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BDS4 SCD > Gerodontology/End of Life Care > Flashcards

Gerodontology/End of Life Care Flashcards

1
Q

What is dementia

A
  • syndrome
  • usually of a chronic or progressive nature
  • deterioration in cognitive function i.e ability to process thoughts
  • beyond what might be expected from normal ageing
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2
Q

What does dementia effect

A
  • memory
  • thinking
  • comprehension
  • calculation
  • learning capacity
  • language
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3
Q

What do people with dementia often have problems with

A
  • day to day memory
  • concentrating, planning organising
  • language
  • visiospatial skills
  • orientation
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4
Q

What is the impact of day to day memory difficulties

A

may find it difficult to recall recent events

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5
Q

What is the impact of concentrating, planning or organising difficulties

A
  • difficult to make decisions
  • solving problems
  • carrying out sequence of taks
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6
Q

What is the impact of language difficulties

A
  • difficulties following a conversation or finding the right word for smth
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7
Q

What is the impact of problems with visiospatial skills

A

problem judging distances e.g on stairs
struggle to see third dimension

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8
Q

What is the impact of problems with orientation

A
  • losing track of day or date
  • becoming confused about location
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9
Q

What is the impairment in cognitive function in dementia usually preceded by

A
  • ability to control emotions
  • more withdrawn socially
  • reduced motivation
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10
Q

What are the main types of dementia

A
  • alzheimers
  • vascular
  • dementia with lewy bodies
  • frontotemporal
  • rare forms - HIV associated, parkinsons, MS etc
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11
Q

What is alzheimer’s

A
  • reduction in size of cortex
  • plaques and tangles present!
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12
Q

Alzheimer’s

What are plaques

A
  • deposits of protein fragment called beta-amyloid
  • these build up in spaces between nerve cells
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13
Q

Alzheimers

What are tangles

A
  • twisted fibres of tau protein build up inside cells
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14
Q

What are distinictive features of alzheimers

A
  • short term memory loss
  • aphasia
  • communication difficulties
  • muddled over everyday activities
  • mood swings
  • withdrawn
  • loss of confidence
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15
Q

What is vascular dementia

A
  • reduced blood flow to brain
  • damages and kills brain cells
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16
Q

What can vascular dementia be caused by

A
  • narrowing and blockage of small blood vessels deep inside the brain - known as small vessel disease
  • single large stroke
  • lots of mini strokes
  • usually linked to underlying CV problems e.g BP, smoking, obesity
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17
Q

What are distinctive features of vascular dementia

A
  • memory problem of sudden onset
  • visiospatial difficulties
  • symptoms of stroke
  • anxiety
  • delusions
  • seizures
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18
Q

What is dementia with lewy bodies

A
  • deposits of abnormal protein called lewy bodies
  • desposited in brain cells
  • these deposits are also found in those with parkinsons
  • they build up in areas responsible for memory and muscle movement
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19
Q

What are distinctive features of dementia with lewy bodies

A
  • cognitive ability fluctuates
  • visiospatial difficulties
  • attention problems
  • overlapping motor disorders
  • speech and swallowing problems
  • sleep disorders
  • delusion
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20
Q

What does the frontal lobe deal with

A
  • behaviour
  • problem solving
  • planning
  • control of emotions
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21
Q

What are the main symptoms of frontotemporal dementia

A
  • changes in personality and behaviour
  • difficulties with language
  • younger age of onsert
  • ubiqitin associated clumps of protein
  • TDP-43
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22
Q

What are distinctive features of frontotemporal dementia

A
  • STML may not always be present
  • uncontrolled repetition of words
  • mutism
  • repetition of words of other people
  • personality change
  • decline in personal and social conduct
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23
Q

What are behavioural features of dementia

A
  • depression - diagnosis may precede dementia by several years
  • apathy/emotional blunting
  • anxiety
  • irritability
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24
Q

What is apathy

A

someone who is content to sit in a chair all day

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25
Q

What is emotional blunting

A

refers to lack of persons affective response
may not respond to gestures of love

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26
Q

Dementia patients can experience hallucinations, what is a hallucination

A

abnormal senesory perception to stimulus that is not present
commonly visual but cna also be autidory
it is a diagnostic criterion for dementia with lewy bodies

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27
Q

What is a delusion

A

fixed false belief that is resistant to reason or confrontation with facts
can involve paranoia

28
Q

How should we manage psychosis in dementia px (delusions and hallucations)

A
  • avoid explanations
  • strong declarative statements to end discussion
  • avoid lengthy convos
  • dont argue, correct or contradict hallucination/delusion
  • distract
29
Q

What are the metabolic risks of antipsychotic medications

A
  • increased blood sugar
  • increased cholesterol
  • orthostatic risks
  • lowered BP on standing
  • sedation is a risk for those on these meds
30
Q

