Oral Health of the Elderly Flashcards
Today the Elderly equals ____
Their health care costs equals _____
___ million people
13 % of US popl
36 %
31 million people
Socioeconomic Considerations
*Life expectancy is greater for ___ of all ages.
*Women outlive men ___ years
*Number about ___ million by __
*___% of older adults live in the community
*___% (85 +) living in nursing homes
Socioeconomic Considerations
*Life expectancy is greater for women of all ages.
*Women outlive men 7-8 years
*Number about 37 million by 2030.
*85% of older adults live in the community
*15% (85 +) living in nursing homes
Implications for Dentistry
*___ go to the dentist more than___
*Nearly ___ as many teeth are projected to be at___ for dental disease in 2030 as were in 1972.
*More primary __ ___ and __ ___ will be required.
___ and___ needs will increase.
Implications for Dentistry
*Women go to the dentist more than men
*Nearly twice as many teeth are projected to be at risk for dental disease in 2030 as were in 1972.
*More primary oral health and preventive services will be required.
*Periodontal and prosthodontic needs will increase.
*Higher levels of___ and ___ will result in the elderly seeking __ ___ throughout their lives.
*More will ___ their teeth and a higher risk for ___ caries with increasing age may predict the need for more ___ dental care as our population ages.
*Incidence of edentulism is ____g in age 65+
*US=___%
*Texas=___%
Expectations of the Elderly
*Higher levels of income and education will result in the elderly seeking dental services throughout their lives.
*More will retain their teeth and a higher risk for root caries with increasing age may predict the need for more complex dental care as our population ages.
*Incidence of edentulism is declining in age 65+
*US=20.5%
*Texas=16.8%
*Dentists’ Attitudes
*The demand for geriatric care will far ___ the number of dentists currently willing and able to provide such care.
*__ ___ DDS retirement will reduce the number of dentists.
*The demand for geriatric care will far exceed the number of dentists currently willing and able to provide such care.
*Baby boom DDS retirement will reduce the number of dentists.
Institutionalized Elderly
Institutionalized Elderly
*In the United States, there are an estimated ____ million nursing home beds.
*While __% of those 65 to 74 years lived in a nursing home in 1990, __ in ___ aged 85 or older did.
*___% of these residents are over age 65.
*A report by the U.S. General Accounting Office estimated that ___ % of all Americans age 65+* will reside in a nursing home at some time in their life.
*In addition, long-term care residents are less likely to have ___ to comprehensive dental care.
*Majority have __ ___
Institutionalized Elderly
*In the United States, there are an estimated 1.8 million nursing home beds.
*While 1% of those 65 to 74 years lived in a nursing home in 1990 one in 4 aged 85 or older did.
*80% of these residents are over age 65.
*A report by the U.S. General Accounting Office estimated that 43% of all Americans age 65+* will reside in a nursing home at some time in their life.
*In addition, long-term care residents are less likely to have access to comprehensive dental care.
*Majority have dental needs
Instit Elderly
The Geriatric Dental Patient
The Geriatric Patient
*Need to understand ____ and state its causes and the relationship of osteoporosis to ___ ___
*Become and observer of changes in oral conditions of the aging patient as they pertain to the:
*__ __
*__
*___
*___
*___
*Know what___ looks like and its effects
*What are the considerations for dental ____ care when planning and conducting appointments for the older patient.
* Know about ___ ___ formation and recommendations for plaque ___ in the elderly.
* What are the considerations of___ and ___ in the elderly.
*Need to understand osteroporosis and state its causes and the relationship of osteoporosis to perio disease .
*Become and observer of the changes to oral conditions of the aging patient as they pertain to the:
*oral mucosa
*lips
*tongue
*teeth
*periodontium
*Know what xerostomia looks like and its effects
*What are the considerations for dental hygiene carewhen planning and conducting appointments for the older patient.
* Know about dental plaque formation and recommendations for plaque removal in the elderly.
* What are the considerations diet and nutrition of in the elderly.
What affects health outcomes?
___ ___s 30%
__ ___ 20%
___ and ___c Factors 40%
___ ___10%
___ : Length of Life
___ : Quality of Life
What affects health outcomes?
