Growth and Ageing Essay

7/24/2019 Growth and Ageing Essay

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Growth and Ageing Assignment

You have been put in charge of a dental team providing dental care to a large

(100 bed) nursing home facility. Discuss the likely dental health needs of the

residents of this facility and describe how you would plan and deliver appropriate

care to them?

he strategy used to identify the literarure listed involved a thorugh search of

the !"#$ %rtcile &earch Database using key search terms and limiting this to the

#'. urther searches included ochrane *eview+ ,ub "ed+ -ritish Dental ournal+

/nternational %ssociation for Dental *esearch and individual ournal websites+ eg

Gerodontology.

Dental Health in Instituionalised Older People

%s one ages+ ones teeth transform considerably. he adult dentition is e2pected

to last a lifetime and oral health should be a lifetime concept. 3igh 4uality oral

healthcare should be available to all people regardless of their age orcircumstances. 3owever the reality is rather di5erent. he %dult Dental 3ealth

&urvey #' 1667 found that age is the single biggest reason for the decrease in

sound and untreated teeth. 8evertheless+ this pattern of elderly people

e2pecting to lose their teeth is changing because of the 9baby boomer:

generation who are e2pected to maintain and enhance the demand for dental

care amongst the new cohort of elderly1.

his recent trend amongst the elderly is not indicative of dental care in nursing

home facilities. % study looking at residents of nursing homes across -ristol;

found considerable neglect with regards to oral health. of the residentshad not seen a dentist for over ve years. %mongst the denture wearers 7;>

were unable to clean their dentures and needed assistance from the sta5 and

denture@related stomatitisa5ected AA>. !uite shockingly+ unhygienic dentures

were worn by almost all of the subects. hose fortunate enough to be in the

dentate population su5ered a similar plight. of subects and root cariesin CA> of subects. he

overriding message from this study was that residents of care homes re4uired

assistance with cleaning their dentures and teeth yet the appropriate level of

care was not provided for by the sta5.

1 3&* E. D


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% further studyAfound consistent results with the above research. he ndings

showed high levels of both coronal and root caries. ,la4ue retention is a problem

in elderly people who have diFculty in mechanically removing pla4ue owing to

diminished manual de2terity+ impaired vision+ or illness. ,oor denture hygiene

has been found. %lthough residents preferred assistance in cleaning their teeth

and dentures+ only 6G reported that the sta5 had helped them. he compelling

part of this research was that even in cases where sta5 helped the residents

clean their dentures and teeth+ they wer no cleaner than those cleaned by

residenets. his suggest a possible training issue.

he study also found that many residents received medications known to

produce 2erostomia+ A6C were given syrups containing sugar and A7H residents

reported su5ering with dry mouth. /n this case this lead to denture stomatis

(particulary with residents who wear dentures at night)+ angular chelitis+ oral

ulcerations+ sore and ssured tongues. he role of medication and poly pharmacy

plays a part in oral health for the elderly.

he research found that the managers indicated that there was no systematic

approach to arranging dental care. Dental care was sought only when residents

or their relatives complained of acute dental problems such as pain or a broken

denture. Dental assessments were not carried out when residents were admitted+

neither was a care plan developed that included intraoral care. 8o emphasis is

given to prevention in a care home environment.

Dental 'a(tors that (ontri)ute to *ualit+ o' li'e

here are many disabling e5ects of dental and oral disorders that are fre4uent

amongst elderly and that have a profound impact on health. % study deploying a

4uestionnaireGin a nursing home found that the maority of the residents had

diFculty eating+ communicating and had problems with taste. *esearch has

found that elderly edentulous patients could not eat food which was necessary

for a stable diet for e2ample raw carrots+ apples+ steaks or nuts.H urther research

AD &imonsa+%" 'iddb+D -eightonbI Oral health o' elderl+ o((upants inresidential homes The $ancet+ Jolume AHA+ /ssue 61CC+ ,age 1=C1+ ;; "ay 1666

