Week 9 - Dentistry in Elderly Patients

Question 1

increase in elderly population - what are the implications in giving them treatment?

Answer 1

• more chronic diseases: CVS, neuro, respiratory, diabetes, rheumatological
• more complications: potential drug interactions, oral effects of disease, more drugs

Question 2

elderly patient: what are the two groups? define each one

Answer 2

• healthy: comorbidity, medication. to be treated as young people with chronic disease
• frail: disabled, dementia, delirium, depression, de-nourishment, destitution, dependency, drugs, death

Question 3

what is the criteria for the definition of frailty?

Answer 3

• inability to perform activities of daily living 3 days prior to admission
• depression
• dementia
• history of falls
• MUST score 1 or more
• 1 or more unplanned admissions in past 3 mnths
• unable to walk/has walking aid
• bedbound for 4 days or more
• incontinent

Question 4

disability: why does it occur and how does it affect a patient’s dental care?

Answer 4

• neurological disease: stroke/parkinson’s disease
• rheumatological disease: osteoarthritis & rheumatoid arthritis
• loss of manual dexterity/mobility
• impaired physiology: loss of thirst reflex-> dry mouth

Question 5

dementia: what is it?

describe the gradual process in those affected

Answer 5

• global loss of brain function: cognition, function and personality

1. simple forgetfulness, hardening of personality traits
2. struggle with complex tasks, behavioural change, loss of independence
3. inability to communicate, total dependence. personality unrecognisable.

Question 6

delirium - what is it?

what are the predisposing factors?

Answer 6

acute confusional state

predisposing factors:

• frail body: age, multimorbidity, advanced illness, malnutrition
• frail mind: age, stroke, dementia, depression

Question 7

depression/anxiety: why is it more common in elderly people?

Answer 7

• physical illness
• social circumstances
• issues of mulnutrition and dehydration

Question 8

malnutrition: why do elderly people get malnourished

Answer 8

• lack of accessibility
• unable to eat food
• impaired appetite
• unwilling to eat
• GI problems: poor oral health, GI tract issues

Question 9

dependency: what are the various forms?

Answer 9

• family carers
• external carers
• institutionalization: sheltered housing, residential homes, nursing homes

Question 10

disability: what are the issues when it comes to dental care?

Answer 10

• high risk of adverse events e.g. chest pain
• manual dexterity
• access to services
• visual deficits
• communication issues
• allow extra time, dont rush
• respect

Question 11

dementia: what are the issues when it comes to dental care?

Answer 11

• neglect of OH
• comprehension issues
• capacity to consent: may require AWI form
• compliance
• interaction with carers and relatives
• prescribing: risk of delirium with analgesics

Question 12

depression/anxiety: what are the issues when it comes to dental care?

Answer 12

• OH neglect
• compliance
• allow time?

Question 13

malnutrition: what are the issues when it comes to dental care?

Answer 13

• identification of those malnourished

- treatment, communicate with GP

Question 14

destitution: what are the issues when it comes to dental care?

Answer 14

offer realistic treatments in terms of cost

Question 15

dependency: what are the issues when it comes to dental care?

Answer 15

need for domiciliary visits

interaction with carers and communication

Question 16

drugs: what are the issues when it comes to dental care?

Answer 16

• get accurate PMH/drug history
• polypharmacy: interactions & side effects
• avoid harmful drugs: NSAIDs in over 90s cause GI side effects. don’t overuse antibiotics (C. difficile risk)

Question 17

death: what are the issues when it comes to dental care?

Answer 17

• realistic treatments in terms of how long tx will take
• liaise with GP if unsure
• focus tx on patient, not teeth