Health Behaviors 30%
Clinical Care 20%
Social and Economic Factors 40%
Physical Environment 10%
Mortality: Length of Life
Morbidity: Quality of Life
Chronic Illness Sign
Chronic Illness Significance
*Almost ___ercent of the elderly have at least one chronic illness
*About ___ percent have at least two chronic illnesses
*lead to severe and immediate disabilities, such as __ __s and ___
*progressive disability that slowly erodes the ability to care for ___
*___% need help bathing, dressing, eating and toileting
Chronic Illness Significance
*Almost 75 percent of the elderly have at least one chronic illness
*About 50 percent have at least two chronic illnesses
*lead to severe and immediate disabilities, such as hip fractures and stroke
*progressive disability that slowly erodes the ability to care for themselves
*14% need help bathing, dressing, eating and toileting
Circulatory Disease
*Categories
*High ___ __ – 73 million
*___ heart disease – 18 million
*___ – 6.5 million
*____failure – 6 million: Accum of fluid in air sacs in lungs
*___ pectoris – 8 million
*__ ___ __e (PVD)
*__ __ ___s (DVT): Swelling below the blockage site
*___ are at greater risk after 65
*__ __ of all ages are at risk
*Beginning medications reduces risk by ___
Circulatory Disease
*Categories
*High blood pressure – 73 million
*Coronary heart disease – 18 million
*Stroke – 6.5 million
*Heart failure – 6 million: Accum of fluid in air sacs in lungs
*Angina pectoris – 8 million
*Peripheral Vascular Disease (PVD)
*Deep Vein Thrombosis (DVT): Swelling below the blockage site
*Women are at greater risk after 65
*African-Americans of all ages are at risk
*Beginning medications reduces risk by 1/3rd
Cardio Disease
Cardiovascular Disease
*Reduce patient’s risk atherosclerotic cardiovascular disease
*moderate to severe___
*receive ____ and possible treatment
*Collaboration with physicians
*reduce ____
*a target factor for cardiovascular disease
*75 % of adults in the United States have been affected by ___ ___
*estimated 80.7 million adults (____/_____) have been a victim of ___ in 2011
*Women ___ men to see dentist in past 6 months
*Women have ___ periodontal health indicators
Cardiovascular Disease
*Reduce patient’s risk atherosclerotic cardiovascular disease
*moderate to severe periodontitis
*receive evaluation and possible
treatment
*Collaboration with physicians
*reduce inflammation
*a target factor for cardiovascular disease
*75 % of adults in the United States have been affected by periodontal disease
*estimated 80.7 million adults (1 out of every 3) have been a victim of CVD in 2011
*Women 2x men to see dentist in past 6 months
*Women have better periodontal health indicators
Cerebral Disorders
Cerebral Disorders
*CVA – usually ____ in elderly
*____ leading cause of death in US (7%)
*____new strokes each year
*A__ ___ and ____at greatest risk
*___ deaths/year
*_/__ of all stokes occur in age 65+
*Risk Factors
*Chronic ____
*___
*____
*Tobacco use
*____ disease
*___
*___
*Elevated ___ & ___
*___ Use
*___
Cerebral Disorders
*CVA – usually ischemic in elderly
*Third leading cause of death in US (7%)
*730,000 new strokes each year
*African American Women at greatest risk
*160,000 deaths/year
*2/3 of all stokes occur in age 65+
*Risk Factors
*Chronic hypertension
*Atherosclerosis
*Smoking
*Tobacco use
*Heart disease
*Diabetes
*Inactivity
*Elevated cholesterol & lipids
*Alcohol Use
*Obesity
Stroke Impairments
*___ control and coordination
*___
*____
*Decrease in____ tone of affected side
*___ deficits such as confusion
*___disturbances or perceptions
*Communication deficits (word +_____g)
*Changes in the f____l muscles, movement or sensory problems due to dysphasia or numbness.
*Dentures may no longer __ ___→discomfort, pain
*Reduced __ ___ → dry mouth may result
*Reduced ability to ___ or ___ → poor nutrition→ poor health
*____ therapy → dry mouth
*_____s → dry mouth is a side effect of ___% of drugs, some contain sugar=decay
*Food ____ in mouth → needs total oral care assistance
Stroke Impairments
*Motor control and coordination
*Dysphagia
*Dysarthria
*Decrease in muscle tone of affected side
*Cognitive deficits such as confusion
*Visual disturbances or perceptions
*Communication deficits (word-finding)
*Changes in the facial muscles, movement or sensory problems due to dysphasia or numbness.
