Oral Healthcare of the Elderly

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Oral Healthcare of the Elderly A Growing
Challenge

• Professor Ken Eaton

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Terminology

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

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Topics to Be Covered

• An Aging Population
• General Health and Social Implications
• Oral Health of the Elderly

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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)

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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

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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

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Healthy and Unhealthy

• Picture of healthy active old person
• and unhealthy inactive old person

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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)

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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)

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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

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General Health and Social Implications

• So what are the common risk factors?
• Smoking
• Excessive alcohol consumption
• Poor diet
• Low socio-economic status
• Others

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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

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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.

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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

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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

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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)

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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)

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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)

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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

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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

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Slide of Oral Cancer Goes here
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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

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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?

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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)

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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

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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

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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

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If you have been ...Thank you for listening

• kenneth.a.eaton_at_btinternet.com