Prof dr Jacques Vanobbergen
Community Dentistry and Oral
Public Health
University Gent - Belgium
A comprehensive oral health care concept for frail
elderly patients
September 2015
• Introduction –
accompanying conditions
• Key components
A comprehensive oral health care concept for frail
elderly patients
2
Chalmers Müller Ettinger Pretty McEntee Walls BENECOMO …
Evidence
Gerodent
BENECOMO
New observations Experience
Sharing our experience
A comprehensive oral health care concept for frail
elderly patients
3
Everyone, even the most vulnerable person, has
the right to an oral health care assessment and
oral health care plan
(≠ treatment plan)
• The interest of the patient must
be the highest priority.
• Respect the right to autonomy,
as far as possible.
• Good oral health has positive
benefits for health, dignity, self-
esteem and social integration.
4
Definition of ‘elderly people’
Conclusions observed during the last decades
• Ageing and ageing-within-ageing
5
Definition of frail elderly people
• State of increased vulnerability to stressors
• Groninger Frailty index
• Canadian Study of Health and
Ageing Frailty scores
• Barthel index …
• Katz-scale
• RAI(Resident Assessment Instrument )
• …
6
Definition of frail elderly patient
• The diversity of the population of elderly people
complicates the definition of ‘a frail elderly
patient’. A definition based on age is not very
useful. A definition based on functional capacity
and vulnerability seems to be more useful.
10
Further conclusions observed during the last
decades
• Reduced edentulism Muller et al., 2007
Clin Oral Implants Res.
12
Further conclusions observed during the last
decades
• Increased number of natural teeth
Muller et al., 2007
Clin Oral Implants Res.
15
Further conclusions observed during the last
decades:
• Oral health status of frail and dependent older
people is poor
16
The pathogenic microbiota in the mouth are extremely
diversified, and they can move into the systemic system
and stimulate inflammation.
Further conclusions observed during the last
decades: relationship between oral health and
general health
17
Oral health and systemic health
Evidence
Correlation Impact of oral treatment
ASVD ++ -+
Pneumonia ++ ++
Diabetes ++ ++
Malnutrition + -
Dementia ++ -
Osteoporosis + -
18
• Introduction –
accompanying conditions
• Key components
A comprehensive oral health care concept for frail
elderly patients
19
• Introduction
• Key components
A comprehensive oral health care concept for frail
elderly patients
20
A well elaborated oral health care plan (concept)
will focus on:
• Wellness
• Quality of life
• Prevention
rather than a traditional
model of treating
diseases 21
21
Every one, even the most vulnerable, has the
right to a well elaborated oral health care plan
(≠ treatment plan)
• Infection control
• Increased comfort,
wellbeing and
quality of life.
22
22
Every one, even the most vulnerable, has the
right to a well elaborated oral health care plan
(≠ treatment plan)
• Infection control
• Increase comfort,
wellbeing and
quality of life.
23 23
• Key components
Patient-centred –Team based
Patient Nurse
Nurse aide
Dentist
Dental hygienist
Dental assistant
(Family) doctor
Speech therapist
Informal carer
…
25
• Aldactone 50mg(diureticum)
• Coruno 16mg (angina pectoris)
• Daktarin oral gel
• Hydergine 4,5mg (vascular disease)
• Sipralexa 10mg (anti depressivum)
• Sotalex 160mg (anti arithmica)
• Trazolan 100mg (anti depressivum)
• Zyloric 100mg (gout)
• Corsodyl
• Verbal report: Marevan (Warfarin) was stopped three days before, an initiative taken by the family doctor
Medical history
27
• Aldactone 50mg(diureticum)
• Coruno 16mg (angina pectoris)
• Daktarin oral gel
• Hydergine 4,5mg (vascular disease)
• Sipralexa 10mg (anti depressivum)
• Sotalex 160mg (anti arithmica)
• Trazolan 100mg (anti depressivum)
• Zyloric 100mg (gout)
• Corsodyl
• Verbal report: Marevan (Warfarin) was stopped three days before, an initiative taken by the family doctor
• After a call with the family doctor: Bisphosphonates IV – weekly in the hospital: treatment of prostate cancer
Medical history
31
Communication problem
• Need for more written communication
between caregivers (patient file)
• Need for more careful mutual consultations
and interaction between caregivers
• Be aware: combined medication in the
nursing home (administered by nursing
home nurses) and in the hospital
• Be aware: unnecessary interruption of
anticoagulant medication
32
• Key components
Patient-centred –Team based
Integrated oral health care
Continuous education
Professional oral health care
Continuous monitoring
41