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Oral Healthcare of the Elderly

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Oral Healthcare of the Elderly A Growing Challenge Professor Ken Eaton * * Terminology Elderly Older people Old people Old Political correctness v WHO? – PowerPoint PPT presentation

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Title: Oral Healthcare of the Elderly


1
Oral Healthcare of the Elderly A Growing
Challenge
  • Professor Ken Eaton

2
Terminology
  • Elderly
  • Older people
  • Old people
  • Old
  • Political correctness v WHO?

3
Topics to Be Covered
  • An Aging Population
  • General Health and Social Implications
  • Oral Health of the Elderly

4
An Aging Population
  • Currently in the United Kingdom 10 million
  • people are aged 65 years or more
  • 3 million are 80 years or older
  • By 2033 it is projected that 15.5 million will be
    65 years or older

  • (Government Actuarys Office 2013)

5
An Aging Population
  • No longer three score years and ten but four
    score years and ten
  • A quarter of children born today 1 November 2013
    can expect to live to the age of 100

6
An Aging Population
  • The economic consequences are considerable
  • In 2012, Some 100 billion from the budget of the
    Department of Work and Pensions went to the over
    65s
  • A large proportion of the budgets for the NHS and
    social care also went to over 65s

7
Healthy and Unhealthy
  • Picture of healthy active old person
  • and unhealthy inactive old person

8
General Health and Social Implications
  • More people working in paid employment after
    their 65th birthdays
  • Ideally family support for the elderly
  • But 25 live alone
  • Decreased quality of life (loneliness, ill
    health, poor care) for some
  • More and more elderly in care and nursing homes
    or hospitals)

9
General Health and Social Implications
  • 400,000 over 65s in Care or nursing homes in
    England in 2011
  • Over 18,000 such homes
  • Quality of care?
  • (CQC Report 2012)

10
General Health and Social Implications
  • Health problems of the over 65s include
  • arthritis, cancers, cardiovascular diseases,
    dementia, diabetes, poor eyesight, poor hearing,
    respiratory diseases
  • Many of these diseases are chronic and have the
    same risk factors as those for oral diseases
  • There is therefore a need for closer integration
    of oral and general health care

11
General Health and Social Implications
  • So what are the common risk factors?
  • Smoking
  • Excessive alcohol consumption
  • Poor diet
  • Low socio-economic status
  • Others

12
General Health and Social Factors
  • Most of the diseases suffered by over 65s are
    chronic diseases
  • Often they are not the cause of death
  • Death may result from infection which is not
    combated because of weakened immune systems

13
General Health and Social Implications
  • Acquired infections whilst in hospital and
    residential care.
  • The commonest cause of death from hospital
    acquired infection is now pneumonia.
  • Good oral cleanliness prevents this
  • Who cleans the mouths of the sick?
  • A recent example.

14
General Health and Social Implications
  • Many diseases of the elderly could be prevented
    or ameliorated by healthier life styles before
    becoming elderly
  • A good example is healthy diet, exercise, not
    smoking and avoidance of excessive consumption of
    alcohol to prevent obesity

15
Oral Health of the Elderly
  • Over 65s suffer from the same three groups of
    oral diseases as young people
  • Some are more at risk because of reduced salivary
    flow, poor diet, poor oral hygiene,
  • impaired resistance to infections
  • Even healthy mouths contain 100s of species of
    potentially harmful microbes

16
Oral Health of the Elderly
  • The three groups of oral disease are
  • Dental Caries (tooth decay)
  • Periodontal Diseases (gum diseases)
  • Diseases of the soft tissues (inside of the mouth
    and tongue)

17
Oral Health of the Elderly
  • As far as retaining teeth and dental caries the
    oral health of adults, including the elderly, has
    improved significantly since 1968
  • When 37 of adults in England had no natural
    teeth
  • By 2009, this figure was 6
  • (Adult Dental Health Survey 2009)

18
Oral Health of the Elderly
  • By 2009, only 15 of 65 74 year-olds and 30
    of 75 84 year-olds had no natural teeth.
  • However, 30 of 65 74 year-olds and 40 of 75
    84 year olds had a partial denture or denture(s)
  • (Adult Dental Health Survey 2009)

19
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20
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21
Oral Health of Oral Elderly
  • The situation is not so good for periodontal
    diseases and diseases of the oral mucosa.
  • And in particular for oral cancer

22
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23
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24
Oral Health of the Elderly
  • A number of things can limit any individuals
    ability to clean their mouths and control their
    diet
  • Poor eyesight, lack of manual dexterity,
  • forgetfulness, state of mind are more likely
    to occur after 65 years of age
  • Those living in care and nursing homes have
    little control of their diet

25
Slide of Oral Cancer Goes here
26
Oral Health of the Elderly
  • The elderly are far more at risk of xerostomia
    (dry mouth)
  • Causes may include
  • Side effect of various medications
  • Damage to salivary glands
  • Sjorgrens syndrome
  • Others

27
Oral Health of the Elderly
  • Many elderly people and a high percentage of
    those living in care or nursing homes and who are
    in hospital therefore need daily help with mouth
    cleaning and a balanced diet
  • Do they receive this help?

28
Oral Health of the Elderly
  • In Glasgow care homes in 2006
  • Over 75 of residents needed attention to basic
    oral hygiene
  • 33 needed fillings or extractions
  • 73 of those with some natural teeth had tooth
    decay
  • 38 showed signs of diseases of the oral mucosa
    (Sweeney et al. 2007)

29
Oral Health of the Elderly
  • So what is happening to address these problems?
  • In Scotland National oral health improvement
    strategy for priority groups frail older people,
    people with special care needs and those who are
    homeless
  • In England A national group (Janet Clarke) and
    local initiatives

30
Oral Health of the Elderly
  • Promoting older peoples oral health guidelines
    for support nurses and care staff. (DH England
    2011)
  • British Society for Disability and Oral Health
    unlocking barriers to care (2004)
  • Surveys in Wales, Brighton, Medway, etc.
  • Residential Oral Care in Sheffield (ROCS)
  • Training programmes for nurses and carers

31
Oral Care of the Elderly
  • Good Practice in Europe
  • Denmark and Sweden (comprehensive oral care
    service for residents of care homes)
  • Netherlands and Flanders ( Dutch Associations of
    Nursing Home Physicians guidelines for carers)
  • France UFSBD Training programme for carers

32
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33
If you have been ... Thank you for listening
  • kenneth.a.eaton_at_btinternet.com
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