Challenges of service provision for older people Flashcards
2011 census
% people over 65
How many people over 90
16.4% people >65 (1 in 6)
430,000 people >90
Demographic population changes
> 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
Predictions 2033 and beyond
23% pop. > 65 years
>3.2 million >85
By 2050 ratio of working to retired people could be 2:1
Frail older adults
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
Older people and their teeth
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
Influences on ageing
Genetic & environmental factors Lifestyle Effect of illness and disability Effects of medication Personality: pessimistic or optimistic Psychiatric history Level of independence: mobility, daily activities
Oral/ dentate status of older people
> 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
Oral Healthcare for Older People 2020 vision
Published May 2003
BDA Key Issue Policy Paper
Looks at dental service provision for older people needed by 2020
Meeting the Challenges of Oral Health for Older People: A Strategic Review
Dec2005
Recommendations:
-extended consultation to plan long-term dental care needs
-train more dentists in gerodontology
-equip other health professionals with oral health skills
Frail Older Adults Barrier to Dental Care
Medical problems Drug interactions Ability to understand and tolerate dental treatment Financial Access Low expectations Acceptance of loss and function and pain
Frail Older Adults Benefits of Oral Health Care
Improve eating Improve speech Improve facial appearance Decrease pain -all to help reduce social isolation -poor masticatory function may mean poor/ restricted diet
Conditions affecting independence
Cardiovascular Respiratory Malignancy Musculoskeletal Endocrine Neurological Mental Health Lifestyle factors
Common oral health problems
Tooth loss and replacement Tooth wear Collapsing/ failing/ terminal dentition Dry mouth due to medication Compromised self-care due to disability
Tooth loss and replacement
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
Tooth wear
Reduced face height Pulp death Sensitivity Aesthetics Sharpness to tongue Brittle Difficult extractions
Collapsing/ failing/ terminal dentition
Multiple abscesses possible Compromised treatment plan? Balance symptoms v frailty Pain or no pain Past sell-by-date?
Dry mouth
Medication/ age Difficulty in wearing dentures Root caries Difficulty with mastication Difficulty with speech Soreness and ulcers Lack of appetite
Periodontal disease
Multiple abscesses Bleeding gums Mobility Pain Halitosis Aesthetics
Shortened dental arch concept
Anterior teeth and premolars can, at least for several years, compensate for the function of molars
Staff attitudes to oral health care
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
Treatment challenges in the community
Accessing those who currently not seen by a dentist Assessment and screening Treatment planning Px management Treatment
Accessing services
> 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)
National Care Standards 2003
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
Assessments and screening
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
Prevention
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
