Chapter 26: Geriatrics

Chapter 26: Geriatrics

Introduction (1 of 2)

• People in the United States are living longer and healthier lives than ever before.

• The geriatric population is among the fastest-growing segments of society.

• As individuals age, the cumulative effects of both oral and systemic diseases lead to a higher prevalence of oral diseases among the elderly.

Introduction (2 of 2)

• Increasing numbers of "well elderly" individuals can retain their natural teeth and maintain normal oral function throughout old age.

• The age group of 85 and older is the most rapidly growing segment in the U.S. population.

Population Characteristics (1 of 2)

• Growth of the older population has outpaced other demographic segments, including the total population and those under age 65.

• The elderly population is expected to double over the next 30 years, reaching approximately 72 million by 2030.

Population Characteristics (2 of 2)

• The current elderly generation has greatly benefited from community water fluoridation and the use of fluoride in toothpaste.

• Many older adults will reach advanced age with their natural teeth intact, reinforcing the importance of oral health for all ages, especially the elderly.

Figures

Figure 26–1

• Image of Heloise A. Arnold, R D H, a centenarian and graduate of the Fones School of Dental Hygiene in Bridgeport, Connecticut.

Figure 26–2

• Graph showing the number of people in the U.S. aged 65 and over, segmented by age group, between 1900 and projected figures through 2050.

Figures 26–3 to 26–11

• Population by Age and Sex for selected years (1980, 2000, 2020, 2040):

  • Each figure uses census data to analyze the resident population structure by age and sex.

Population Characteristics: The Elderly Defined

• The World Health Organization (WHO) categorizes old age as follows:

  • Elderly: Ages 65 to 75

  • Old: Ages 76 to 90

  • Very old: Over 90 years of age.

Frail Elderly

• A functional definition of elderly developed by Ettinger and Beck emphasizes the ability to seek dental services:

  • 70%: Functionally independent older adults

  • 14%: Frail older adults

  • 5%: Functionally dependent older adults

• Living arrangements for older adults are closely linked to income, health status, and availability of caregivers.

Figure 26–7

• Displays living arrangements of older adults in the United States (2000) with percent distribution based on samples.

Health

• Leading causes of death for adults over 65 include:

  1. Heart disease

  2. Cancer

  3. Stroke

  4. Alzheimer’s or other dementias.

• The most common illnesses in older Americans include:

  • Arthritis

  • Hypertension

  • Impaired hearing

  • Heart disease

  • Impaired vision.

Table 26–1: Top Five Chronic Health Conditions among the Elderly by Sex

• 
  

• Data based on 2007–2008 averages.
  

  Men	Women
  1. Hypertension	1. Hypertension
  2. Arthritis	2. Arthritis
  3. Heart disease	3. Heart disease
  4. Cancer	4. Cancer
  5. Diabetes	5. Diabetes
  Health: Leading Diseases

  • Cancer (lung, breast, prostate, and colon) is the second leading cause of death in older adults.

  • Cerebrovascular disease (stroke) ranks as the third leading cause of death.

  • Awareness of special management needs for this group is paramount for oral health professionals.

  Physiologic Changes (1 of 2)

  • Major results of the aging process include:

    • Reduced physiological reserve of various bodily functions (e.g., heart, lungs, kidneys).

    • Impaired homeostatic mechanisms (e.g., fluid balance, temperature control, blood pressure).

  Physiologic Changes (2 of 2)

  • Impairment of the immune system, which increases the incidence of neoplastic and age-related autoimmune conditions.

  Physiologic Changes: Osteoporosis (1 of 2)

  • Bone is metabolically active throughout life. Osteoporosis is prevalent among older adults.

  • Advanced osteoporosis can lead to chronic back pain from mechanical strain caused by:

    • Kyphosis or vertebral compression fractures.

  Physiologic Changes: Osteoporosis (2 of 2)

  • Recent studies suggest changes in alveolar bone due to osteoporosis may exacerbate periodontal disease.

  • Prevention is the key to effectively managing osteoporosis.

