Dental Care for Elderly People - Essay Example

Running Head: Dental Care for elderly alized People of TARGET: “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.” Introduction As dental care in any country should result in ensuring that people retain their healthy teeth, until the old age, preventive dental care plays an important part, particularly in developed countries for people retaining their natural teeth till death. However, many studies have indicated that dental care does not reach the elderly, particularly if they are residing in health-care institutions or nursing homes, where the care-takers may not give due importance to dental care.(Fiske J). This has resulted in more demand on dental care by such institutionalized elders. Several studies conducted in this direction, reveal that more than 65% of such patients require oral hygiene medication and treatment. (Mersel & others, 2000). Such patients are reported to be having prominent bone loss, with deep pockets around remaining teeth, while 85% are reported to have attachment loss, ranging from 4 to 6 mm. (Friel) The profile of people staying in a nursing home would vary drastically, ranging from those who can maintain themselves, physically and mentally; to those who are completely dependant on care-takers. The general consensus is that elderly people living in a nursing home suffer more from periodontal diseases, as compared to those living in their homes. There is lesser evidence of institutionalized elders seeing a dentist, as studies suggest that such percentage is significantly lower, when compared to national average. Various problems that such patients confront include poor oral care, older dentures, while many have old or damaged prostheses. In addition, according to such studies, presence of significant denture plaque was recorded, while 1 in 6 patients suffered from denture related stomatitis. Accordingly, the need was felt for concentrated prosthetic treatment for patients staying in a care home in Wolverhampton, particularly for those elders who had loose fitted or lost dentures.(Awath-Behar, 1990) While inadequate dental care may not be fatal, the affect of same results in such elderly patients being uncomfortable while eating food, with others. In addition, the quality of life depends on the number of healthy teeth, as indicators for same include the ability to choose one’s food and socialize, without any feeling of pain. The loss of teeth can, therefore, alter the food consumption habits, which may result in reduced intake of fibrous and other items that are essential for a healthy life. Hence, self confidence, social networking and self-esteem has a direct relationship with the tooth loss.(Fiske) However, it is essential that elderly patients, particularly institutionalized people, should whole-heartedly participate in the treatment plan, while such plan should consider the patient’s needs on case-to-case basis. Factors responsible for lack of oral health among institutionalized elderly The lack of information regarding the dental care history for the institutionalized elderly is the major contributing factor for the care-takers not being able to plan the treatment line accordingly. In addition, the dental health care is not on the top priority list of the health-care options for such people. While special health-care teams make frequent visits to the concerned institutions for assessing the needs of the institutionalized patients, the oral assessment may not be included within their scope of work. (Fiske). While basic oral care history may not be traceable in majority of cases, the attitude of grass-root health-care workers is not up-to the desired level. According to Fiske et al, elderly people in such institutions are not able to take any help from the care-takers for simple jobs like cleaning of their dentures. Health care workers do not include oral care in their schedule of tasks. (Nettleton, 1995) Moreover, factors that could contribute to such condition would be the poor knowledge among the institutionalized people about oral hygiene, along with the limited or no access to regular dental services. However, it is essential to realize that oral care and dental history has relevance to malfunctioning of other systems in the human body. For example, poor dental hygiene can lead to diabetic conditions, while studies have revealed links between periodontal disease and cardiovascular abnormality, as well as strokes.(DeStefano & Anda, 1993). Hence, there is an established need to give the required priority to dental care, particularly for institutionalized patients. Another important factor which is responsible for lack of dental care for such people is the non-ability to communicate with the health care workers and medical staff. This is particular for patients with dementia and deafness, as they may not be able to communicate their needs, in an effective manner. Studies conducted in this direction, in 2000, have revealed that only 16.4% patients were able to participate actively in OHI. (Marsel & others). Planning for treatment As Geriatric patients have different kind of opinion about their dental treatment needs, many older patients have shown keenness to have normal speaking, eating and other day-to-day functional abilities. In this direction, the role of healthcare workers, particularly in large institutions like big nursing homes, is important as they can help medical professionals and dentists in explaining the attitudes and other facts related to the particular patient. This can result in saving of time, along with proper medication as well as treatment. Ward staff can also participate in the preventive hygiene program for the nursing home patients, while educating such staff is essential in this direction. Similarly, training program and classes for professional nurses must be included in the treatment