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Dental Hygiene > Care of the Elderly > Flashcards

Care of the Elderly Flashcards

1
Q

Definition
Gerontology:
Geriatrics:
Gerontologists 3 sub groups:

Gerodontology in dentistry:

what is more important than numerical age

A

Gerontology:thestudyofsocial,psychologicalandbiologicalaspectsof ageing
• Geriatrics:thebranchofmedicinewhichstudiesdiseasesintheolder adults
• Gerontologistsuse3sub‐groups:Youngold(65‐74yrs),Old(75‐84yrs), Oldestold(85+yrs)
• Gerodontology:dentistryfor>65yearold
*Clinically,biologicalageismoreappropriatethannumerical

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2
Q

Demogrpahics

A

UK’spopulationisageing – Lifestyleandhealthcare improvements – Decreaseinfertility • Proportionof>65yrs: – 15%(1985) – 18%(2016) – 26%(2041) • Thefastestincreaseinthe85+years agegroup

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3
Q

Oral Health trends

A

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

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4
Q

Oral health challeneges

A

– 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

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5
Q

Grade Explanation of activity

A

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

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6
Q

Define Dementia:

A

Aprogressive,neurodegenerativediseasethat effectstheabilitytoperformdailylivingactivities • Composedofavarietysyndromes • Thereareover100differentspecificconditions whichcancauseapersontohaveadementia. • ThecommonestformofdementiaisAlzheimer’s Disease(AD),60%ofalldementiadiagnoses. • Canbereversibleandirreversible • Commonlyattributedto“age” – 1in1000<65yrs – 5‐10in100>65yrs

.

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7
Q

Oral health dementia

A

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

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8
Q

Dementia Management

A

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

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9
Q

Safe guarding - Who is a Vulnerable Adult?

A

• 18+ • Whoisormaybeinneedofcommunitycare services • Dueto: ‐Mentalorotherdisability ‐Unabletotakecareofthemselves ‐Unabletoprotectthemselvesagainstharmor exploitation
Factorscontributingtovulnerability
• Olderpersonwhoisparticularlyfrail • Individualwithamentaldisorder,includingdementiaora personalitydisorder • Significantandimpairingphysicalorsensorydisability • Learningdisability • Severephysicalillness • Unpaidcarer whomaybeoverburdened,underseverestress orisolated

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10
Q

Safe guarding- Key questions

A

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:

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11
Q

Safe guarding- Prevention

A

Assessing Individuals’ needs
Responding to harm/abuse
Responding to harm/abuse ‐Identifying relevant services
Responding to harm/abuse ‐taking a consensual
approach
Safeguarding

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12
Q

Medical considerations

A
  1. Candirectlyinfluenceoraltissuesand health – Forexample:diabetes,radiotherapy, polypharmacy
  2. Canindirectlyinfluenceoralhealth – Forexample:CVD,CVA,COPD,Arthritis, neurologicaldeficit
  3. Canlimitabilitytoaccess/copewith treatment – Forexample:CVD,COPD,Arthritis, neurologicaldeficit
    • Influenceontreatmentplanning
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13
Q

Impact on the patient and management

A
  • 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
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14
Q

Our approach to providing care

A
  • Patient‐centredtargets
  • Assesswiderissuessuchassocialandfamilialsupport,transportationneeds, anxietyissues,consentandperceivedneedfortreatment.
  • Workwithpractices,healthauthoritiesandcolleaguestoorientservices appropriately
  • Careaimedatmaintainingafunctionaldentition
  • Minimallyinvasivedentistry
  • Functionally‐orientatedtreatmentplanning
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15
Q

Best way to clean a denture

A

Aim:disturbthebiofilmonthedenture
CochraneReview:Interventionsforcleaningdenturesinadults ‐Poorqualityevidence ‐Weakevidencetosupportenzymecleaners/effervescenttablets ‐Brushingwithpastescanremoveplaqueandkillmicrobesbetterthan inactivetreatments.
Conclusion: ‐Nofirmevidencetosupportbrushingvsoaking ‐Bothmethodsbetterthansoakinginwater.

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16
Q

How should a denture be stored overnight?

A
  • Denturesinwateraftercleaningtopreventwarping. • NHSchoices • BritishOralHealthFoundation
  • Drystorage • BritishSocietyofGerodontology
  • Drystoragebenefits?Manfredietal2013–organismsindenturebiofilmlesslikely tosurviveindrystorage
17
Q

Social consideration

A
  • Cost
  • Attendance
  • Anxiety
  • Mobility
  • Livingarrangementsandindependence.
  • Perceivedimportance/needto maintainhealth
  • Perceivedneedtoself‐care(e.g. maintainhealthydiet)
18
Q

Prevention strategy tailored to individual needs.

A

Allmeasuresarecoordinatedandsupervisedbythedentalteamandreinforced withgoodpatientmotivation. Homeandsurgery‐based.
Evidence‐basedcomponents: Plaquecontrolandregulartooth‐brushingwithfluoridatedtoothpaste Increasefluorideavailability Denturehygieneadvise Dietadvise Fissuresealants Regulardentalassessmentswithappropriateradiographs.

19
Q

NICE 2016 guidance for oral health for adults in care homes

A

Outlinesresponsibilitiesof: Carehomemanagers /Carehomestaffproviding/dailycaretoresidents o Peoplewhoprovideoral healthservicestocarehomes (CDS,GDPs,OHPteams)

  • ‘Denturesshouldbeconsideredanimportantreservoirof organismswhichcouldcolonisethepharynx,andthe importanceofcontrollingdentureplaqueforthepreventionof aspirationpneumoniacannotbeoveremphasised.’
  • ‘Whererigorousoralhygieneprocedureshavebeeninstituted areductionintherateofpneumoniaanddeathshasresulted.’
20
Q

Treatment- informed consent

A

InformedConsent:Anyadvicegivenshouldalsobeprovided inwrittenformatthatthepatientcanrefertoathomeorgive toarelativeorcarertoread. • Uselargefont • Needadditionaltimeorextravisitstotoleratetreatment.

21
Q

Treatment- Caries

A

Coronalcariesmostcommonin25‐34yrsand75-84yrs(ADHS2009). Secondarycarieshasincreasingprevalencewith age • Rootcariesmorecommon20%75‐80yrswith rootcaries.
Riskfactorsforcariesincreaseswithage Complexityofrestorationsincreaseswithage Abilitytoundergocomplextreatmentreduces withage

22
Q

Treatment prevention

A

Prevention • Different approach to prevention – Increased use of mouthwash, varnish, gels – Promoting healthy diet – Involving carers/family • MID

23
Q

Treatment Periodontal disease

A

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

24
Q

Treatment tooth wear

A

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

25
Q

Treatment Oral Cancer

A

Issues: • Mostcasesofmouthcanceroccurin olderadultsaged50to74. • Onlyoneineight(12.5%)casesaffect peopleyoungerthan50.
Management: • Oralcancerscreening. • Earlydetectionandreferral. • BDAOralcancerToolkit:tohelpdental healthprofessionalsidentifyandrefer possiblecasesoforalcancer. • Controlriskfactors

26
Q

Shortened Dental Arch

A

• Aconceptsuggestingthatreplacementofeverytoothisnot necessary • ApatientmaybeabletomaintainagoodQoLwitha“shortened dentalarch”if: – Functionismaintained – Aestheticrequirementsaresatisfied • Theremainingdentitionmusthoweversatisfytheserequirements • Insomecasesitmightbeusefultoplanforreplacementteethif theremainingteethareofpoorprognosis

27
Q

Dentue care

A

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

Dental Hygiene (9 decks)

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