Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS4 Special Care > End of Life Care > Flashcards

End of Life Care Flashcards

1
Q

What are the different end of life trajectories?

A

Short period of evident decline- incurable cancer

Long term limitations with intermittent serious episodes
-> occurs over 2-5 years- deterioration occurs over this time, after episodes the patient is worse than before
-> heart and lung failure (death can still be sudden)

Prolonged dwindling over 6-8 years (Slow deterioration)
-> older people (frailty and dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the oral health changes seen in different end of life trajectories?

A

Sudden- minimal changes

Terminal cancer- Xerostomia, oral soft tissue pathology

Progressive functional loss- poor OH, caries, Periodontal disease, infection, tooth loss, xerosotmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the features of the end of life oral condition of older people?

A
  • Gingival inflammation and calculus
  • Staining
  • Caries
  • Recession
  • Presence of infection- Candidosis
  • Trauma
    -> If we manage this better it would improve quality of life in later years
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the medical and social model in oral health of older patients?

A
  • Medical model- curing disease
  • Social/patient centred model- health is bigger than absence of disease (QoL may be more important than treating patients)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the oral aspects that lead to better QoL?

A
  • Lack of pain
  • Lack of bleeding
  • Social interaction
  • Ability to chew
  • Talking as normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the common complications experienced by end of life patients?

A

Frailty

Polypharmacy- 5+ medicines

Difficulty in maintaining continence- stress, neuromuscular, functional

Falls

Bone Health

Nutrition and Weight Loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is frailty?

A

State of increased vulnerability to stressors due to age related decline in physiological reserve across neuromuscular, metabolic and immune systems
-> Distinct to single organ conditions associated with advancing age and multimorbidity (but can co-exist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the issues with polypharmacy in older people?

A
  • Dry mouth
  • Side effects- cumulative
  • Remembering to take medicines
    -> Consider whether patient needs to take certain medicines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can difficulties in maintaining continence be managed?

A

Easy access/modified toilets

Functional continence issue- patient may be catheterised (ensure this is empty before starting treatment)

Plan appointments at suitable time for patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs of Frailty?

A

Unintentional weight loss (4.5 kg in last year)

Self-reported exhaustion

Weakness (measured by grip strength in lowest 20% per age)

Slow walking speed (slowest 20% by gender/height)

Low physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is frailty graded?

A

Presence of 3 or more signs – FRAIL

Presence of 1 or 2 signs – PRE-FRAIL

Nil present – FIT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Rockwood frailty?

A

Consequence of and defined by an accumulation of deficits that are associated with ageing.

-> Measured by adding the number of deficits a person has to create a Frailty Index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is considered in the comprehensive geriatric assessment carried out by an MDT?

A

Physical health

Social/environmental

Function

Mobility

Medication review

Psychological/mental health

-> can devise problem list and personalised plan with relevant interventions and reviews

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the main causes of falls in older people?

A

Intrinsic- Hypotension (bring patient up slowly in chair)

Extrinsic- trip hazards in home

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the dental implications of falls in patients?

A

Dental trauma can occur as a result of this

May cause isolation- patient worried about falling so don’t leave house (domiciliary care)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the features of OP?

A
  • Associated with oestrogen withdrawal in female older patients during menopause
  • Abnormal bone production occurs resulting in thinning of the bone and increased fracture risks
  • Bisphosphonate drugs are provided- Dental risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is it important that older people have good fitting dentures and/or functional teeth in terms of nutrition?

A

Necessary for chewing various foods leading to a broader food selection
-> patients with out this may turn to a diet that is easier to chew which may be high sugar and less nutritious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the effects of nutritional deficiency in tooth formation?

A

Enamel hypoplasia

Delayed eruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the dental effects of nutritional deficiency in older patients?

A
  • Delayed healing
  • Erosion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the general health effects of nutritional deficiency in older patients?

A

Unintentional weight loss

Sarcopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What occurs in Parkinson’s disease?

A

Accumulation of alpha-synuclein protein causes the formation of Lewy-bodies in cerebral neurons
-> Lewy-bodies disrupt the production of the neurotransmitter dopamine

22
Q

What are the symptoms of Parkinson’s disease?

A

Motor:
Tremor
Stiffness
Slow movement

NM:
Drooling
Hallucinations
Consitpation

23
Q

How can drooling in Parkinson’s patients be managed?

A

Topical anticholinergics

Botox injections into salivary glands

24
Q

What considerations may need to be made when treating Parkinson’s patient in dental setting?

A

Medication- aim to get patient in time where medication is having desired effect
-> do treatment soon after they have taken medication
-> if lengthy procedure allow them to take mid-appointment

Suctioning is important

Dyskinesia- indicates IV midazolam for muscle relaxation (risk of dysphagia- balance)

25
Q

What should you do if you suspect one of your patients has dementia?

A

If you notice they have forgotten about appointments or look disorientated
-> signpost to GMP for formal assessment

26
Q

What are the features of mental health in older people?

A
  • Impacted by age
  • Lower levels of referral to services
  • High levels of depression in care homes (related to medical diseases?)
  • CBT is useful in older people
  • Higher mortality with more diseases/co-morbidities - cluster medicine
  • May be more likely to neglect self care if poor
  • Dental diseases can contribute to poor mental health
27
Q

What is immunosenescence and its implications?

A

Changes that occur in immune system due to increasing age
-> increased risk of cancer (due to poorer surveillance)

-> Increased bacterial and viral infection risk (changes to mucous membranes and immune system)

-> autoimmune diseases

28
Q

What happens to different parts of the immune system due to age?

