Geriatrics (Final): Week 1

Age

we are reconsidering the definition of geriatrics. ____ cannot be the only criteria.

•Health

•Performance

•Productivity

Aging is a biologic reality with its own dynamic and multidimensional set of accumulating processes that contribute to a decrease in:

•Frailty

•Disability

•Morbidity

•Mortality

Aging is a biologic reality with its own dynamic and multidimensional set of accumulating processes that are responsible for an increase in:

aging

a normal process that is genetically determined and environmentally modulated. It is characterized by a progressive decline in the ability to restore homeostasis increasing a person's vulnerability to stress and disease:

heterogeneity

•Great diversity, variability among individuals

•Wide range of medical and dental profiles (health and function)

mosaic process

The idea that not all organ systems age at the same rate:

- chronologic

- biologic

What are 2 ways that age is measured?

chronological age

ID the type of measurement of aging:

- can't be altered

- measures the passage of time from DOB

- little reverence to how you feel and function

biological age

ID the type of measurement of aging:

- can be modulated

- measures how well your physiological functions are working

- most relevant

homeostenosis

What is the opposite of homeostasis?

1

typically organs decline at a rate of about __% per year

weakest

it is often in a person's ______ organ system where symptoms of decrease organ function are 1st noticed

stress

the hallmark of age is how we respond to ______

•Exercise

•Diet

•Smoking/secondhand smoke

•Alcohol consumption

•Stress

•Sleep

•Staying connected to others

•Lifestyle factors can modulate how quickly an individual ages. These include:

•Tobacco use

•Poor nutrition

•Lack of physical activity

•Excessive alcohol use

•During dental exam, it is important to screen for the following behaviors in your patients like:

•Moving around: to and from bed, up and down stairs, walking on level surface

•Dressing/Changing clothes

•Toileting

•Basic hygiene: Bathing and Oral hygiene

•Eating

What are some examples of Activities of Daily Living (ADL) (basic needs):

•Managing finances

•Preparing meals

•Managing meds

•Hobbies

•Shopping for food, other essentials

•Telephone calls/Using computer

•Laundry

•Housekeeping & Home maintenance

•Transportation

What are some examples of Instrumental Activities of Daily Living (IADL) (tasks requiring higher patient function):

75 and older

there is a significant decrease in ADLs and IADLs in what age group?

•Independent

•Frail

•Dependent

What are the 3 Functional-ability classifications for geriatric patients?

independent

ID the Functional-ability classifications:

•Fit, robust, active, energetic​

•Living with no active disease or well-controlled disease​

•Living independently, unassisted in the community​

•Can perform ADLs and IADLs easily

frail

ID the Functional-ability classifications:

•includes a collection of biomedical factors which influences an individual's physiological state in a way that reduces their capacity to withstand environmental factors. These individuals are vulnerable and prone to dependency with a reduced life expectancy.

frail

ID the Functional-ability classifications:

•They comprise about 20% of the population over 65. These older adults can no longer access dental care without the help and support of others. Their oral health needs require a greater understanding of medicine and pharmacology and a careful evaluation of their ability to tolerate treatment and their ability to maintain daily oral hygiene.

frail

ID the Functional-ability classifications:

•A person who has declined in ability to perform IADLs and possibly some ADLs

•More vulnerable, less controlled diseases, decreased ability to respond to stressors

•Loss of some independence, but live in the community with the help of family, friends or caregivers

dependent

ID the Functional-ability classifications:

•Severely frail

•No longer able to live in their community independently

•Completely dependent on others for ADLs and IADLs

•They are either homebound or living in long-term care facilities

•Increased risk for mortality

- heart disease

- cancer

- stroke

- diabetes

Four chronic diseases, ________ cause almost two-thirds of all deaths each year.

80

For adults age 65 and above, __% have at least 1 chronic health condition

62

For adults age 65 and above, __% have 2 or more chronic health conditions

diabetes

what disease is directly influenced AND influences the occurance and progression of periodontal disease?

diabetes

Patients with periodontal disease are twice as likely to develop ______

endocarditis

This infection of the endocardium typically occurs when bacteria from another part of the body, such as the oral cavity, spread through the bloodstream and attach to certain areas in the heart:

•Oral sensory and motor deficits

•Poor tongue function ad lip seal

•Dysphagia

•Reduced oral clearance of foods and increased food packing

•Reduced dexterity negatively affecting ability to perform oral hygiene

•Increased caries and perodontal risk

What are some oral problems that can result after a stroke?

