L2 - part 1 Flashcards
homebound vs nursing home
homebound (almost 2 million over age 65) outnumber the 1.4 million residents of nursing homes
why homebound
result of physical or cognitive impairment
no access to dental care
scope of practice in homebound
assessments
simple extractions
denture fabrication and repairs
simple fillings
ADL’s *
eating bathing dressing toileting transfer
*patients who need help with 2+ ADL’s need at home help or long term care
case study take aways
- importance of good communication with medical primary care providers
- be wary of ageism (treat if can tolerate- not by age)
- centenarians need dental care too *
100-104?
105-109?
110+
centenarians
semi-super-centenarians
super-centenarians
study of these began in 1994 by thomas pearls – in new england
compression of morbiditiy and mortality
interesting about centenarians?
morbidity (illness)
mortality (life-span)
have delayed onset or absence of most common age-related systemic diseases (hypertension, diabetes, CVD)
- most dont have these
live long suprinsingly good health
then at very old get something and die
oral health of centenarians?
important for eating, talking, socializing, self-esteem and had not yet been studied
fastest growing segment of US population? **
people aged 85+ constitute the FASTEST GROWING SEGMENT OF THE US POPULATION
PERCENTAGE WISE
Perferred term for 65+
older adult
defining geriatric today
a person’s FUNCTIONAL status more than chronological age defines geriatric today
AGE ALONE IS NOT ENOUGH TO DEFINE THIS POPULATION
functional status can be
affected by cognitive and / or physical impairments
Geriatrician
primary care physcians either FAMILY OR INTERNAL medicine, plus geriatric trianing
1 issue geriatricians deal with
polypharmacy
all the different rx’s and their interactions
IADL’s *
instrumental activities of daily living
- managing money
- shopping
- preparing meals
- heavy housework
- light housework
- using the telephone
geriatric core competency (5 M’s)
- mind
- mobility
- medications
- multi-complexitiy
- someone to support them? vision? hearing? oral hygeine adequate? - matters most
mild cognitive impairment
slight but noticeable decline in cognitive abilities, including memory and thinking skills
may or may not interere with daily life and fucntion , may be stable for years
MAY BE RREVERSIBLE ** - Increased risk for dimentia
mentation / mind that may be reversible
mild cognitive impairment
delirium
depression
delirium
reversible
- altered mental status from baseline; disorientation to time place, person
causes include inappropriate medication and / or untreated infection (UTI’s), dehydration; up to 50% of hospitilized older adults
depression
reversible
geriatric depression scale (15 questins)
dimentia
NON REVERSIBLE
- AD’s, vascualr dimentia- daily function affected
progressive decline
rate of decline varies
matters most / goals of care
adapting tx plans and sites of tx
aesthetics(family never saw this pt wthout dentures in mouth)
function
pain free
what to consider with dimentia patients
dentures – careful bc if lose them they can get out of whack and wonder where you are to help and where they are
risk factors for dental disease
age
retaining natural dentition – edentulous rate dcreasing over time
funcitonal impairment – physical and or cognitive
resistance to oral hygeine assistance
risk factors for caries
dentin layer thickens over time and pulp recedes
decrease in saliva
increase in sugar consumption
gingival recession exposing caries prone cementum and
larger gingival interdental areas – food traps
caregivers
unpaid / paid person wo helps another individual with his/her ACTIVITIES OF DAILY LIVING (ADL's) - bathing - dressing, toileting, transfers, continence feeding
patients who need assistance with ADL’s …
USUALLY REQUIRE help with oral hygeine
oral hygiene guidelines for patients at high risk for careis
inform patient/ caregiver hygeine is inadequate
ask caregiver to scub teeth for 2 minutes
rx prevident or 1.1 NaF gel for daily use
mouth carriers (like beaching trays) + prevident for 5 minutes / day
3-4 mouth hygience recall for patient with caregiver
- communicating effectively with older adults
TAKE MASK OFF
- ask if they can har
- stay eelevel, close to patient
speak slowly and in lower frequency do not screm or increase pitch
never be backlit – may be trying to read lips
visaul impairments
large font
help patient in and out of chair
keep floor clean
elder friendly hallways, etc
elder abuse
AFFECTS PEOPLE OF ALL RACES, ETHNICITIES, SOCIAL CALSSES AND AGE
MANDATED TO REPORT SUSCPISION
Actions of omission or commission that potentially or actually threatens the well being of the adult
patterns of assaultive and coercive behavior inluding inflicting injury, psychological abuse, deprivation, progressive social isolation, intimidation and threats
behaviors perpetrated bby someone able to establish control over another
most common elder abuse
FINANCIAL
– under reported often due to co-dependency of abuser and victim
- physical
- emotional
- caregiver neglect
- self -neglect– not paying bills, not eating properly, refusing assistance
- sexaul
many times emotiona abuse, financial abuse and neglect go together
caregiver who insists on giving the history of a traumatic injury
like broken front tooth, back eye, lip laceration
- suspect possible to abuse
what can dentist do to help in abuse cases
dentist are mandated reporters of SUSPECTED ABUSE
- can initiate an appropriate investigation and intervention
provide supportive evidence and documentation
MA abuse hotline and online information