plan. (Longhurst, 1998). In fact oral health care training can be given to able and normal elderly residents of the nursing home, which would ensure better interaction and participation of other patients, towards maintaining healthy oral hygiene. Such training program would ensure the application of golden rule,” Prevention is better than cure”. However, many patients might find it difficult to implement simple oral hygiene treatment plans, due to their prevailing disabilities, like arthritis, which restricts free movement. Therefore, the treatment plan must consider the needs of every individual patient, while motivating all patients for participation in the general dental health care program should be given the top priority. Considering the links between general health and dental care, necessary training to patients is required, particularly with respect to healthy eating and dietary habits.(C.O.M.A.,1992). Therefore, the dental care treatment plan, for elderly patients, in a 100 bed nursing home, would prove result-oriented, if the treatment is based on individual needs and capacity to implement the plan by concerned patient, considering his or her mental and physical ability to do the same. At the same time, screening and assessing the need for dental care for each patient, upon the entry to nursing home would help the dentist in preparing an individual-specific treatment plan. While a dentist should remain on-call, round the clock, nursing staff can help in maintaining the required oral hygiene and identifying the need for specialized investigation by the concerned dentist. Additionally, the treatment plan should consider the special needs of elderly people, as they would have higher amounts of plaque, increased dentine exposure, gingival recession, decreased salivary flow, root decay, coronal caries, among others. (Friel, 2010). As patients belong to varied backgrounds, the relevant treatment planning should consider their economic, social, educational and family history, which is necessary for assessing their rehabilitative needs, including dental care needs. Hence, balancing the dental treatment plan with these issues is essential, while priorities should be given to the pressing needs of dental care. (Lindquist & Ettinger, 2003) As, dental care treatment plan would involve several health care workers and dentists, along with the necessary equipment for carrying out the investigation and dental check-ups; it is essential that proper budgeting of expenditure towards maintenance of these facilities is duly accounted for. Manpower and logistical requirements Considering the expenses required for meeting the plan needs, proper balancing of available services with requirement of the elderly, in this direction, is necessary. For example, the nursing home can consider utilizing services of mobile check-up vans and other periodical investigative facilities, which can visit the nursing home, at times, as per the requirement of drafted treatment plan. Planning logistics on the lines of local referral network could be the best possible solution, which would involve working with external medical agencies and professionals, to pursue a multi-disciplinary approach for patient care, including dental health care. At the same time, the minimum requirement for providing dental care to the residents of such a nursing home would include formulating a panel of medical professional and paramedics, which can help in meeting the needs of the residents, on a continuous basis. This includes the training of nurses and hygienists for providing the follow-up services. Accordingly, planning and budget approval for such requirement is essential. The logistics would also involve provision of comfortable residential facilities for such staff. The equipment required for discharging dental care responsibilities include dental chairs, dental heaters, electric compressors, drills and trays, among other gadgets. However, in case of large nursing home, laboratory and dental surgery equipment would be necessary to carry out the emergency operations. Conclusion The priorities for dental health care being low; particularly in a nursing home; there is need to recognize the problems and factors responsible for same. Accordingly, the treatment plan and execution should consider the requirement of individual patients, while formulating a feasible action program, in this direction. In-text citation references Awath-Behar S, Harper RS. “Retrospective study of dental treatment for elderly hospital in- patients in Wolverhampton. Comm Dental Health” 1990;7:437-442 C.O.M.A. “The nutrition of elderly people. Report of the working group of the committee on medical aspects of food policy”. 1992. London, HMSO DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. “Dental disease and risk of coronary heart disease and mortality”. BMJ. 1993 Mar 13;306(6879):688–691 Fiske J, Griffiths J, Jasieson R, Manger D. “Guidelines for oral health care for long-stay patients and residents. Gerodontology” 2000;17 (1):33-8 Friel (2010) “Oral Health for Older People/Domiciliary Dental Care” (lecture) Lindquist & Ettinger (2003) “The complexities involved with managing the care of an elderly patient”. J Am Dent Assoc;134;593-600 Longhurst R. “A cross-sectional study of the oral healthcare instruction given to nurses during their basic training”. BrDent J\99S\ 184: 453-457 Mersel A, Babayof I, Rosin A. “Oral health needs of elderly short-term patients in a geriatric department of a general hospital.” Spec Care Dentist. 2000 Mar-Apr;20(2):72-4. Nettleton S. “Protecting a vulnerable margin: towards an analysis of how the mouth came to be separated from the body”. In Health and disease: a reader. Eds. Davey B, Gray A, Seale S. 2nd ed. Buckingham: Open University Press, 1995. Tim Friel, Lecture: Oral health for older people. 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