Medicine for the elderly

Question 1

how has the elderly dentate population changed overtime?

Answer 1

there are now more elderly people with their own teeth

Question 2

what are the two groups of elderly people?

Answer 2

healthy- treat as young person with chronic diseases
frail-assess frailty

Question 3

what are the 9 D’s of frailty ?

Answer 3

disability
dementia
delirium
depression
de-nutrition
destitution
drugs
dependent
death

Question 4

how is frailty assessed?

Answer 4

healthy
well-no active disease symptoms
manageable- controlled by medications
vulnerable- symptoms limit activities
mildly frail- dependent on some indoor and outdoor activities
moderately frail-dependent on outdoor activities
severely frail-fully dependent
very severely frail- fully dependent approaching end of life
terminally ill- approaching end of life

Question 5

how does disability affect the elderly?

Answer 5

physical- mobility and manual dexterity-affects OH
sensory- deaf/blindness
physiological- reduced thirst reflexes- dry mouth
-impaired taste

Question 6

what are the dental considerations for elderly disabilities?

Answer 6

-higher risk of adverse events e.g MI due to multiple chronic diseases
-access to care
-manual dexterity and OH
-communication issues
-allow time and don’t rush
-respect

Question 7

how does dementia affect the elderly?

Answer 7

chronic confusion-progressive difficult disease- global loss of brain function
- forgetful
-will become fully dependent
-behavioural changes
-communication/consent barriers

Question 8

what are the treatment options for dementia?

Answer 8

no cure
-mainly supportive treatment
-cholinesterase shown to delay not cure
-sedatives used but increase mortality

Question 9

what are the dental considerations for patients with dementia?

Answer 9

-consent (may need AWI form from Gp)- must be able to understand, retain, communicate back.
-communication and understand treatment
-good communication with carers/relatives
-poor OH-neglect
-analgesics may cause delerium (acute confusion)

Question 10

how does delirium affect the elderly?

Answer 10

acute confusion- normally underlying cause such as infection or new drug/pain

Question 11

how does depression affect the elderly ?

Answer 11

neglect OH- reduced energy/motivation- be sympathetic don’t rush these patients.

Question 12

how does de-nutriton affect the elderly ?

Answer 12

protein malnutrition (more so in frail)
-weakness- forget to eat, reduced appetite, unable to eat
-may cause impaired healing

Question 13

how does destitution affect the elderly?

Answer 13

• 20% of elderly population live In poverty
  -access to care
  -be considerate
  -offer realistic treatment to patients

Question 14

how does dependency affect the elderly?

Answer 14

dependent patients will have carers/relatives or be institutionalised- who you must have good communication with

Question 15

how do drugs affect the elderly?

Answer 15

-polypharmacy-likely on a lot of med
-antiplatelets (clopidogrel and aspirin)
-anticoagulants (warfarin and rivaroxaban)
both may cause excessive bleeding

> 80s- avoid NSAIDS - GI side affects
and avoid antibiotics (c.difficile infection)

assume the elderly have impaired renal function

Question 16

how should you approach elderly patients?

Answer 16

-establish comprehension
-establish functional abilities
-understand medications and what they’re used for
-have good communication and patience
-consent and communication with carers
-offer realistic treatment and sensible meds
-avoid high risk medication