Elderly patients – as time goes by
Life expectancy is longer than ever. But there is still work to do when considering how we look after our elderly patients, argues Rachel Pointer.
People have always associated tooth loss with old age. The Adult Dental Health Survey (NHS, 2011) revealed that more than half of those over the age of 85 had retained at least some of their natural teeth. Standards of care and education have improved and teeth can be restored, rather than removed.
However, the 2017 Royal College of Surgeons report, Improving Older People’s Oral Health, claimed that 1.8m over-65s have an urgent dental condition, from oral sepsis to extensive decay.
It listed its recommendations, including one that ‘preventive advice on maintaining good oral health should be easily available for older people themselves, their families and their carers’.
How are we going to cope?
For elderly people, oral health-related problems can have a tremendous impact on their quality of life and emotional wellbeing.
Dental pain is isolating at any age; but social withdrawal and difficulties with speaking, eating and brushing because of sore teeth and/or gums for a patient who is already vulnerable will be devastating.
The problem of an ageing population worldwide has been covered extensively. It comes down to one thing: how are we going to cope with more people who are living longer? A long life is not always a healthy life. There are currently more than 850,000 people across the UK with dementia, according to the Alzheimer’s Society. Many of whom do not have a diagnosis – and this figure is bound to rise.
Managing the elderly patient
For the dental professional, you need to give constant consideration to the specific and vast dental needs of elderly patients.
If their toothache leads to eating problems, malnutrition may be the result. A patient who is malnourished will take longer to recover from even a minor illness.
A sore mouth can make swallowing uncomfortable, which may impede their ability (or desire) to take their medication.
Many elderly patients will already suffer from xerostomia. Medication (including some over-the-counter formulations) can be the cause of this – though it may also be due to dehydration.
Brushing effectively, or for long enough, may be impossible. Even without dental pain, a health condition or limited dexterity can make daily cleaning hard.
Studies have found evidence to link a poor standard of oral health with aspiration pneumonia. One, by Scannapieco (2006), concluded: ‘The mouth can be colonised by respiratory pathogens and serve as a reservoir for these organisms… oral interventions aimed at controlling or reducing oral biofilms can reduce the risk of pneumonia in high-risk populations… the evidence is substantial that improved oral hygiene may prevent pneumonia in vulnerable patients.’
Pneumonia can increase hospital stays by an average of eight days; NICE guidelines warn that in the most fragile patients it can be fatal.
The ageing population
Two more significant challenges for dental care practitioners are the problems of working with restored teeth (peri-implantitis is a growing concern) and the issue of the care home population – namely, how to support residents as well as staff.
The BDA has provided evidence to NICE for a new quality standard for oral health in care homes. The resulting guidance (NICE, 2017) included recommendations that adults who move into a care home have their oral care needs assessed on admission and that they are supported in cleaning their teeth twice a day.
To climb this mountain, we must look at prevention first.
Ensure the whole dental team is able to talk through and demonstrate correct technique to clean the inside of the mouth properly and which adjunctive products to use. In terms of tools, recommend a brand that you know can offer high functionality. This is to ensure a gentle, efficient clean suitable for all ages.
Talk to families and listen to their needs and worries. Reach out to local care homes to offer advice in good preventive care. Highlight what symptoms to look out for and when to call in a dentist.
Receding gums may be part of getting older. However, there is much we can do to protect the dignity and quality of life of elderly patients.
Smiling less and losing social confidence can erode identity; something as simple as oral pain management can be life changing.
Dental conditions affect nearly two million elderly people. We must give this group’s needs as much attention as we do to our younger patients.
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This article first appeared in Oral Health magazine.