Geriatric Medicine and Dentistry

Question 1

What is the icf definition of ageing?

Answer 1

How the individual adapts biologically, socially and psychologically to disease, the environment and social factors are reflected in their oldness.

Question 2

How do senses and responses change in response to ageing?

Answer 2

All the senses decrease (except touch)

Speed of responses decreases

Question 3

How is hearing loss different between males and females?

Answer 3

Males are affected more by hearing loss than females

Question 4

What causes falls to be so dangerous

Answer 4

Likelihood increases with age

Females > males

Associated with living alone, presence of chronic illness, impaired mobility, and postural instability

Question 5

What are the complications of falls?

Answer 5

Bruising

Lacerations

Pressure sores

Dehydrations

Loss of confidence

Can lead to significant decline in health

Question 6

What systemic changes occur as we age?

Answer 6

Reduced elasticity of vessels

Thickening of artery walls

Heart needs to maintain same output

Reduced kidney function

Loss of elasticity in the lungs

Metabolism less sensitive to insulin

Hormonal changes in women

Prostate enlargement in men

Osteoarthritis

Osteoporosis/osteopenia

Muscle mass decreases

Question 7

What medical comorbidities are common with ageing?

Answer 7

Progression of chronic diseases

Manifestation of diseases with longer latent periods

Age-related diseases (T2DM, Cancer)

Changes to immune function

Complications associated with ageing (Immobility/Falls, DVT, aspiration pneumonia)

Question 8

Why is cardiovascular disease more common in older people?

Answer 8

Heart less compliant

Heart of 65 year old beats at 70 bpm which increases with age

Question 9

What are people with T2DM at increased risk of?

Answer 9

Congestive heart disease

Cerebrovascular disease

Periperal vascular disease

Diabetic retinopathy

Kidney failure

Question 10

What happens to patients’ T2DM with age?

Answer 10

Managed initially by diet control

Oral hypoglycaemics

Insulin supplementation

Question 11

What happens to bone with age?

Answer 11

Osteoporosis as bone becomes more porous and weak.

More common in women due to oestrogen drop following menopause.

This increases fracture risk: Hip, wrist, back, etc

Question 12

How is osteoporosis treated?

Answer 12

Load bearing exercise

Dietary calcium/vitD

Bisphosphonates and other antiresorptives (eg denosumab)

Question 13

Why would patients use denosumab instead of bisphosphonates?

Answer 13

Worsening renal function. Some patients forget to take meds everyday so take 1 denosumab injection a month which is easier to manage.

Question 14

What is osteoarthritis?

Answer 14

Mechanical wear and tear on cartilage causing it to degenerate.

Question 15

What are the features of osteoarthritis?

Answer 15

Overgrowth of bone

Many joints affected (Hips, knees, hands, spine, feet)

Pain

Stiffness

Question 16

What are the age-related cognitive changes?

Answer 16

Associated with decreased efficiency of processing information

Associated with decreased information retrieval

Normal ageing does not have to mean significant decrease in memory or learning

Question 17

What is the most common learning problem in older adults?

Answer 17

Errors of omission

Question 18

What is dementia?

Answer 18

Broad category of degenerative diseases characterised by progressive brain impairment

Different forms of dementia affect different parts of the brain in different ways.

Question 19

What are the manifestations of dementia?

Answer 19

Often part of a spectrum:

Mild causes difficulty making sense of new info.

Severe leads to loss of self-care capabilities.

Most common kind is Alzheimer’s disease.

Some dementias are reversible

Question 20

When is dementia diagnosed?

Answer 20

3 or more cognitive impairment criteria (no need to know them specifically)

Question 21

What is Alzheimer’s disease?

Answer 21

Accumulation of amyloid proteins or Tau proteins causing loss of neurons in the brain and atrophy. This eventually leads to short-term memory loss

Question 22

What are the symptoms of Alzheimer’s disease?

Answer 22

Short-term memory loss and this eventually leads to problems with language, disorientation, mood swings, loss of motivation, not managing self care and behavioral issues.

Question 23

How are patients with Alzheimer’s diseae managed dentally?

Answer 23

May be difficult in advanced stages of disease

Best to manage early

Aggressive preventative therapy is required 2 -3 monthly recall.

Question 24

What are the dental problems associated with Alzheimer’s disease?

Answer 24

Seizure medications can cause dry mouth and gingival hyperplasia

Dry mouth from medications

As the disease progresses oral care will become the responsibility of the carer

Question 25

How should dentist prepare before the appointment?

Answer 25

Caregiver needed?

Cognitive and physical abilities?

Behavioral problems

Special problems (need for modification of surroundings)

Assistance needed for parking/transport?

Medical history

Medications/medication list.

Calling carers before appointment will assist in preparing for these issues.

Question 26

How should communication with Alzheimer’s patients be organised?

Answer 26

Minimise noise and distractions

Only 1 person speaks at a time

All parties should be involved in the discussion

Learn from caregiver’s communication techniques

Use patient’s name

Be trusting, honest, direct, and not patronizing

Be calm and reassuring to the patient

Don’t rush

Be positive

Do not correct the patient

Question 27

What dental techniques are used on patients with dementia?

Answer 27

Hand overe hand: Guide patient through activity

Rescuing: Assist by taking over task

Bridging: Improve sensory connection with object

Chaining: Carer commences activity which is continued by patient

Distraction

Question 28

What are the types of restraints that are usable for patients?

Answer 28

Physical: Tying or holding patient down, papoose board

Chemical restraints: Sedatives, NO, GA

Question 29

Why is dentistry important for older adults?

Answer 29

Important for health and wellbeing of the older person and quality of life

90% of older adults have some degree of dental disease requiring treatment

Poor oral health can cause pain and infection, affect diet and nutrition, compromise existing health, and put at risk of other comobidities such as aspiration pneumonia

Question 30

Which elderly people have the worst oral health in Australia?

Answer 30

Older people living in residential aged care facilities

Question 31

Which elderly risk groups require the most dental care?

Answer 31

Functionally dependent: Often have unsatisfactory dentures and high requirement for dentures and extractions

Frail elderly: Of those with no natural teeth, 22% may require prosthetic care. 23% of those dentate will require dental treatment

Functionally independent: Significant variation in dental requirements by both dental status and affordability of care. 14% use public clinics. around 39% of dentate may require 1 filling 1 extraction

Question 32

What are the objectives of domiciliary care?

Answer 32

Provide assessment guidance and treatment

Provide information to support group

Support professional and non-professional carers

Provide sensitive and palliative care for terminally ill patients

Assist in regular oral hygiene