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

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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 )

• …

6

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

• Reduced edentulism Muller et al., 2007

Clin Oral Implants Res.

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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.

15

Further conclusions observed during the last

decades:

• Oral health status of frail and dependent older

people is poor

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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

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Oral health and systemic health

Evidence

Correlation Impact of oral treatment

ASVD ++ -+

Pneumonia ++ ++

Diabetes ++ ++

Malnutrition + -

Dementia ++ -

Osteoporosis + -

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• 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

Co-operation treaty

De Visschere-Vanobbergen 2010

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• Key components

Patient-centred –Team based

Patient Nurse

Nurse aide

Dentist

Dental hygienist

Dental assistant

(Family) doctor

Speech therapist

Informal carer

…

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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

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

• After a call with the family doctor: Bisphosphonates IV – weekly in the hospital: treatment of prostate cancer

Medical history

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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

Communication

Follow-up

Research 40

• Key components

Patient-centred –Team based

Integrated oral health care

Continuous education

Professional oral health care

Continuous monitoring

41

Hopeful to the future

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JVO - 22 september 2015 43

Community Dentistry

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