A

Macrophages work more slowly

T cells do not respond as well

Less complement protein is produced

29
Q

Which medications can make a patient become immunosupressed?

A

Oral corticosteroids- inflammatory autoimmune conditions
-> prednisolone for asthma or temporal arteritis

Disease modifying medications- severe autoimmune diseases
-> methotrexate- RA
-> mycophenolate- SLE

Chemotherapy agents- 5-fuorouracil (5-FU) capecitabine for bowel cancer

Immunomodulatory treatment for cancer treatment
-> rituximab to treat NHL/lymphocytic leukaemia

30
Q

How may dental treatment be adapted for patients on immunosuppressive drugs?

A

If very immune supressed- consider ABP

Biologics- strict timing schedule
-> do treatment in window when blood cells are most stable (week 5 in 6-week cycle)

31
Q

What are the oral effects of cancer treatment?

A

Mucositis

Xerostomia

Candidal infections

Bisphosphonates causing MRONJ- used in metastatic secondary bone cancers/multiple myeloma

ORN

32
Q

Why may patients be sent for an oral assessment before starting bisphosphonates or chemo?

A

So that teeth of poor prognosis can be removed to avoid complications in the future
-> Prevent MRONJ if bisphospohonates
-> Prevent infection due to neutropenia in chemo

33
Q

What drug types are associated with MRONJ, give examples?

A

Bisphosphonates- alendronic acid

Tyrosine Kinase Inhibitors- sunitinib

Immunosupressants- methotrexate

SERM- raloxifene

Monoclonal antibodies- Bevacizumab

mTOR- Sirolimus

Radium 223

Fusion proteins- Aflibercept

34
Q

What are the complications of diabetes?

A

Associated with obesity

Small vessel disease
-> Renal- CKD
-> Retinal- vision loss
-> Peripheral- peripheral neuropathy

35
Q

What adjustments can be made for patients who have diabetes in dental setting ?

A

Written information in larger font

Transfer device from wheelchairs if PVD has lead to amputation or mobility issue

GA- consult medical teams if modifications to insulin regime are required (fasting)

Sessions should be scheduled for the morning
-> higher endogenous cortisol levels increase blood glucose and decrease the risk of hypoglycaemia

Avoid scheduling an appointment time that coincides with the maximum insulin activity peak or when it may lead to a meal being missed

36
Q

Which Hb1AC levels allow dental treatment to proceed?

A

<7%- any treatment

9%- only emergency treatment
-> if surgical it should be in hospital setting

> 12%- postpone all procedures until glycemic control improves

37
Q

What are the risks for diabetic patients in the dental setting?

A

Hyperglycaemia Hypoglycaemia

Fatigue/reduced tolerance for long treatment

Greater risk of infection

Poor wound healing

Increased risk of periodontal disease

Complications related to comorbidities/secondary vascular complications

38
Q

What are the causes of stroke?

A

Ischaemia- blood clot occluding an artery (85%)

Haemorrhage- ischaemic area ruptures

39
Q

What side does a left hemisphere stroke produce deficit in?

A

Right side- opposite

40
Q

What are the risk factors for stroke?

A

AF

Hypertension

Smoking

Diabetes

41
Q

What are the complications of stroke?

A

Complete paralysis on one side

Higher cognitive dysfunction
-> issues sequencing tasks

Loss of speech

Difficulty of swallowing

One sided visual loss

42
Q

What are the different ways that stroke can affect speech?

A

Expressive dysphasia- forming words becomes difficult

Receptive dysphasia- difficulty understanding

Dysarthria- physical difficulty with formation of words (slurred speech)

43
Q

What are the dental implications of stroke?

A

Mobility may be affected- difficulty getting in chair

Understanding may be lost- consent

Issues with swallowing- tube feeding, retention of medicine (alendronic acid/Fe- full thickness burns)

Difficulty with OH- limited dexterity

Higher risk of dental disease- poor oral clearance, dry mouth, pouching

Anticoagulated- delay invasive treatment for 6 months

44
Q

What adjustments may need to be made for patients who have suffered a stroke in dental setting?

A

Patient may have dysphagia- good suction required

Keep patient more upright

Take time with treatment- allow rest breaks

Analgesia- paracetamol is preferred

45
Q

What factors are deemed important by relatives of patients when they are undergoing end of life care?

A

Cleanliness

Free of pain

Have family present

Dignity maintained

46
Q

How may we change our care if a patient is coming to end of their life?

A

If we know that someone is coming to end of life, adopt more conservative approach to avoid overtreatment
-> Allows patient to spend final period of time not receiving treatment

47
Q

What are the issues caused by dry mouth in the elderly?

A

Speech issues

Nutritional function and intake

Impairs social interaction

Protective features of saliva lost

48
Q

What are the risk factors for restoration failure in older people?

A

Lower number of tooth brushings/day

Absence of prosthesis

Posterior location of the tooth

Higher baseline plaque index

49
Q

What is ART?

A

Remove superficial caries with excavator and patch up with GIC

50
Q

What is the 2 year survival rate of ART restorations against conventional?

A

ART- 85.4%

Conventional- 90.9%

51
Q

Why does candiasis tend to effect older people?

A

Disease of the diseased- tends to effect immunocompromised patients

52
Q

How is Oral candidiasis managed?

A

Topical antifungals, improve OH, practice denture hygiene

-> use systemic antifungals if this doesn’t work

BDS4 Special Care (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions