Dementia Care Flashcards
Dementia pt seek care from?
This group of patients will be seeking care from community-based dental care professionals .
An understanding of the diagnosis, the treatment, the course, and the prognosis of the disease process will better prepare the dental team to meet the unique needs of this groupof patients , support their families and advise their care givers.
What is dementia
Dementia is a term that covers a wide range of neurological conditions : vascular, lewy body alzheimers
It impacts on a persons ability to remember , understand , communicate and reason
Dementia is a progressive condition more often has been dismissed as old age
Dementia side effects
Short term memory loss , however long term recall is clear with loss of ability to recall the recent events
- Confusion spatial awareness/ general orientation
- Difficulty with everyday tasks including personal and oral care
- Difficulty with words and numbers
- Mood swings / frustration/irratibilty
- Memory Loss
Oral pain in adults who are cognitively impaired …..
Causes
Refusal to eat
Increased drooling
Restlessness
Moaning / shouting
Disturbed sleep
Aggression
Self injurious behaviour
Early mild stages of dementia
Dementia can be recognized by family and friends with the following :
Mislaying items
Forgetting recent conversations
Struggling to find the right word
Becoming confused, losing interest in other people activities
Mid stage dementia
Muddling up night and day
Wandering and becoming lost
and confused – unable to understand where they are?
Delusions/ Hallucinations
Late stage dementia
Difficulty swallowing
(Dysphagia)
Weight loss
Fatigue
Incontinence
Distress
Aggression
Sarcopenia and Muscle Functions at Various Stages of Alzheimer Disease
Sundowning meaning
Sundowning : typically occurs at the sun going down and into early evening – more likely at this point in the day to wander ,become agitated, pacing around– the sleep and awake cycle is disturbed
Dementia test
Dementia test – series of questions about their daily life , counting backwards, remembering details and instructions
Cognitive and neuropathic test are down why
Cognitive and neuropathic :
To evaluate thinking, memory, reasoning, judgment, language, and attention abilities.
Neurological:
To check for visual perception, movements, problem-solving, senses, balance, and reflexes.
CT scan CT scan of brain is done to check bleeding or tumour in the brain.
MRI
PET
What challenges arise when managing the individuals oral health regime
Reduced attention spans
Capacity to consent LPA
Support from carers
Indicators of oral problems in people living with dementia
Refusal to eat or drink
Frequent pulling at the face or mouth
Leaving previously worn dentures out of the mouth
Increased restlessness, moaning or shouting
Disturbed sleep
Bruxism
How to handle dementia pt appt
Acclimatise
Contact the patient to remind them
Always have a chaperone
Dementia friends
Books out more time
Involve carers
Medical history
Social history
Dental history
- Seek patients consent to inform GP of potential symptoms
- Be aware of Capacity for consent and if Lasting Power of Attorney is in place LPA
Socio – behavioural history
Dental History – ability to chew and swallow, dry mouth , if dentures have been provided but may not be worn
How do you sensitively approach the issue of dementia
CONFIDENTIALITY
Ask the patient : How did you travel here today ?
Did you have breakfast this morning – what did you have ?
Direct Clinical approach- Have you noticed any change in your memory – Do you struggle to recall things you have heard , seen or read?
Do you ever forget names of people or every day objects?
Do you have any difficulty following conversations?
Implications of dementia in oral care
Bruxism
Chewing – forgetting to chew
Swallowing- dysphagia
Denture wearing / soreness / denture marking
Oral care for supporting pt and carer
Oral care for supporting the patient and the carer
Curaprox brush
SLS free toothpaste
Saliva substitute - Orthana
Caries risk assessment
Hydrating with H2O – not sugary drinks
Weight loss and dementia
Some eating and drinking issues associated with dementia can lead to weight loss and malnutrition.
Although the problems may be directly related to their dementia, there may be underlying medical issues such as:
- depression
- mouth pain or dental problems
- difficulty swallowing
- infections or other physical illnesses
- constipation, which can make people feel full and uncomfortable
What to do is noticing changes in eating habits
If you have noticed changes in the person’s appetite, eating or drinking habits, it’s a good idea to book a check-up with their GP or dentist to rule out other causes. Not eating or drinking enough can lead to issues like dehydration, constipation, urinary tract infections (UTIs) and weight loss, which may make their dementia symptoms worse.
Medical history in relation to dementia
Polypharmacy
Patients forgetting to hydrate (jelly drops are 95% water)
Xerostomia – dry mouth
Assessment of a dementia pt
Capacity to consent
Do they understand the information
Can they retain information to make a decision
Are they able to use / access information
Do they have the ability to communicate their decision
Why is safeguarding an issue with dementia pt
Confusion and disorientation in the later stages of dementia places the patient in a vulnerable position
Written instructions to the carer/ chaperone before the visit
How to act during pt appt?
Calm , peaceful environment rather than a busy waiting room
Keep talking to the patient – the carer is an essential part of the appointment – however always address the patient …..
Summarise guidance and instructions in a follow up email or letter.
