Challenges of service provision for older people

Question 1

2011 census
% people over 65
How many people over 90

Answer 1

16.4% people >65 (1 in 6)

430,000 people >90

Question 2

Demographic population changes

Answer 2

> numbers old people
People living longer
Medical intervention and treatment
Better social conditions
Improvements in public health
Women living longer than men
Baby boomers of 19040s and 60s

Question 3

Predictions 2033 and beyond

Answer 3

23% pop. > 65 years
>3.2 million >85
By 2050 ratio of working to retired people could be 2:1

Question 4

Frail older adults

Answer 4

11 million disabled adults UK
1.2m wheelchair users in England
78% >85 recorded as having a disability
-only 5-8% of older adults live in care

Question 5

Older people and their teeth

Answer 5

Old/ v. old:
> prop. edentulous, plastic tooth generation
Entering old age:
-retained most of natural dentition
-requires maintenance to avoid tooth loss
-heavy metal generation
Future older people (middle age or younger):
-good oral health
-cosmetic dentistry, white tooth generation

Question 6

Influences on ageing

Answer 6

Genetic & environmental factors
Lifestyle
Effect of illness and disability
Effects of medication
Personality: pessimistic or optimistic
Psychiatric history
Level of independence: mobility, daily activities

Question 7

Oral/ dentate status of older people

Answer 7

> numbers dentate
More concerned with retaining teeth
Dentate more likely to attend regularly
> expectations from dental services
> awareness of oral & dental health
More frail/ functionally dependent who are dentate

Question 8

Oral Healthcare for Older People 2020 vision

Answer 8

Published May 2003
BDA Key Issue Policy Paper
Looks at dental service provision for older people needed by 2020

Question 9

Meeting the Challenges of Oral Health for Older People: A Strategic Review

Answer 9

Dec2005
Recommendations:
-extended consultation to plan long-term dental care needs
-train more dentists in gerodontology
-equip other health professionals with oral health skills

Question 10

Frail Older Adults Barrier to Dental Care

Answer 10

Medical problems
Drug interactions
Ability to understand and tolerate dental treatment
Financial
Access
Low expectations
Acceptance of loss and function and pain

Question 11

Frail Older Adults Benefits of Oral Health Care

Answer 11

Improve eating
Improve speech
Improve facial appearance
Decrease pain
-all to help reduce social isolation
-poor masticatory function may mean poor/ restricted diet

Question 12

Conditions affecting independence

Answer 12

Cardiovascular
Respiratory
Malignancy
Musculoskeletal
Endocrine
Neurological
Mental Health 
Lifestyle factors

Question 13

Common oral health problems

Answer 13

Tooth loss and replacement
Tooth wear
Collapsing/ failing/ terminal dentition
Dry mouth due to medication
Compromised self-care due to disability

Question 14

Tooth loss and replacement

Answer 14

Decreasing proportion of edentulous
No previous denture wearing experience
Doing so later in life
Less able to learn skills
High expectations
Greater challenge to profession

Question 15

Tooth wear

Answer 15

Reduced face height
Pulp death
Sensitivity
Aesthetics
Sharpness to tongue
Brittle
Difficult extractions

Question 16

Collapsing/ failing/ terminal dentition

Answer 16

Multiple abscesses possible
Compromised treatment plan?
Balance symptoms v frailty
Pain or no pain
Past sell-by-date?

Question 17

Dry mouth

Answer 17

Medication/ age
Difficulty in wearing dentures
Root caries
Difficulty with mastication
Difficulty with speech
Soreness and ulcers
Lack of appetite

Question 18

Periodontal disease

Answer 18

Multiple abscesses
Bleeding gums
Mobility
Pain
Halitosis
Aesthetics

Question 19

Shortened dental arch concept

Answer 19

Anterior teeth and premolars can, at least for several years, compensate for the function of molars

Question 20

Staff attitudes to oral health care

Answer 20

Oral care assistance viewed as more disagreeable than any other nursing activity
Registered nurses had more positive attitudes than nursing assistants or home care aides
Gap between knowledge and practice in nursing personnel’s attitude towards group of pxs

Question 21

Treatment challenges in the community

Answer 21

Accessing those who currently not seen by a dentist
Assessment and screening
Treatment planning
Px management
Treatment

Question 22

Accessing services

Answer 22

> proportion of elderly receiving regular dental checks by raising awareness of problem with carers. GPs/ GDPs
Salaried service working jointly with GDPs in city to > numbers of people in care home able to access oral care: Residential Oral Care in Sheffield (ROCS)

Question 23

National Care Standards 2003

Answer 23

No service user moves into residential home without heaving needs assessment, must include oral health
Care staff must maintain personal and oral hygiene of each service user
Service user must have access to dental services

Question 24

Assessments and screening

Answer 24

Assessments of referrals often done on domi basis
Screening of medium/ long stay units
Screening of homes - some carried out by Salaried Service
12 GDPs in ROCS project covering 98% Care Homes in Sheffield

Question 25

Prevention

Answer 25

Continuing care and regular visits/ recalls
Familiarity with pxs and carers
Communication
Developing working relationship with carers
Involvement of whole dental team
Training care staff in oral health promotion