Five things to focus on when treating elderly patients

In this series, we’ll explore how we can adapt our practice to meet the needs of  different groups of patients, and why a one-size-fits-all approach doesn’t work.

We’ll start by looking at the issues to consider when treating older patients.

After being surrounded by fellow members of Gen Z at dental school, practice might feel like a very different world. Not only will you be one of the youngest people in the team, but it’s likely that many of your patients will be significantly older.

The UK has an aging population with about one-in-five people over 65 in 2022 (compared with 13% in 1972) and this can be as high as one-in-three in some rural or coastal areas. In fifteen years from now, it’s estimated that one in four people will be over 65.

A lot of these patients will have complex dental health needs and sadly, many will also be living with chronic mental and physical health problems or taking medication that compromises their oral health. Lord Darzi’s Independent Investigation of the NHS in England reported that the majority of 65-74 year-olds have at least one long-term health concern and nearly 60% have two or more by the time they reach 75-84. In particular, age is the biggest risk factor for dementia, with an estimated 982,000 people now living with the condition in the UK, according to The Alzheimer’s Society, which projects this to rise to 1.4 million by 2040.

Although it’s vital to treat every patient as an individual, it’s important to understand your own professional responsibilities, especially in these five areas.

1. Communication and treatment planning 

The GDC expects you to treat every patient with respect and dignity and not discriminate on grounds of age or disability (Principle 1, Standards for the Dental Team). Take care with your tone of voice and body language: try to sit chairside and actively listen to your elderly patients without interrupting and never talk down to them. It’s also important not to make assumptions about their capabilities or priorities. For instance, it would be wrong to assume that an older patient won’t be concerned about the appearance of their teeth or understand their treatment options.

If you don’t think you can achieve the patient’s desired outcome (eg because their teeth have been compromised after multiple restorations, they have signs of significant bone loss or advanced gum disease) explain your concerns and try to agree on an alternative treatment plan together or perhaps offer to get a second opinion. You’re not obliged to provide treatment that you don’t think is in the patient’s best interest but it’s important not to be dismissive.

While caring for older teeth can be more challenging, poor oral health shouldn’t be seen as an inevitable burden of old age. The GDC says “you must take a holistic and preventative approach to patient care which is appropriate to the individual patient” (Para 1.4, Standards for the Dental Team). This might include more frequent appointments, or preventative measures such as switching to a high fluoride toothpaste.

2. Assessing mental capacity and best interests

Elderly patients have the same right as any adult to make decisions about their own care and treatment, unless they are found to lack capacity to make a specific decision at a specific time, even with appropriate support.

Capacity is strictly defined because patients with conditions like dementia may still be capable of making decisions, especially in the early stages of the disease. Equally, other health conditions such as infection, dehydration or problems with their medication can cause temporary confusion (delirium) for any patient, including elderly patients, which clears up with appropriate treatment. It’s usually better to see if you can postpone the decision to another day if you think it’s possible your patient might regain capacity.

The purpose of a mental capacity assessment is to determine whether the patient can:

• understand the information relevant to the decision
• retain that information
• use or weigh the information as part of the decision-making process
• communicate their decision by any means, including speech, sign language, or simple muscle movement.

If they’re unable to do one or more of these, the patient is deemed to lack capacity and you’ll need to decide what’s in their best interests. However, you should still do as much as possible to involve them in the decision-making process and consider their past views.

Treating a patient who lacks capacity is a big step so always seek advice from a senior colleague or the DDU first and read our detailed guide. Above all, do your best to meet the patient’s immediate needs – relieving pain, enabling them to chew food – without causing distress. It would be difficult to justify extensive dental treatment or invasive procedures when there are other options.

3. Working with family and carers

It can be helpful to involve family members or carers if you think a patient needs extra support with tooth brushing or diet but you must get consent if the patient has capacity. If the patient has lost capacity, another family member may already have lasting power of attorney for welfare decisions. Check their identity before discussing the patient’s dental health and treatment options and ensure this is on record for next time.

If someone else arranges appointments and accompanies the patient (eg a family member or care home) it could make sense to discuss the best time for these to take place (taking the patient’s wishes into account too). It may be that the patient is more lucid or calmer at certain times of day or that it’s better to avoid early mornings because it takes longer to get ready.

4. Safeguarding

Sadly, elderly patients are more vulnerable to neglect, abuse and exploitation from family members or carers. As a dental professional, you’re well placed to spot signs that something is wrong during appointments – a patient who has unexplained bruises, for example or who is dishevelled or dirty – and the GDC expects you to raise concerns about adults at risk, in line with local procedures (para 8.5, Standards for the Dental Team).

Your practice should have covered its safeguarding policy in your induction but speak to your supervisor or the safeguarding lead if you’re unsure what to do. You can also call the DDU helpline for specific advice.

5. Teamworking and referral

Alongside dentists, dental hygienists and therapists often play a critical role in looking after elderly patients, including preventative care and supporting patient’s ongoing oral health. However, everyone in the team needs to communicate effectively with each other to ensure continuity of care, from keeping complete and accurate patient records to providing all relevant information when delegating a task to another member of the team.

It’s also worth talking to your practice manager or your supervisor if you think more could be done to support your elderly patients eg clearer signage and information leaflets, addressing a trip hazard or providing a hearing loop system.

Finally, if you reach the stage when continuing to treat the patient poses a risk to their safety or care, you’ll need to refer them to the Special Care Dental Service. This is usually a local community team which provides for patients with additional needs, such as treatment under sedation or domiciliary care for the housebound. This should be done after discussion with the patient and/or their carer and you should follow the local procedure set by the relevant Special Care Dental Service to avoid delays.

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While treating elderly patients can be challenging, it is often a very rewarding aspect of dental practice, which can help you improve your communication skills and work where you can make a big difference to someone’s quality of life.

 

Further resources

For more background reading on this patient group, try the following:

British Society of Gerodontology

British Society for Special Care Dentistry

Improving older people’s oral health, Faculty of Dental Surgery, Royal College of Surgeons

Managing patients with dementia, The DDU Journal 

 

Next time – treating children and teenagers

 

The DDU is here for you as a student and throughout your dental career. Visit the join DDU pages to explore the benefits of membership now and beyond graduation.  

This page was correct at publication on 15/07/2025. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.