  Functional Status

  • Defined by geriatricians as a critical indicator of health and well-being in older individuals.

  • Often used to assess an individual’s health status instead of merely identifying specific diseases.

  Cognitive Changes

  • Influenced by developmental transitions, life events, and environmental changes, older adults may experience:

    • Impaired concentration and cognitive clarity.

  • Factors contributing to cognitive decline include:

    • Poor nutrition

    • Vitamin deficiencies

    • Various diseases

    • Hormonal changes.

  • Generally, older individuals take longer to retrieve or recall information.

  Cognitive Changes: Dementia

  • Dementia is defined as the loss of established intellectual functions, which includes:

    • Impairment of memory

    • Language difficulties

    • Perception issues

    • Impaired calculation

    • Deterioration of abstract thinking, judgment, and executive function.

  • It's crucial to evaluate an elder patient's ability to communicate, understand, consent to treatment, and participate in care.

  Cognitive Changes: Alzheimer’s Disease

  • The most common form of dementia in the elderly.

  • Characterized as a progressive, degenerative illness that affects the brain, resulting in:

    • Memory loss

    • Diminished intellectual capacity

    • Decline in thinking ability

    • Changes in behavior.

  Cognitive Changes: The Dental Provider and Alzheimer’s Disease (1 of 2)

  • Patients with Alzheimer's benefit from an understanding and empathetic approach from their caregivers.

  • Recommended communication strategies for providers include:

    • Using short words and sentences

    • Repeating instructions and explanations.

  Cognitive Changes: The Dental Provider and Alzheimer’s Disease (2 of 2)

  • Nonverbal communication techniques can be effective, including:

    • Maintaining direct eye contact

    • Smiling

    • Gentle touches (e.g., patting the arm or hand).

  Common Oral Manifestations (1 of 4)

  • For the first time, there are more older adults with natural teeth than without.

  • This revelation allows for the maintenance of functional dentition.

  Common Oral Manifestations (2 of 4)

  • The decline in edentulism is attributed to:

    • Water fluoridation

    • Increased public awareness of preventive approaches

    • Improved access to dental services

    • Decrease in early tooth loss.

  Common Oral Manifestations: Results of Tooth Retention

  • The decline in tooth loss results in:

    • More natural teeth at increased risk for caries (coronal, recurrent, and root)

    • Periodontal diseases.

  • Despite this, many older adults do not prioritize oral health care.

  Common Oral Manifestations (3 of 4)

  • Periodontal disease is not inherently age-related.

  • Oral cancer predominantly occurs within older age segments.

  Common Oral Manifestations (4 of 4)

  • Early diagnosis of oral cancer significantly enhances patient prognosis.

  • Regular oral cancer examinations are crucial, recommended at least annually for all patients.

  Long-Term Care

  • Referring to health, social, and residential services for chronically disabled individuals over an extended period.

  • Common symptoms leading to nursing home placement include:

    • Incontinence

    • Behavioral issues (often associated with dementia, such as wandering).

  • This population often exhibits high levels of:

    • Edentulism

    • Coronal and root caries

    • Poor oral hygiene

    • Periodontal diseases

    • Soft tissue lesions.

  Surgeon General’s Report (1 of 4)

  • Highlights the importance of dental care for frail older adults due to:

    • The cumulative nature of oral diseases that become complex over time.

    • Severe oral problems adversely impacting quality of life.

    • Significant health impact of dental diseases.

  Surgeon General’s Report (2 of 4)

  • About one-third of community-dwelling elderly individuals have untreated coronal or root caries, and other oral health issues, which may include:

    • Periodontal disease

    • Dental attrition

    • Unreplaced missing teeth

    • Abrasion and erosion

    • Broken or failing restorations

    • Xerostomia

    • Mucosal diseases

    • Oral cancer

    • Alveolar ridge atrophy.

