Study considers ways to integrate oral health into geriatric fellowship training
Primary care educator and oral health advocate addressing unmet health need in vulnerable elders
Hugh Silk, MD
According to the U.S. Department of Health and Human Services, oral health is one of the greatest unmet health care needs for the elderly. But a national study co-authored by Hugh Silk, MD, has found that geriatric medical fellowship programs provide little oral health training for doctors who will provide care to the growing older adult population.
“Medicare has no dental benefit. We know that 70 percent of older adults do not visit the dentist due to lack of dental insurance coverage,” said Dr. Silk, professor of family medicine & community medicine. “Because these patients are more likely to seek care from a medical provider, the need for geriatricians-in-training to be familiar with oral health conditions and local dental resources is essential.”
Oral disease in older adults can not only amplify chronic and systemic health conditions, but also impact daily life including the ability to communicate, chew and swallow, which can result in poor nutrition, isolation, pain and lack of sleep, among other issues.
Published in the Journal of the American Geriatrics Society, the survey of 148 geriatric fellowship program directors nationwide revealed that nearly two-thirds of respondents reported that fellows receive only one to two hours of training in oral health, while almost a quarter received none at all.
The survey was conducted by Silk and colleagues in the Department of Family Medicine & Community Health at UMass Medical School. It is one in a series spearheaded by the Center for Integration of Primary Care and Oral Health. The center, one of six nationwide, was established by UMMS and Harvard’s Medical and Dental Schools in July 2016 through a cooperative agreement with the U. S. Health Resources and Services Administration.
A founder and co-principal investigator for the center, Silk is a longtime advocate for the integration of dental care into primary care. He has worked toward that goal as a primary care educator as well as in his clinical practice, teaching medical and nursing students how to incorporate dental health into their practices and collaborate with dental professionals. Silk established the oral health elective at UMMS; founded and co-chairs the Massachusetts Medical Society’s Committee on Oral Health; serves as director of the “From the First Tooth – Engaging Medical Clinicians in Oral Health” multistate initiative funded by the Dentaquest Foundation; and has been instrumental in developing and disseminating the Society for Teachers of Family Medicine’s “Smiles for Life” curriculum for medical providers. In 2016 he was awarded the American Association of Public Health Dentistry’s Public Service Award.
Silk and study co-authors suggest that there are opportunities to promote greater oral health training for fellows if there is a faculty champion, or leadership that supports interprofessional education. Geriatric fellowship programs can also tap into existing national and local resources such as the Smiles for Life geriatric oral health module that Silk was instrumental in creating.
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