Medicine and the Elderly Flashcards
List the two groups of elderly patients and a brief description of each:
Healthy - independent
- treat as you would treat a young patient with a chronic disease
Frail - these patients need special considerations
What is fraility?
2 or more of the following:
- inability to perform 1 or more activities of daily living
- depression
- dementia
- history of falls
- unable to walk/has a walking aid
- bedbound for 4 or more days
- incontinent (urine/faeces)
List the 9 D’s:
- disability
- dementia
- delirium
- depression
- de-nourishment
- destitution
- dependency
- drugs
- death
List some special considerations for disabled patients:
- loss of manual dexterity/mobility
- loss of physical capacity
- impaired physiology: loss of thirst reflex
- access to services/communication issues
- high risk of adverse events
List some dementia considerations:
- neglect
- comprehension
- capacity to consent
- interaction with carers and relatives
- be respectful
- prescribing - risk of delirium with analgesics
What is delirium?
Causes?
Delirium: acute confusional state, frail body, frail mind at risk
Causes: infection, drug interactions, pain, dehydration, often pre-existing dementia
List some special considerations for depression:
Destitution:
Depression:
- oral neglect
- compliance
- allow time
Destitution (poverty) - offer realistic treatments in terms of cost
Special considerations for de-nourishment:
Dependency:
Death:
Denourishment: poor oral health (GI problems?)
- wound healing may be slower
Dependency: need domicilliary visits, interaction with carers and communication
Death:
- be realistic with treatment in terms of time
- treat patient, not just their teeth
Special considerations with drugs?
- polypharmacy
- get accurate history, use BNF to research drug
- consider impaired renal function
- antiplatelets/anticoagulants
- avoid harmful drugs: NSAIDs avoid in over 80s, avoid overuse of antibiotics
- use smallest dose possible for analgesics
What are the treatments for edentulous patients?
Partially dentate?
Dentate?
Edentulous: complete replacement dentures
- implant retained prostheses (fixed or removable)
Partially dentate: removable partial denture
- fixed prostheses (implant retained, tooth retained)
- stabilise existing dentition
Dentate: maintenance
- keep treatment intervention to a minimum
All patients should have regular inspection visits
What are some reasons for increased tooth retention?
- improved awareness of OH
- improved access to care
- Oral health promotion
- fluoride toothpastes
- fluoride water supplies and mouthwashes
List some threats to oral health and which diseases they can lead to:
Threats:
- poor plaque control
- personal behaviour (smoking)
- systemic disease
- xerostomia
- exposed root surface
- high sucrose diet
- irregular denture maintenance
- poorly designed removable partial dentures
Diseases: Periodontal disease, Caries, Tooth wear
Is periodontal disease part of the ageing process?
Although periodontal disease is commonly seen in the elderly, it is not part of the ageing process but as a consequence of disease progression in the susceptible patient over a number of years
- older patients may have social, medical and ohysical features that can impact on periodontal condition (rheumatoid arthritis)
List some erosive conditions excluding dietary, which cause tooth wear:
- alcohol abuse
- hiatus hernia
- duodenal ulceration
- certain medications
What medical factors influence the mouth?
Xerostomia - medication induced: Candida infections common
- antidepressants, antihypertensives, anxiolytics
Gingival overgrowth - use of:
- calcium channel blockers, anti-epileptic drugs, cyclosporin
