bureau of the Census. Statistical Abstract of the United States: 1996, 116th ed. Washington, DC, 1996.

2. Niessen LC, Aging successfully: oral health for a lifetime, guest editorial. J Esthetic Dent 10(5)226-8, 1998.

3. Rowe JW, Kahn RL, Successful Aging. Pantheon, New York, 1998.

4. Manski RJ, Moeller JF, Maas WR, A comparison of dental care expenditures and office-based medical care expenditures, 1987. J Am Dent Assoc 130:659-66, 1999.

5. Http://www.census.gov/, US Department of Commerce, Bureau of the Census, Jan 20, 1998.

6. Niessen LC and Despain B, Clinical strategies for prevention of oral diseases. J Esthetic Dent 8:3-11, 1996.

To request a printed copy of this article, please contact/Linda C. Niessen, DMD, MPH, Baylor College of Dentistry, Dallas, TX 75246.