Geriatric Medicine and Dentistry Flashcards
What is the icf definition of ageing?
How the individual adapts biologically, socially and psychologically to disease, the environment and social factors are reflected in their oldness.
How do senses and responses change in response to ageing?
All the senses decrease (except touch)
Speed of responses decreases
How is hearing loss different between males and females?
Males are affected more by hearing loss than females
What causes falls to be so dangerous
Likelihood increases with age
Females > males
Associated with living alone, presence of chronic illness, impaired mobility, and postural instability
What are the complications of falls?
Bruising
Lacerations
Pressure sores
Dehydrations
Loss of confidence
Can lead to significant decline in health
What systemic changes occur as we age?
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
What medical comorbidities are common with ageing?
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)
Why is cardiovascular disease more common in older people?
Heart less compliant
Heart of 65 year old beats at 70 bpm which increases with age
What are people with T2DM at increased risk of?
Congestive heart disease
Cerebrovascular disease
Periperal vascular disease
Diabetic retinopathy
Kidney failure
What happens to patients’ T2DM with age?
Managed initially by diet control
Oral hypoglycaemics
Insulin supplementation
What happens to bone with age?
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
How is osteoporosis treated?
Load bearing exercise
Dietary calcium/vitD
Bisphosphonates and other antiresorptives (eg denosumab)
Why would patients use denosumab instead of bisphosphonates?
Worsening renal function. Some patients forget to take meds everyday so take 1 denosumab injection a month which is easier to manage.
What is osteoarthritis?
Mechanical wear and tear on cartilage causing it to degenerate.
What are the features of osteoarthritis?
Overgrowth of bone
Many joints affected (Hips, knees, hands, spine, feet)
Pain
Stiffness
What are the age-related cognitive changes?
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
What is the most common learning problem in older adults?
Errors of omission
What is dementia?
Broad category of degenerative diseases characterised by progressive brain impairment
Different forms of dementia affect different parts of the brain in different ways.
What are the manifestations of dementia?
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
When is dementia diagnosed?
3 or more cognitive impairment criteria (no need to know them specifically)
What is Alzheimer’s disease?
Accumulation of amyloid proteins or Tau proteins causing loss of neurons in the brain and atrophy. This eventually leads to short-term memory loss
What are the symptoms of Alzheimer’s disease?
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.
How are patients with Alzheimer’s diseae managed dentally?
May be difficult in advanced stages of disease
Best to manage early
Aggressive preventative therapy is required 2 -3 monthly recall.
What are the dental problems associated with Alzheimer’s disease?
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
How should dentist prepare before the appointment?
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.
How should communication with Alzheimer’s patients be organised?
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
What dental techniques are used on patients with dementia?
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
What are the types of restraints that are usable for patients?
Physical: Tying or holding patient down, papoose board
Chemical restraints: Sedatives, NO, GA
Why is dentistry important for older adults?
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
Which elderly people have the worst oral health in Australia?
Older people living in residential aged care facilities
Which elderly risk groups require the most dental care?
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
What are the objectives of domiciliary care?
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