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
Stroke Impairments
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
*
*Dentures may no longer stay in →discomfort, pain
*Reduced fluid intake → dry mouth may result
*Reduced ability to chew or swallow→ poor nutrition→ poor health
*Oxygen therapy → dry mouth
*Medications → dry mouth is a side effect of 85% of drugs, some contain sugar=decay
*Food remains in mouth → needs total oral care assistance
*
Diabetes
Diabetes
*Affects approximately __ in ___ Americans age 60 and older
*The number of adults age 75+ with an increase from about __ million in 2000 to more than __ million in 2050
*____ of patients 60+
*___ million are undiagnosed
*__% of diabetic patients with severe periodontal disease have experienced one or more major ___, ____ or ___ vascular events when compared to only __ % of diabetics without periodontal disease (Mealey 2006)
*Uncontrolled diabetics exhibit higher levels of ____ that can degrade ___ ___ (Ryan 2003, Salvi 1997)
*Periodontal disease results in higher ___-inflammatory cytokine _____that causes insulin ____. (Grossi 1998)
Diabetes
*Affects approximately one in four Americans age 60 and older
*The number of adults age 75+ with an increase from about 1 million in 2000 to more than 4 million in 2050
*23.1% of patients 60+
*5.7 million are undiagnosed
*82% of diabetic patients with severe periodontal disease have experienced one or more major cardiovascular, cerebrovascular or peripheral vascular events when compared to only 21% of diabetics without periodontal disease (Mealey 2006)
*Uncontrolled diabetics exhibit higher levels of collagenase that can degrade periodontal tissues. (Ryan 2003, Salvi 1997)
*Periodontal disease results in higher pro-inflammatory cytokine TNFalpha that causes insulin resistance. (Grossi 1998)
Oral Conditions
____Mouth
*Can result from medications
___l Infections
*High __ ___r levels or taking____
*Poor ___
*Poor ___ increases chance of ___ after dental surgery
Oral Conditions
*Dry Mouth
*Can result from medications
*Fungal Infections
*High blood sugar levels or taking antibiotics
*Poor Healing
*Poor control increases chance of infection after dental surgery
Mental Disorders
Mental Disorders
__ in ___ have mental disorder
___ largest Category
*Anxiety
*ASD (__ ___ Disorder)
*___phobia/___l Phobia/___ Phobia
*OCD (__ ___e Disorder)
*PTSD (__ __ __s Disorder)
*GAD (__ ___y Disorder)
*Childhood disorders
*___
*Mood - Major ___ and ___ar Disorder (Manic/Depressive)
*Psychoses
* Personality Disorders – ____, _____, schizoaffective (combo)
*Schizophrenia – delusions/hallucinations
*Substance Related – work, sex, gambling, caffeine, nicotine, food, eating, drugs, alcohol
Mental Disorders
1 in 4 have mental disorder
2nd largest Category
*Anxiety
*ASD (Acute Stress Disorder)
*Agoraphobia/Social Phobia/Simple Phobia
*OCD (Obsessive Compulsive Disorder)
*PTSD (Post Traumatic Stress Disorder)
*GAD (General Anxiety Disorder)
*Childhood disorders
*Tourette’s
*Mood - Major Depression and Bipolar Disorder (Manic/Depressive)
*Psychoses
* Personality Disorders – schizoid, narcissistic, schizoaffective (combo)
*Schizophrenia – ____/hallucinations
*____ Related – work, sex, gambling, caffeine, nicotine, food, eating, drugs, alcohol
Dental Implications
*____ brushing
*___ at teeth
*May do __ oral care
*May not ___ treatment
*May +___ your office
*Lot of the ___ cause side effects – xerostomia
*Dyskinesia and dystonia - abnormal ____s (dentures are difficult)
* Sometimes behavior is ___
Dental Implications
*Over brushing
*Picking at teeth
*May do no oral care
*May not accept treatment
*May upset your office
*Lot of the meds cause side effects – xerostomia
*Dyskinesia and dystonia - abnormal movements (dentures are difficult)
* Sometimes behavior is unusual
Cognition and other age related dementias
Cognition and Other Age Related Dementias
*Symptoms of :
*Rapidly ___ memory
*Dis___
*____
*Difficulty___ thoughts
*Paranoid suspicion about her ___ and the ___ ___
*Cause – death of___ ___s in brain
*2007 there were ___ million cases
*Management - home health/community-> adult day care ->facility
*Symptoms of :
*Rapidly failing memory
*Disorientation
*Confusion
*Difficulty expressing thoughts
*Paranoid suspicion about her family and the hospital staff
*Cause – death of neuronal cells in brain
*2007 there were 5.1 million cases
*Management - home health/community-> adult day care ->facility
Dental Considerations
Dental Considerations
*Cost -is ___ that of non-dementia
*2005 – cost was ______
*Dental Management
*____
____ appointments
*___
*Focus on p____
*Acknowledge ___
*Decide what is ___
Dental Considerations
*Cost -is 3X that of non-dementia
*2005 – cost was $300 billion
*Dental Management
*Uncooperative
*Morning appointments
*Sedation
*Focus on preventive
*Acknowledge caregiver
*Decide what is maintainable
Tests to help diagnose
Tests to Help Diagnose
___ ___ Scale
___ ____ Test
___ ___ ____ exam
*____ testing for substance abuse
Tests to Help Diagnose
*Geriatric Depression Scale
*Clock Drawing Test
*Mini-mental state exam
*CAGE testing for substance abuse
Cancer
Cancer
*Primarily a disease of those passed ___
*Treatment has extreme oral side effects that affect ability to eat
*___
*____
*Complications of ___ amd ____y must be taken into consideration before dental treatment
Cancer
*Primarily a disease of those passed 65
*Treatment has extreme oral side effects that affect ability to eat
*Mucositis
*Candidiasis
*Complications of radiation and chemotherapy must be taken into consideration before dental treatment