aspiration pneumonia

Oral hygiene strategies in hospitalized and nursing home populations also can reduce the incidence of ________

reduce

Treatment of periodontal disease may ____ the severity of Rheumatoid Arthritis

•Diminished ability to chew and eat if RA involves the temporomandibular joint

•Diminished salivary output (Sjögren's Syndrome), leading to xerostomia and caries

•Reduced dexterity, which affects the ability to perform oral hygiene

•Increased caries and periodontal disease risk

Rheumatoid Arthritis can result in multiple oral problems, such as:

Osteoporosis

_______ is linked with periodontal bone loss and tooth loss.

bisphosphonates

_______ used to treat osteoporosis carry a risk of medication-related osteonecrosis of the jaw (MRONJ).

IV

What type of bisphosphonates poses a greater risk than oral bisphosphonates for osteonecrosis?

- IV

- oral

- intramuscular

before

Dentists should stress the importance of dental clearance _____ starting bisphosphonte therapy

•Self care deficits

•Dependence

•Resistant behavior, lack of understanding leading to resistance to care

•Chronic disease burden

•Dietary changes, swallowing difficulties

•Postural iparments

•Decreased compliance with medications, OHI, regular dental visits

How does Alzheimer's disease/Dementia contribute to worsening oral health:

Dentinal tubule sclerosis, resulting in decreased permeability:

•Diminished pulp space

•Diminished dentin sensitivity

•Diminished susceptibility to effects of bacterial metabolites

•Increased tooth brittleness

What types of changes are seen in dentin due to aging:

Decreased volume:

•Diminished reparative capacity

•Diminished sensitivity/change in nature of sensitivity

What types of changes are seen in dental pulp due to aging:

Fatty replacement of acini

•Decreased physiological salivary reserve

What types of changes are seen in salivary glands due to aging:

- Advancing age

- Smoking

- Poor oral hygiene

What are the 3 main risk factors for periodontitis:

- Depressed cellular immune response

- thymic involution

•T-cell alteration: up to 50% have defects

•Dysregulation of immune response; not deficiency

•Diminished pain response

What is the causes of a blunted immune response in elderly patients

•Tooth loss/ pain = ability to chew/ food choices

•Weight loss = ill-fitting dentures/ loss of appetite

•Decreased taste = spicier/ acid (tooth erosion)

•Hyposalivation= dysphagia/ caries

•Dysphagia - difficulty swallowing

•Reduction in bone density - osteoporosis/ tooth loss

•Impaired immune function - oral microbiome

•Polypharmacy - affect taste and smell, nausea, vomiting

What are some physiological changes that have a DIRECT impact on oral health:

•Decrease basal metabolic rate (BMR)

•Loss of cognitive function

•Deterioration of vision

•Decrease smell and taste

•Decrease gastric acid (achlorhydria)

•Slower peristalsis

•Frailty and loss of dexterity

•Constipation

What are some physiological changes that have an INDIRECT impact on oral health:

•Kidney disease

•Hypertension

•Diabetes

•Head Injury

•Neurologic condition

•Smoking

•Tooth decay

•Untreated mouth sores

•Poor oral health

What are some causes of dysguesia:

•↓ salivation

•↓ gastric secretions

•↓ pancreatic secretions

•↓ sensory stimuli

•Increase plasma insulin

What are some effects of dysguesia:

increasing

There is a steadily_______ aging population, with 85+ being the fastest growing age group

increasing

There is an _______ diversity in aging population

decreasing

The rate of edentulism in 65+ group rapidly ______

•Impaired visual acuity

•Decreased manual dexterity

•Decreased upper-extremity mobility

The geriatric population is at risk for dental caries from poor oral hygiene due to:

- poor oral hygiene

- poor nutrition

- xerostomia

- limited access

What are some risk factors that result in increase dental caries in the geriatric population:

•Decayed or missing teeth

•Periodontal disease, poor oral hygiene

•Salivary hypofunction

•Oral and pharyngeal cancers

What are some common dental findings in the geriatric population:

age

____ is the primary risk factor for oral cancer

4

Men are affected by intraoral squamous cell carcinoma at ___times the rate of women

tobacco

Oral cancer is strongly linked with the use of _______

exacerbates

Alcohol use ________ the effects of tobacco

••Localized disease is generally treated surgically

••Large, localized tumors may be managed with radioactive implants

••Extensive disease requires surgery followed by beam irradiation

••Radiation alone may shrink inoperable tumors

••Newer protocols combine surgery and chemotherapy with the goal of a cure

What are the treatment options for Squamous Cell Carcinoma:

stability

moving forward with dental care for geriatric patients, dental treatment philosophy is focused on _____ rather than ideal

medically

moving forward with dental care for geriatric patients, dental treatment wii be more ______ focused