G D &imonsa+ %" 'iddb+ D -eightonbI Oral health o' elderl+ o((upants in

residential homes The $ancet+ Jolume AHA+ /ssue 61CC+ ,age 1=C1+ ;; "ay

1666

H &heiham.B. &teele E. "arcenes&. inch+ %.E.B. Ealls. The impact of oral

health on stated ability to eat certain foods; Findings from the National Diet and

Nutrition Survey of Older People in Great ritain. Berontology Jolume 1C /ssue 1pages 11 @;0 uly 1666.
http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Simonshttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff1http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=EAM+Kiddhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=D+Beightonhttp://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)01343-4/fulltext#aff2http://www.thelancet.com/journals/lancet/issue/vol353no9166/PIIS0140-6736(00)X0142-0


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as shown poor oral health may be an important contributing factor to the

development of signicant involuntary weight loss among the frail elderlyC.he

poor oral status of the institutionalised elderly+ found in this and previous

studies+ may contribute to the eating problems and low nutrient and vitamin

levels found in this group. hese results+ combined with the reduced ability of

elderly people to communicate+ may cause weight loss+ dehydration+ and debility.


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eating and associated embarrassment. 3e emphasised the importance of

aesthetically acceptable and functionally ade4uate dentitions so people can feel

condent about eating at home or in company. iske et aP" e2plored the

emotional reactions to tooth loss and found that tooth loss a5ected self@esteem+

condence+ enoyment of food+ selection of food+ socialisation and forming close

relationships even when teeth were replacedby dentures

Treatment planning Issues

%s people age their health deteriorates and when treatment planning for this

population this needs to be considered. /t is believed that there are currently

=00+000 people with dementia in the #'+ of whom 1H+000 have early onset

dementia+ ie onset before the age of CH. his is considered a maor

underestimate by up to three times because of the way the data relies on

referrals to services. % further compelling statistic is that of of all the peopleliving in care homes+ CG> have some form of dementia6

/t is well recognised that oral health declines as dementia progresses. he impact

of the disorder+ especially in the latter stages+ leads to poor oral hygiene with an

increase in periodontal disease+Chigher levels of coronal and cervical decayand a

greater incidence of other dental problems such as denture wearing or the ability

to comply with oral care procedures. 10he commonest medications used in

dementia also have the potential to cause 2erostomia and+ if medications are

syrup@based+ the potential for the development of caries is increased. O be awre

of the oral manifestations of systemic diseases and the impact they may have onthe treatment plan. %void interaction with and look for oral side e5ects of drugs

taken

he decision making process in planning oral healthcare for people with

dementia or with other forms of cognitive impairments should incorporate a

multidisciplinary care team approach involving the medical practioner+

psyhicatric team+ relatives and carers. reatment should begin from diagnosis so

that oral care can be planned throughout the disease process and does not

become crisis management in the nal phase of the condition. reatment

planning must take account of the stage of the illness and the level of cognitive

impairment. ake a multidicpilinary approach and liase with other individuals

responsible for each patient care e.g general medical practioner+ carer

physiotherapist+ family.

%nother study found that access to dental care for the frail and elderelyw as

worse than other groups. 11


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Ehen considering treatment planning the number of visits etc should account for

this. he study also found that ,atients are retaining some or all of thgeir teeth

into old age and therefore re4uire more comple2 treatment. eeth that re4uire

e2traction are likely to be heavily restored and more likely to re4uire a surgical

approach.

Fiske 7, Gri11iths 7, 7amieson R, +anger 6. Guidelines 1or oral health care 1or long)stay 0atients and residents.