How should we tx plan for early stage dementia

A
  • MDT?
  • plan for future due to progressive nature
  • identify and attempt to retain key teeth
  • focus on high quality restorations
  • are complex restorative tx able to be cared for in the long term?
  • establish prevention regime
31
Q

What are key teeth to retain for QoL

A
  • oclcuding pairs
  • anterior teeth
32
Q

How should we tx plan for midstage dementia

A
  • maintenance and prevention
  • consider medical status
33
Q

How should we tx plan for late stage dementia

A
  • focus on comfort
  • moist, clean and healthy mouth which is free of pain and infection
  • non invasive
  • emergency management - limited options
34
Q

What are the difficulties for IV sedation in elderly

A
  • venous access hard
  • dose required changes with age
35
Q

What is the problem with GA in elderly

A
  • complications risk increases
  • risk of HAI
36
Q

What are the 3 end of life trajectories

A
  • unexpected death trajectory
  • terminal cancer trajectory
  • progressive functional loss trajectory
37
Q

What are the oral self care function changes in unexpected death trajectory

A

no changes

38
Q

What are the oral health changes in unexpected death trajectory

A

minimal changes

39
Q

What are the oral self care function changes in terminal cancer trajectory

A

varied

40
Q

What are the oral health changes in terminal cancer trajectory

A
  • xerostomia
  • oral soft tissue pathology
41
Q

What are the self care function changes in progressive functional loss trajectory

A
  • decreased
42
Q

What is the oral health changes in progressive functional loss trajectory

A
  • poor OH
  • caries
  • oral pain and infection
  • tooth loss
  • denture related problems
  • xerostomia
  • soft tissue pathology
43
Q

What are problems elderly suffer with

A

frailty
polypharmacy
continence
falls
bone health
nutrition and weight loss

44
Q

What is the dentists role in helping elderly with their nutrition

A
  • providing a good set of dentures means they can chew better and have wider variety of foods
45
Q

What causes parkinsons disease

A

accumulation of alphasynuclein protein causes the formation of lewy bodies in cerebral neurons
disrupts production of dopamine

46
Q

What do px present with in the early stages of parkinsons

A
  • tremor
  • stiffness
  • slowness of movement
47
Q

What should we consider when treating px with parkinsons

A
  • be aware of timing of medication, it is critical
  • may need to take meds mid procedure
  • px with dyskinesias may find it hard to lie still
  • IV sedation with midazolam can help these px to relax their muscles and reduce movement to provide safe tx
48
Q

What is immunosenscene

A

changes in immune system with increasing age
functions less wel
risk of cancer, autoimmune disease and infeciton risk increases
macrophages work slower, t cell response reduces

49
Q

For those with diabetes, what HbA1c level is required prior to proceeding with tx within dental clininc

A

<7%

50
Q

If a diabetic’s HbA1c levels are >9% what can be done

A

emergency tx only
any surgical procedures should be in hospital settings

51
Q

In diabetics with HbA1c >12%, what should be done

A

postpone until glycaemic control improved

52
Q

What are the risks of diabetes

A
  • hyperglycaemia
  • hypoglycaemia
  • fatigue
  • increased risk of infection
  • poor wound healing
  • increased risk of perio disease
  • complications related to comorbidities
53
Q

Why should diabetics be booked in in the morning

A

higher cortisol levels
this increases blood glucose levels
decreases risk of hypo

54
Q

What are risk factors for stroke

A

atrial fibriliation
hypertension
diabetes
smoking

55
Q

How can stroke effect speech

A

expressive dysphasia
receptive dysphasia
dysarthria

56
Q

What is expressive dysphasia

A
  • forming of language difficult, struggling to get the words out
57
Q

What is receptive dysphasia

A
  • understanding effected
  • px may vocalise but understanding of what others are saying may be lost
58
Q

What is dysarthria

A
  • difficulty with physical formation of words, speech may appear slurred or harder to understand
59
Q

What are dental considerations for stroke

A
  • understanding may be affected if they have higher cortical involvement
  • movement and mobility around surgery
  • speech and swallowing may be impared
  • may have feeding tube
  • adaptions to toothbrush handles
  • higher risk of dental disease due to poor oral clearance
  • dry mouth, pouching
60
Q

When is risk of recurrent stroke highest

A

first 30 days after initial event

61
Q

When is it best to do elective and invasive dental tx with stroke

A

ideally deferred to 6 months post stroke

62
Q

What should you consider for stroke px when considering dental tx

A
  • stability of disease
  • anticoag regime
  • transfer potential
63
Q

For stroke px with dysphasia, what is essential during dental tx

A

oral suction

64
Q

Which analgesic is preferrable for stroke px

A

paracetamol

65
Q

What are the major oral complaints in elder px

A

dry mouth
ulceration
infection
pain

BDS4 SCD (5 decks)

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