Social and psychological aspects of ageing Flashcards
Identify and discuss the perspectives of the older/elderly patient and the result of those perceptions
For geriatric patients, these are some common perspectives they have:
• Negative perception towards dentists due to past experiences (LA not used until 1940s and air turbine not until mid 1950s)
• Expectation for treatment rather than prevention (prevention is a relatively new concept)
• Expectations that dentures are inevitable as emphasis on preventing periodontal disease via plaque control started much later (1960s)
• The connections between systemic issues and periodontal issues were not known or considered
• Expectations that being old means ill health, less physical activity and accept feeling unwell
Result: Older individuals often do not seek health care unless there’s pain/ problem
Identify the characteristics and other factors that influence interactions between the older/elderly patient and dental practitioner
- Biopsychological Model
(Biological factors, social factors, psychological background) - Perceptions towards healthcare
- Personal health perceptions
Explain the biopsychological model and how this influences interactions between the older/elderly patient and dental practitioner
- The biopsychosocial model views health and illness behaviors as products of biological characteristics, psychological factors and social conditions
- As healthcare professionals, we must help older patients deal with the psychological and emotional aspects of health and illness
List and explain the components of the biopsychosocial model
- Biological factors:
• Illnesses related to ageing like
• Example, arthritis and how this affects their ability to maintain their periodontal health
Social factors
• Expectations; age barriers (old patient vs young clinician)
• Extent of social involvement (family status, past and present relationships) impacts whether the patient has more positive outlook
Psychological background
• Locus of control: When self control is taken from an individual, it can become frightening and make a person feel dependant. For example, leaving your faith in the clinician
• Attitudes:
• Positive attitude- patient accepts that without their cooperation, prognosis will be poor
• Negative attitude- patient not able or willing to accept their part in treatment (E.g. oral hygiene)
Explain how perceptions towards healthcare provides influences the interactions between the older/elderly patient and dental practitioner*
- Previously, most adults relied on opinions/advice of health professionals
- Today, patients are interested in knowing much more about their health care and are taking control of their own health
- However, the older patient may be uneager to play a role in their treatment
- New elderly (60- 64 years) held significantly more positive attitudes towards dental practitioners than old elderly (+75 years)
- Lack of respect due to advanced age
Explain how the personal health perceptions of an older person influences their interactions with dental practitioners
- Expectations that health deteriorates with old age causes older individuals to underreport symptoms.
- Those born around 20th century, most likely did not receive dental care during childhood. Thus, total tooth loss by age 20 to 30 years was more common
- Those aged 70 to 90 or older who have retained some teeth feel fortunate- may expect deterioration to edentulous state (I have 3 teeth, that is better than 0)
- However, older people exposed to preventive and restorative dental care during lifetime are more likely to continue healthy oral habits to preserve their teeth
- It is important to remember that older people are capable of learning new tasks. It may require more time and repeated exposure to information, but they will be able to apply new information better than someone who is younger
Identify the patient related barriers with respect to dental care of older/elderly patients
- Cost
- Access to dental services
- Fear/apprehension
- Mood/ depression
Identify the practitioner-related barriers with respect to dental care of older/elderly patients
- Age affects treatment planning
- May provide rudimentary (limited) treatment
- Previous attendance patterns
- Lack of confidence treating older patients
Discuss the patient related barriers with respect to dental care of older/elderly patients
- Cost: retired, living on pension, not enough money. May not be able to afford electric toothbrush. Thus, we have to work around what they use, for example modifying their technique with the manual toothbrush/ enabling better mobility
- Access to dental services: if relying on the public system, there are usually long waiting lists. Public systems usually focus on problems, not prevention.
- Fear/apprehension: Negative perception towards dentists due to past experiences, for example LA not used previously.
- Mood/ depression: Serious chronic medical issues, stressful life events (E.g. death of spouse) and social isolation can increase likelihood of depression
Discuss the practitioner related barriers with respect to dental care of older/elderly patients
- Age affects treatment planning: Can’t sit in chair very long, need to spend more time focusing on OHI so they can understand it better
- May provide rudimentary (limited) treatment: patient can’t sit for too long
- Previous attendance patterns: might have to rely on public transports or other family members to drop them off
- Lack of confidence treating older patients: might be hard to scale and clean in patients who have missing teeth/ unstable periodontium, inexperience dealing with such patients
Identify issues with communication and discuss strategies to improve communication
Identifying issues
• Clinicians underestimate the ability of older patients to communicate effectively. This leads to ‘elderspeak’:
• Using exaggerated intonation, higher pitch, volume
• Speaking very slowly, using simple vocabulary and grammar
• Oversimplifying communication style can be insulting and imply older patient is not capable of making intelligent decisions
Strategy of improvement
• Validate older patient by acknowledging their concerns
• Shared decision-making to enable patient to show that their preferences and goals are valued as well
Effect: Reduces patient stress, increases confidence in treatment
Discuss strategies to improve empathy and identify its positive effects on treatment
• Empathy is about understanding their patient and sharing/ understanding their emotions
Effects of Empathy
• Helps develop a sustaining relationship between patient and clinician
• Reduces patient’s feeling of isolation
Associated with better outcomes and fewer malpractice claims
Discuss the three things required to improve the clinical experience of a patient
Knowledge
• Understand the psychology and sociology of ageing, diseases of ageing, pharmacology & drug interactions, biology & physiology of ageing, related systemic diseases
Skills
• Proper communication, ability to adapt tx plans & diagnose tx needs, management of elderly
Attitudes
• Being empathetic, caring/compassionate, positive attitude toward and respect for elderly, flexibility in tx planning