Gerodontology!!!"#$%#&'99):;

!e*uirments 'or pro.iding appropriate (are

,lanning and delivering appropriate level of care to the residents of my hospital

will re4uire a muiltidiciplinary approach and liase with other individuals

responsible for each patient care e.g general medical practioner+ carers

physiotherapist+ family. 3owever+ bearing in mind that we are living in the age of

austerity. oo much resource cannot be used up. 3owever+ in the curerent

climate and austerity resources are limited.

he rst thing / would implement is an initial assessment1;of oral health on

arrival to the nursing home. his initial assessment would involve a simple

4uestionnaire which would alert sta5 to any problems with regards to oral health.

his 4uestionnaire would then be reviewed by sta5 who would pick up on

anything of concern and provide the residenmt with the appropatie level of care

by getting a dentist tp do a more comple2 e2amination involving and orale2amination. hese 4uestionnaire would be submitted every C months. /f

possible this 4uestionnaire should be carried out with family rather than sta5 to

eliminate bias.

he inLuence of diet and nutrition on oral and general health is fundamentally

important.. DaviesPR suggested that good nutrition can have a marked e5ect on

the health+ happiness and independence of older people whereas the poor oral

status of institutionalised older people maycontribute to eating problems+ weight

loss+ dehydration and debilityR. &ugars are not only detrimental to dental health+

they can also have a negative impact on general healthPS hus the reduction of

sugar intake for dental health can also benet general health e.g. reduced

incidence of obesity+ diabetes+ coronary artery disease. he food served to the

residents should be healthy and maority of them should have healthy choices.

%lso dietary advice should be givn and sugar should be limited. 3ealthy eating

choices in line with health promotion.

11 hris o2 E.iden(e summar+: wh+ is a((ess to dental (are 'or 'rail elderl+people worse than 'or other groups; -ritish Dental ournal ;07+ 116 @ 1;; (;010)

1; Fiske 7, Gri11iths 7, 7amieson R, +anger 6. Guidelines 1or oral health care 1or long)stay 0atients and residents.Gerodontology!!!"#$%#&'99):;.


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% further thing i would implement is changing the facilities available to the

residents. / believe that facilities should provide or privacy and dignity in

personal oral care. very resident if budget allows will hav ensuite room tailored

with 2tures and adaptions that meet their needs. Bood lighting and reminders

would also be on their room. his strategy will help promote independence and

self care in a dignied manner.

here is little data on the availability of oral hygiene e4uipment however there is

a wealth of professional anecdotal evidence about the diFculty in obtaining

toothbrushes in hospitals. Despite the fact that a toothbrush is the cheapest and

most e5ective tool for oral hygiene.

and is more e5ective than a foam stick. mouth care packs and foam sticks are

still in general use. . /t is reeommended that managers of long stay and

residential accommodation take on theresponsibility of ensuring that appropriateoral hygiene e4uiptnent is readily available and thatsta5 are made aware of

procedures for obtaining. %II residents will be provided wityh a tootbrush+ regular

tooth paste+ Loss+ mouthwash and denture cleaning e4uipment.

he role of the sta5 is fundamentally important. he maority of residenets are

partially or totally dependent on nursing sta5 and caregivers to maintain oral

hygiene. *easearch as shown % study1Ashowed that a one hour practical

demonstration to nondental health care sta5 in a nursing home improves oral

health considerably. he study indicates that training of care@givers can improve

oral hygiene and health in nursing homes and other long@term care facilities by

enhancing the knowledge of the nursing sta5 through a short one@time lecture

and educational demonstration.urthermore+ the outcome of this study was

assessed C months after the intervention+ and apparently the nursing sta5 was

fully aware of their participation in a health promotional study. %ll tyhe sta5 in

my care home would receive this training and to support the concerpt of oral

health care.


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anyone in long@stay and residential accommodation+ and this includes people in

seeure units. %ccess and referral to dental services should be included in

admission+ transfer and discharge procedures.

ommunication between the dental team and other disciplines is most e5ective

when the dental team provides an input to multi@disciplinary care and

assessment. ollaborative eare planning which provides an opportunity to

demonstrate the contribution of oral health care to general health and well@being

should be endorsed.

inally+ amongst for the care home there will be a code of conduct serving as a

constitioun. 8egotiated and agreed standards and procedures for oral care

promote a structure and process for putting theory into practice and supporting

sta5 in what may be viewed as an unrewarding task. $ocally negotiated

standards should includeQ

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Growth and Ageing Essay