Care of the Elderly Flashcards
Definition
Gerontology:
Geriatrics:
Gerontologists 3 sub groups:
Gerodontology in dentistry:
what is more important than numerical age
Gerontology:thestudyofsocial,psychologicalandbiologicalaspectsof ageing
• Geriatrics:thebranchofmedicinewhichstudiesdiseasesintheolder adults
• Gerontologistsuse3sub‐groups:Youngold(65‐74yrs),Old(75‐84yrs), Oldestold(85+yrs)
• Gerodontology:dentistryfor>65yearold
*Clinically,biologicalageismoreappropriatethannumerical
Demogrpahics
UK’spopulationisageing – Lifestyleandhealthcare improvements – Decreaseinfertility • Proportionof>65yrs: – 15%(1985) – 18%(2016) – 26%(2041) • Thefastestincreaseinthe85+years agegroup
Oral Health trends
Adultsretainingnaturalteethintoold agewithfewerbecomingedentate • Proportionofedentulismisdeclining: – 28%(1978) 6%(2009)2 • Proportionwith>21teeth1: – 74%(1978) 86%(2009) – Itisestimatedby2028,only8%of 65‐74yrsinUKwillbeedentate
• Changingattitudestowardsoralhealth. – Positiveattitudetowards maintainingdentition – Negativeattitudetowards extractions – Negativeattitudetowardsdentures
Oral health challeneges
– Ageisthebiggestreasonfordecreaseinsoundand untreatedteeth
– Theaverageover75yohave13‐15teeth,50% crownsrestoredand20%exposedrootsrestoredor decayed
Complexrestorativedentistryis increasinglyprevalentin>45yrs4 • Moremaintenance,asmore enterthe‘restorativecycle’. • Maintenanceoffixedmulti‐unit bridgesandimplantsposeahuge challengeforthosenolonger abletomaintainoralhygiene
• Increasingprevalenceofchronic illnesswithage5 – 57%65‐74yrs – 67%>75yrs • Canlimitactivity5 – 31%65‐74yrs – 48%>75yrs
Grade Explanation of activity
0 Fullyactive,abletocarryon allpre‐diseaseperformance withoutrestriction
1Restrictedinphysically strenuousactivity but ambulatoryandabletocarry outworkofalightor sedentarynature,e.g.,light housework,officework
2Ambulatoryandcapableof allself-carebutunableto carryoutanywork activities.Upandabout morethan50%ofwaking hours
3 Capableofonlylimited self-care,confinedtobedor chairmorethan50%of wakinghours
4 Completelydisabled.Cannot carryonanyself-care.Totally confinedtobedorchair
5 Dead
Define Dementia:
Aprogressive,neurodegenerativediseasethat effectstheabilitytoperformdailylivingactivities • Composedofavarietysyndromes • Thereareover100differentspecificconditions whichcancauseapersontohaveadementia. • ThecommonestformofdementiaisAlzheimer’s Disease(AD),60%ofalldementiadiagnoses. • Canbereversibleandirreversible • Commonlyattributedto“age” – 1in1000<65yrs – 5‐10in100>65yrs
.
Oral health dementia
If undiagnosed then liasewith GP, highlighting concerns and request a review. • Management will vary with progression of dementia • Gaining patient compliance • Consent • Medication for the management of dementia can have wide ranging side effects • Oral health and general health closely correlate with the terminal stages of neurogenic disease • No evidence that poor oral hygiene linked to dementia
Dementia Management
Close communication with patient and carers/family
Frequent support and health promotion
Monitoring progression of neurogenic disease
Short, simple and holistic treatment
Plan for the future
Safe guarding - Who is a Vulnerable Adult?
• 18+ • Whoisormaybeinneedofcommunitycare services • Dueto: ‐Mentalorotherdisability ‐Unabletotakecareofthemselves ‐Unabletoprotectthemselvesagainstharmor exploitation
Factorscontributingtovulnerability
• Olderpersonwhoisparticularlyfrail • Individualwithamentaldisorder,includingdementiaora personalitydisorder • Significantandimpairingphysicalorsensorydisability • Learningdisability • Severephysicalillness • Unpaidcarer whomaybeoverburdened,underseverestress orisolated
Safe guarding- Key questions
Does the adult have care and support needs?
Is the person experiencing, or at risk of, abuse and neglect?
What is the nature and seriousness of the risks?
What does the adult at risk want to happen now?
If you remain unsure whether to raise a safeguarding concern, seek advice:
Safe guarding- Prevention
Assessing Individuals’ needs
Responding to harm/abuse
Responding to harm/abuse ‐Identifying relevant services
Responding to harm/abuse ‐taking a consensual
approach
Safeguarding
Medical considerations
- Candirectlyinfluenceoraltissuesand health – Forexample:diabetes,radiotherapy, polypharmacy
- Canindirectlyinfluenceoralhealth – Forexample:CVD,CVA,COPD,Arthritis, neurologicaldeficit
- Canlimitabilitytoaccess/copewith treatment – Forexample:CVD,COPD,Arthritis, neurologicaldeficit
• Influenceontreatmentplanning
Impact on the patient and management
- Access
- Communicationproblems: Impairmentsinhearing,vision
- Inabilitytoconsent
- Tolerance
- Adaptation:toprosthesis,oralcare regimes
- Difficultyeating,speaking,swallowing
- Drymouth
- Mucosalissues:atrophicmucosaand decreasedabilitytorepair.
- Candidosis
- Oralulceration
- Tastedisturbance
- Gingivalovergrowth
- Lichenoidreaction
- Increasedriskofdisease
- Increasedriskofpoor/failureofhealing
Our approach to providing care
- Patient‐centredtargets
- Assesswiderissuessuchassocialandfamilialsupport,transportationneeds, anxietyissues,consentandperceivedneedfortreatment.
