A comprehensive oral health care concept for frail elderly patients

A comprehensive oral health care concept for frail
elderly patients
September 2015
Prof dr Jacques Vanobbergen
Community Dentistry and Oral
Public Health
University Gent - Belgium
A comprehensive oral health care concept for frail
elderly patients
• Introduction –
accompanying conditions
• Key components
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A comprehensive oral health care concept for frail
elderly patients
Sharing our experience
New
observations
Experience
Evidence
Chalmers
Müller
Ettinger
Pretty
McEntee
Walls
BENECOMO
…
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Gerodent
BENECOMO
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, selfesteem and social integration.
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Definition of ‘elderly people’
Conclusions observed during the last decades
• Ageing and ageing-within-ageing
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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 )
• …
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Definition of frail elderly people
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Definition of frail elderly patient
• Frailty increases with age.
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Definition of frail elderly patient
• The diversity of frailty in older age groups
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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.
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Further conclusions observed during the last
decades
Muller et al., 2007
Clin Oral Implants Res.
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• Reduced edentulism
Further conclusions observed during the last
decades
• Reduced edentulism
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Further conclusions observed during the last
decades
• Reduced edentulism
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Further conclusions observed during the last
decades
• Increased number of natural teeth
Muller et al., 2007
Clin Oral Implants Res.
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Further conclusions observed during the last
decades:
• Oral health status of frail and dependent older
people is poor
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Further conclusions observed during the last
decades: relationship between oral health and
general health
The pathogenic microbiota in the mouth are extremely
diversified, and they can move into the systemic system
and stimulate inflammation.
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Oral health and systemic health
Evidence
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Correlation
Impact of oral treatment
ASVD
++
-+
Pneumonia
++
++
Diabetes
++
++
Malnutrition
+
-
Dementia
++
-
Osteoporosis
+
-
A comprehensive oral health care concept for frail
elderly patients
• Introduction –
accompanying conditions
• Key components
19
A comprehensive oral health care concept for frail
elderly patients
• Introduction
• Key components
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A well elaborated oral health care plan (concept)
will focus on:
• Wellness
• Quality of life
• Prevention
rather than a traditional
model of treating
diseases
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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.
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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.
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Co-operation treaty
De Visschere-Vanobbergen 2010
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• Key components
 Patient-centred –Team based
Patient
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Nurse
Nurse aide
Dentist
Dental hygienist
Dental assistant
(Family) doctor
Speech therapist
Informal carer
…
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Medical history
•
•
•
•
•
•
•
•
•
•
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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
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Medical history
•
•
•
•
•
•
•
•
•
•
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
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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
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• Key components
 Integrated oral health care
Oral Health
Care Team
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• Key components
 Continuous education
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• Key components
 Continuous education
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• Key components
 Professional oral health care
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• Key components
 Professional oral health care
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• Key components
 Continuous monitoring
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Communication
Follow-up
Research
• Key components
 Patient-centred –Team based
 Integrated oral health care
 Continuous education
 Professional oral health care
 Continuous monitoring
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Hopeful to the future
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Thanks for your cooperation
JVO - 22 september 2015
Community Dentistry
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