  Surgeon General’s Report (3 of 4)

  • Drug therapy may lead to oral health issues such as:

    • Xerostomia (dry mouth)

    • Bleeding disorders in oral tissues

    • Lichenoid reactions (changes in oral tissue)

    • Tissue overgrowth

    • Hypersensitivity reactions.

  Surgeon General’s Report (4 of 4)

  • As teeth age, the following changes occur:

    • Enamel, dentin, and pulp experience progressive changes, making older teeth:

    • More brittle

    • Less resilient

    • Less soluble

    • Less permeable

    • Darker in color.

  Preventive Strategies

  • Significant portions of the elderly population lack access to basic dental care.

  • Dental care utilization peaks in middle age and drops dramatically after age 65.

  Senior-Friendly Dental Practice

  • Adjustments are essential to accommodate the frail elderly population.

  • Many frail older adults can visit standard dental offices if they are mobile, and the practice is senior-friendly.

  Health Promotion (1 of 2)

  • Individuals who attend semiannual dental visits often do not receive extensive systemic oral health education.

  • For those who do not seek regular dental care, this education is even more crucial and should be disseminated in alternative settings.

  Health Promotion (2 of 2)

  • The dental community must creatively reach out to underserved older adults.

  • Regular examinations and preventive care throughout the lifespan are crucial for maintaining good oral health and reducing the prevalence of periodontal disease and the need for dentures.

  Public Policy

  • Although preventive dentistry has seen improvements, advances have primarily benefited younger cohorts.

  • Programs are necessary to enhance dental care accessibility for elderly populations to bridge the age-based utilization gap and improve oral health among older individuals.

  Table 26–2: Policy Strategies to Change Perceptions Toward Oral Health Care for People Who Are Elderly (1 of 2)

  • Work on changing perceptions of oral health and disease to integrate it as a crucial element of overall health:

    • Include oral health services in all health promotion and disease prevention programs.

    • Develop training for non-dental health professionals on enhancing oral health.

    • Accelerate research to build a scientific base that effectively enhances oral health.

    • Survey the dental needs of older adults across various living arrangements to inform service delivery.

    • Build community-based dental care systems at regional and state levels to serve low-income older adults and those in nursing homes.

  Table 26–2: Policy Strategies to Change Perceptions Toward Oral Health Care for People Who Are Elderly (2 of 2)

  • Address existing barriers to oral health service access by:

    • Increasing the number of dental professionals trained for providing mobile or on-site care.

    • Providing oral health benefits in all public health programs for elderly individuals.

    • Utilizing public-private partnerships to improve oral health outcomes for those suffering from oral diseases.

    • Enhancing collaboration between dental, medical, and nursing programs and community organizations serving those with special access needs.

  Dental Providers (1 of 3)

  • As hard tissue disease management progresses, greater emphasis will be placed on diagnosing and treating soft tissue lesions.

  • Improved diagnostic techniques will benefit older adults, who are at the highest risk for oral cancer, often avoiding extensive surgical outcomes.

  Dental Providers (2 of 3)

  • Oral health care professionals must ensure that dental settings accommodate the aging population, which includes:

    • Accessible senior-friendly offices

    • Medical forms in large print

    • Easily readable signage

    • Informative health literature and appointment cards.

  Dental Providers (3 of 3)

  • Research demonstrates a link between poor oral health and systemic diseases such as:

    • Diabetes

    • Cardiovascular disease

    • Respiratory disease (especially prevalent among older adults).

  • Oral health issues in long-term care residents often go unnoticed until acute symptoms arise (e.g., pain or infection).

  Summary (1 of 2)

  • Future elderly individuals will possess more teeth, visit dental professionals more frequently, and generally have higher education, better financial stability, and different perspectives on healthcare needs.

  • The growing size and longevity of this elderly population will prompt discussions about potential modifications to Social Security, Medicare, Medicaid, and other related benefits.

  Summary (2 of 2)

  • Effective dental care must now be regarded as a lifelong commitment.

  • As understanding increases regarding the relationship between oral and systemic health, and as more individuals maintain their natural teeth into old age, it is essential to empower older adults to adopt preventive oral health practices.

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