- Workwithpractices,healthauthoritiesandcolleaguestoorientservices appropriately
- Careaimedatmaintainingafunctionaldentition
- Minimallyinvasivedentistry
- Functionally‐orientatedtreatmentplanning
Best way to clean a denture
Aim:disturbthebiofilmonthedenture
CochraneReview:Interventionsforcleaningdenturesinadults ‐Poorqualityevidence ‐Weakevidencetosupportenzymecleaners/effervescenttablets ‐Brushingwithpastescanremoveplaqueandkillmicrobesbetterthan inactivetreatments.
Conclusion: ‐Nofirmevidencetosupportbrushingvsoaking ‐Bothmethodsbetterthansoakinginwater.
How should a denture be stored overnight?
- Denturesinwateraftercleaningtopreventwarping. • NHSchoices • BritishOralHealthFoundation
- Drystorage • BritishSocietyofGerodontology
- Drystoragebenefits?Manfredietal2013–organismsindenturebiofilmlesslikely tosurviveindrystorage
Social consideration
- Cost
- Attendance
- Anxiety
- Mobility
- Livingarrangementsandindependence.
- Perceivedimportance/needto maintainhealth
- Perceivedneedtoself‐care(e.g. maintainhealthydiet)
Prevention strategy tailored to individual needs.
Allmeasuresarecoordinatedandsupervisedbythedentalteamandreinforced withgoodpatientmotivation. Homeandsurgery‐based.
Evidence‐basedcomponents: Plaquecontrolandregulartooth‐brushingwithfluoridatedtoothpaste Increasefluorideavailability Denturehygieneadvise Dietadvise Fissuresealants Regulardentalassessmentswithappropriateradiographs.
NICE 2016 guidance for oral health for adults in care homes
Outlinesresponsibilitiesof: Carehomemanagers /Carehomestaffproviding/dailycaretoresidents o Peoplewhoprovideoral healthservicestocarehomes (CDS,GDPs,OHPteams)
- ‘Denturesshouldbeconsideredanimportantreservoirof organismswhichcouldcolonisethepharynx,andthe importanceofcontrollingdentureplaqueforthepreventionof aspirationpneumoniacannotbeoveremphasised.’
- ‘Whererigorousoralhygieneprocedureshavebeeninstituted areductionintherateofpneumoniaanddeathshasresulted.’
Treatment- informed consent
InformedConsent:Anyadvicegivenshouldalsobeprovided inwrittenformatthatthepatientcanrefertoathomeorgive toarelativeorcarertoread. • Uselargefont • Needadditionaltimeorextravisitstotoleratetreatment.
Treatment- Caries
Coronalcariesmostcommonin25‐34yrsand75-84yrs(ADHS2009). Secondarycarieshasincreasingprevalencewith age • Rootcariesmorecommon20%75‐80yrswith rootcaries.
Riskfactorsforcariesincreaseswithage Complexityofrestorationsincreaseswithage Abilitytoundergocomplextreatmentreduces withage
Treatment prevention
Prevention • Different approach to prevention – Increased use of mouthwash, varnish, gels – Promoting healthy diet – Involving carers/family • MID
Treatment Periodontal disease
PeriodontalDisease
Issues • Chronicperiodontitisoftenpresentsinthe morematurepatients.61%75‐84yrsaffected by>4mmperiodontalpockets.BUTsevere periodontitisisnotanaturalconsequenceof aging. • Cumulativeeffectofdisease • Physiologicalchanges • Increasingriskfactors
Management • Importanttoeffectivelyassess prognosis • Beawareofcontraindicationsto treatments • Workwithfamilyandcarers • Utilisethemostsuitableoralhygiene tools • LiaisewithGP/medicalcolleagues whereappropriate
Treatment tooth wear
TWincreaseswithage.52%16‐24yo comparedto95%75‐84yowithanywear. • Toothwearprevalence: – 95%ofdentate75‐84yrs(ADHS2009) – 44%moderatewear – 6%severewear • Abilitytoundergocomplextreatmentreduces withage
Management • Preventionremainsimportant • Differentapproachtoprevention – Increaseduseofmouthwash,varnish,gels – Promotinghealthydiet – Involvingcarers/family • Protecttoothtissue • Adhesivedentistry • Beawareofphysiologicandpathologictooth wear
Treatment Oral Cancer
Issues: • Mostcasesofmouthcanceroccurin olderadultsaged50to74. • Onlyoneineight(12.5%)casesaffect peopleyoungerthan50.
Management: • Oralcancerscreening. • Earlydetectionandreferral. • BDAOralcancerToolkit:tohelpdental healthprofessionalsidentifyandrefer possiblecasesoforalcancer. • Controlriskfactors
Shortened Dental Arch
• Aconceptsuggestingthatreplacementofeverytoothisnot necessary • ApatientmaybeabletomaintainagoodQoLwitha“shortened dentalarch”if: – Functionismaintained – Aestheticrequirementsaresatisfied • Theremainingdentitionmusthoweversatisfytheserequirements • Insomecasesitmightbeusefultoplanforreplacementteethif theremainingteethareofpoorprognosis
Dentue care
Dentures must be kept clean to avoid infections
Gloves/soap+denture cream/ toothbrush of denture brush/ soaking solution such as sodium hypochlorite (milton) / named denture container
Brush denture to remove any food and bacteria
Try to rinse denture after every meal
Soak dentures daily in sodium hypochlorite 1%
Soak for 3 minutes- plastic denture
1 minute- dentures with mental parts
