Oral health of older people Flashcards
(33 cards)
What age are people expected to live now?
Beyond 60 in low, middle & high income countries
What is healthy ageing?
Process of developing and maintaining the functional ability that enables well- being in older age
What are the majority of health conditions experienced by older people due to?
Non-communicable diseases
What can ageing be associated with & what does it impact?
Associated with physiological changes that can impact on nutritional status
Psychosocial and environmental changes, such as isolation, loneliness, depression and inadequate finances, which can have significant impacts on diet.
What can physiological changes be caused by?
- sensory impairments (decreased sense of taste or smell)
- reduced appetite
- dental problems
- impaired gastric acid secretion
- limited mobility and ability to care for oneself
Consequences to ageing?
- There are consequences to ageing including movement function, sensory function (hearing and vision), cognitive function (dementia etc), and immune function
- Multiple-morbidities:
- Anxiety and depression
- Osteoarthritis
- Dementia
- COPD
- Diabetes
- Cancer
- Ischaemic heart disease
- Stroke
- Hearing and vision impairments
- Falls
Those living longer and their added years are in good health are more likely to…
Contribute to society
Those living longer but experiencing poor health…
May mean increased demands on health and social care
Underlying principles of ageing & long term care?
- Long-term care should be affordable and accessible
- Care should be provided to enhance older people’s dignity, and enables their self-expression
- Care should be person-centred and focused around the needs of the older person rather than the structure
- Regulation of these structures is important
- Building workforce capacity and supporting of carers
Why is Oral Health Important?
- Good oral health is important for well-being
- People living longer, keeping their dentition and needing more complex treatment
- Prevention is very important
- Mouth is a mirror of health and disease: systemic diseases, bacterial and viral infections and nutritional deficiencies
How does oral health affect general health?
- Being free of pain and discomfort
- Ability to function: chewing, eating will have an impact on nutrition
- Ability to smile and socialise will have an impact on self-esteem and mental health
- Increased risk to infections: dental abscess, candidiasis, pneumonia
- Frailty, disability and dementia: increases risk of poor general and oral health and access to care
Oral Health Needs of Older people?
- High levels of dental caries
- High prevalence of periodontal disease
- Tooth loss
- Mouth cancer
- Candida infection
- Dry mouth
- The oral health profiles of older people varies between high, middle and low income countries
- In high income countries such as the UK, older people are keeping their teeth longer
How to manage patients with dementia?
- People with dementia may find it hard to communicate or co-operate.
- Those caring for them may not have the time, confidence or the training .
- It is important to recognise that some people have good days and bad days
- Try to find out the individual’s best time of day for mouth care.
- Use clear short instructions
- Smiling and using appropriate touch and reassuring gestures.
- It sometimes takes two people – one to distract, hold hands or encourage whilst the other brushes the teeth.
General findings of oral health of older people in long term care?
- Older adults living in residential and nursing care homes are more likely to be edentulous, and less likely to have a functional dentition
- Older adults living in care homes have higher caries prevalence, where the majority of dentate residents have active caries
- Signs of severe untreated caries appear to be more common in the oldest age groups across all settings
What is the access to dental care like for older people in long term care?
- Care home managers experience much more difficulty in accessing dental care for their residents
- Dental services are patchy and often no regular or emergency dental care arrangements exist
Why are people who are hospitalised associated with a deterioration in oral health?
- Increase in hospital acquired infections
- Poor nutritional intake
- Longer hospital stays
- Increased care costs
What is the ambition for oral health for vulnerable older people?
- To be able to eat, sleep, socialise & maintain this throughout life
- Live well - as people age they are able to eat, drink, speak, smile & socialise without pain discomfort or embarrassment
- Prevent well - people are supported by evidence-based advice & interventions to enable them to maintain a healthy life throughout their lives
- Support well - throughout any phases of dependency or frailty, carers are trained & equipped to support daily mouth care & facilitate access to dental services
- Die well - people have the support they need to ensure their mouths remain free from pain & discomfort & to help them maintain dignity until the end of their lives
What are the 5 As regarding access to healthcare?
Availability
Affordability
Acceptability
Physical accessibility
Accommodation
What is definition of the 5 As?
Availability
- refers to the adequacy of supply given by the relationship between volume and type of services (provision) and volume and type of needs (demand).
Affordability
- applies to the cost implications to the patient in relation to need
Acceptability
- refers to attitudes and beliefs of users and providers about each other’s characteristics.
Physical accessibility
- is defined by the suitability of the location of the service in relation to the location and mobility of the patient (geographical and physical barriers).
Accommodation
- refers to the way services are organised in relation to the client’s needs and the patient’s perception of their appropriateness (opening times, booking facilities, waiting times).
What is the case for action for the ageing population?
Older people have the skills, experience and wisdom to make a positive contribution to society
Ageing Population and the Public Health
Response
- A systems-wide response to promote active ageing with Integration of health and social care for best outcomes
- Health systems need to adapt to manage health conditions in older age groups adopting a multi- disciplinary approach and not treating conditions in silos
- Health systems need to be affordable and accessible to older people
NICE guideline recommendation to managers of care homes?
Managers ensure their home’s policies set out plans and actions to promote and protect people’s oral health.
8 guidances set out by NICE for oral health in care homes?
1.Raise awareness with all relevant partner organisations.
- Identify an oral health champion
- Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision.
- Think about what data you need to measure improvement and plan how you will collect it
- Develop an action plan, to put the guideline into practice, and make sure it is ready as soon as possible.
- For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan.
- Implement the action plan with oversight from the lead and the project group.
- Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners
NICE states care home policies set out plans and actions to promote and protect residents’ oral health, what should they include information about?
- local general dental services and emergency or out-of-hours dental treatment
- community dental services
- oral health promotion or similar services,
- assessment of residents’ oral health and referral to dental practitioners
- plans for caring for residents’ oral health and daily mouth care and use of mouth and denture care product
