Gerodontology/End of Life Care Flashcards
(65 cards)
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
2
Q
What does dementia effect
A
- memory
- thinking
- comprehension
- calculation
- learning capacity
- language
3
Q
What do people with dementia often have problems with
A
- day to day memory
- concentrating, planning organising
- language
- visiospatial skills
- orientation
4
Q
What is the impact of day to day memory difficulties
A
may find it difficult to recall recent events
5
Q
What is the impact of concentrating, planning or organising difficulties
A
- difficult to make decisions
- solving problems
- carrying out sequence of taks
6
Q
What is the impact of language difficulties
A
- difficulties following a conversation or finding the right word for smth
7
Q
What is the impact of problems with visiospatial skills
A
problem judging distances e.g on stairs
struggle to see third dimension
8
Q
What is the impact of problems with orientation
A
- losing track of day or date
- becoming confused about location
9
Q
What is the impairment in cognitive function in dementia usually preceded by
A
- ability to control emotions
- more withdrawn socially
- reduced motivation
10
Q
What are the main types of dementia
A
- alzheimers
- vascular
- dementia with lewy bodies
- frontotemporal
- rare forms - HIV associated, parkinsons, MS etc
11
Q
What is alzheimer’s
A
- reduction in size of cortex
- plaques and tangles present!
12
Q
Alzheimer’s
What are plaques
A
- deposits of protein fragment called beta-amyloid
- these build up in spaces between nerve cells
13
Q
Alzheimers
What are tangles
A
- twisted fibres of tau protein build up inside cells
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- withdrawn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
15
Q
What is vascular dementia
A
- reduced blood flow to brain
- damages and kills brain cells
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
17
Q
What are distinctive features of vascular dementia
A
- memory problem of sudden onset
- visiospatial difficulties
- symptoms of stroke
- anxiety
- delusions
- seizures
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
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
20
Q
What does the frontal lobe deal with
A
- behaviour
- problem solving
- planning
- control of emotions
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
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
23
Q
What are behavioural features of dementia
A
- depression - diagnosis may precede dementia by several years
- apathy/emotional blunting
- anxiety
- irritability
24
Q
What is apathy
A
someone who is content to sit in a chair all day
25
What is emotional blunting
refers to lack of persons affective response
may not respond to gestures of love
26
Dementia patients can experience hallucinations, what is a hallucination
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
27
What is a delusion
fixed false belief that is resistant to reason or confrontation with facts
can involve paranoia
28
How should we manage psychosis in dementia px (delusions and hallucations)
* avoid explanations
* strong declarative statements to end discussion
* avoid lengthy convos
* dont argue, correct or contradict hallucination/delusion
* distract
29
What are the metabolic risks of antipsychotic medications
* increased blood sugar
* increased cholesterol
* orthostatic risks
* lowered BP on standing
* sedation is a risk for those on these meds
30
How should we tx plan for early stage dementia
* 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
What are key teeth to retain for QoL
* oclcuding pairs
* anterior teeth
32
How should we tx plan for midstage dementia
* maintenance and prevention
* consider medical status
33
How should we tx plan for late stage dementia
* focus on comfort
* moist, clean and healthy mouth which is free of pain and infection
* non invasive
* emergency management - limited options
34
What are the difficulties for IV sedation in elderly
* venous access hard
* dose required changes with age
35
What is the problem with GA in elderly
* complications risk increases
* risk of HAI
36
What are the 3 end of life trajectories
* unexpected death trajectory
* terminal cancer trajectory
* progressive functional loss trajectory
37
What are the oral self care function changes in unexpected death trajectory
no changes
38
What are the oral health changes in unexpected death trajectory
minimal changes
39
What are the oral self care function changes in terminal cancer trajectory
varied
40
What are the oral health changes in terminal cancer trajectory
* xerostomia
* oral soft tissue pathology
41
What are the self care function changes in progressive functional loss trajectory
* decreased
42
What is the oral health changes in progressive functional loss trajectory
* poor OH
* caries
* oral pain and infection
* tooth loss
* denture related problems
* xerostomia
* soft tissue pathology
43
What are problems elderly suffer with
frailty
polypharmacy
continence
falls
bone health
nutrition and weight loss
44
What is the dentists role in helping elderly with their nutrition
* providing a good set of dentures means they can chew better and have wider variety of foods
45
What causes parkinsons disease
accumulation of alphasynuclein protein causes the formation of lewy bodies in cerebral neurons
disrupts production of dopamine
46
What do px present with in the early stages of parkinsons
* tremor
* stiffness
* slowness of movement
47
What should we consider when treating px with parkinsons
* 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
What is immunosenscene
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
For those with diabetes, what HbA1c level is required prior to proceeding with tx within dental clininc
<7%
50
If a diabetic's HbA1c levels are >9% what can be done
emergency tx only
any surgical procedures should be in hospital settings
51
In diabetics with HbA1c >12%, what should be done
postpone until glycaemic control improved
52
What are the risks of diabetes
* hyperglycaemia
* hypoglycaemia
* fatigue
* increased risk of infection
* poor wound healing
* increased risk of perio disease
* complications related to comorbidities
53
Why should diabetics be booked in in the morning
higher cortisol levels
this increases blood glucose levels
decreases risk of hypo
54
What are risk factors for stroke
atrial fibriliation
hypertension
diabetes
smoking
55
How can stroke effect speech
expressive dysphasia
receptive dysphasia
dysarthria
56
What is expressive dysphasia
* forming of language difficult, struggling to get the words out
57
What is receptive dysphasia
* understanding effected
* px may vocalise but understanding of what others are saying may be lost
58
What is dysarthria
* difficulty with physical formation of words, speech may appear slurred or harder to understand
59
What are dental considerations for stroke
* 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
When is risk of recurrent stroke highest
first 30 days after initial event
61
When is it best to do elective and invasive dental tx with stroke
ideally deferred to 6 months post stroke
62
What should you consider for stroke px when considering dental tx
* stability of disease
* anticoag regime
* transfer potential
63
For stroke px with dysphasia, what is essential during dental tx
oral suction
64
Which analgesic is preferrable for stroke px
paracetamol
65
What are the major oral complaints in elder px
dry mouth
ulceration
infection
pain
