OHRQoL Flashcards
4 aspects of human rights
- Accessibility to services
- Non-discrimination
- Physical access
- Economic
- Information
- Acceptability of health facilities/ goods/ services
- Ethics
- Culturally appropriate
- Availability
- Facilities
- Effective public health
- Preventative programme
- Goods and services
- Good quality service
- Restructured to meet needs of older people
- Robust and routine evidence
sustainable development and economics
- Significant proportion of the population will be older
- Older people contribute through food production and raising future generations
- Development enhances an equitable society, well-being and productivity
- Development needs to be inclusive
- Economics
- Minimise expenditure whilst maximising contributions
- Flawed models based on old age being 65
- Minimise expenditure whilst maximising contributions
- Older people contribute to economy through consumption
- Greater proportion of wealth in UK
- Older people are an investment not a cost
biological Vs chronological age
- Depends on factors influencing person on where they are on the biological scale
- Biological model may be better than chronological model for old age
- Some factors are changeable (behaviours, lifestyle, personal characteristics)
- and some are non-changeable (physical environment, genetics, socio-economic status – can change but increasingly harder)
defining oral health
- multifaceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow, and convey a range of emotions through facial expressions with confidence and without pain, discomfort, and disease of the craniofacial complex.
basis of patient centred care
very few diseases have an absolute cure – most can be treated
change in clinician perspective – how does opt want to live their life
Oral health related quality of life
- Multidimensional construct
- Subjective
- Individualised
“A multidimensional construct that reflects (among other things) people’s comfort when eating, sleeping and engaging in social interaction; their self esteem; and their satisfaction with respect to their oral health”
oral health related quality of life measures
- geriatic/general oral health
- dental impact profile
- oral health impacts profile (long and short)
geriatric/general oral health measure QoL covers
Chewing, eating, social contacts, appearance, pain, worry, self-consciousness
dental impact oral health QoL measures
Appearance, eating, speech, confidence, happiness, social life, relationships
oral health impacts QoL measures
Functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap
what is the value of OHRQoL
aids:
clinical practice and policy
- Assessment on entry to care homes
- FiCTION trial
- Caries management
- Strategic targeting/public health interventions
Research and service
- Surveys
- Clinical trials
- Cost utility analysis
- Health services research
- Population surveys
The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review
- natural dentition
No clear consensus on being edentulous on OHQoL
- More teeth you have the better OHQoL
- Also, the more missing teeth you have the more negatively impacted your OHQoL is
Want to keep anterior teeth/fill anterior spaces for improved OHQoL
Occluding pairs – very important for all ages – the more pairs the more positive OHQoL
- Key to find, store and maintain occluding pairs for function
The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review
- caries
No clear consensus – so many variables to measure caries
- Carious lesions (active)
- Restored teeth
- Root caries
Would think caries would have a negative impact but when merge all the data together = no consensus
The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review
- periodontal
Too many variables to produce a statistical significance overall
But (like caries) if you look at each domain individually then can see negative impact
The Influence of Oral Health Factors on the Quality of Life in Older People: A systematic review
- prosthetic
RPD - mixed
Poor dentures negative impact of OHQoL
- Ulcer, bad breath, non-functional
Fixed better than Removable
Implant retained prostheses = better OHQoL
oral health related factors that can impact QoL
- natural dentition
- caries
- periodontal status
- prosthodontic status
- xerostomia
- hyposalivation
- clinical symptoms of dry mouth
- orofacial pain
- chewing ability
shortened dental arch with resin retained bridges Vs full RPD
- SDA/RRB
- improved quality of life @ 24 months
- improved cost effectiveness
- RPD Group
- initial improvement @ 6 months but diminished @24 months
argument that restoring to SDA over further restoring (unless have occluding pairs in posterior)
2 models for translating QoL into clincal practice
- prevention
- delivery of clinical care
life course and prevention
- Equal or equitable
- Reduction in care as life course progress – but need to address – need preventative strategies in place throughout life course
“medicine is failed prevention” Sir Michael Marmot
Caring for smiles
- Scotland’s national oral health promotion, training and support programme
- Education and Training Programme
- Lectures to carers, upskill carers
- Adults who move into a care home have their mouth care needs assessed on admission
- First set of principles - OHQoL
- Adults living in care homes have their mouth care needs recorded in their personal care plan
- Develop a care plan based on assessment
- Unique to them
- Adults living in care homes are supported to clean their teeth twice a day or undertake daily oral care for dentures
issue for elderly dental care in scotland
Systematic review highlight that existing training programmes
- Improve knowledge and influence attitudes
- No change in oral hygiene
- “If you always do what you have always done you will always get what you have always got”*
- Henry Ford
potential model to improve OH of elderly
Fluoride Varnish Programmes for Older people in caring environments
A randomised feasibility study
- Pilot work undertaken 2014-2015
- Sample size – 13 of 78 residents
- Enormous drop – death, ill, change in consent capacity
- Sample size – 13 of 78 residents
Complexity of systems and delivery highlighted
- How to get in, delivery, where in care home
Significant finding on arresting caries roots
- F varnish beneficial for root caries, but 50:50 for teeth whether restored or extracted
- More results in 2021 - COVID impact
Innovation
- Need to remove biofilm in theory
3 trajectories in end of life
- Top – cancer
- Middle – chronic heart/lung, gradual decrease with sudden dips of hospital
- Bottom – long slow decline - extended life
to treat or not to treat
- Older people’s end of life trajectory tends to be longer
- Average 2-3 years when admitted to care home (bell shaped curve so varies)
- Predicting how long this person is going to live is hugely challenging
- If dentists know the person is in the end stages of life they conform to a more conservative approach
- There is however a risk of overtreatment
- 67% of older people received “usual care” of which 62% died within 3 month
HPT, RPD, restorations, paying money, visiting dentist regularly
what do we need to manage to improve oral health
- Report OHRQoL as good yet, oral health is remarkably poor
- “Secondarisation of oral problems” (medical or social)
- Other more complex issues which affect them at this stage of life
- Lack of input from dentists in the team approach (in end of life care)
- Major complaints are:
- Dry mouth
- Ulceration
- Infection and Pain
barriers to oral health care for elderly
more how than who - Clinical support, education and training is not a panacea
Numerous barriers:
- Integrated working between health and social care
- Mutual decisions improve outcomes
- Nominated care lead
- Sharing in planning interventions and flexibility
- Current health care systems are flexible enough
oral health improvement plan scotland - 3 parts related to elderly
- Domiciliary Care Provision
- Upskill care workers
- Enhanced Skills – Gerodontology specialism?
- More services being able to be provided in primary high street setting for them
- Reduce OH inequality
- More services being able to be provided in primary high street setting for them
- Partnership between health and social care
domicillary care
Lower societal cost when compared to fixed clinic – Swedish Population
controversial in UK
- Believed to be expensive – study shows not
Safety
- Limited in what you can do in care homes in Scotland
Overall not significant risk to health to provide domiciliary care
positive impact on OHRQoL
- Increased number of teeth, anterior teeth and occluding pairs of teeth have a positive impact on OHRQoL for older people
- We need to consider stage of life course and integration of disciplines in how we manage our patients across health and social care
- Further education and research is essential to shape how we move forward in the care of older people
