KESIHATAN PERGIGIAN WARGA EMAS

DR HIRZI B KAMALUDIN
KP TG TUALANG
 JKM
• Person that is over 60 years of age (as used by UN
World Assembly on Ageing in 1982 at Vienna Austria)
 Process of gradual maturation
 Constant process – growth & development of
living organism
 Depending on genes, environment, lifestyle
 • 65 – 74 yo
Young old • Impairment

• 75 – 84 yo
Old old • Disability

Oldest • 85+ yo
old • Handicap
 YEAR ELDERLY POPULATION %
(MILLION)
1970 0.546 5.2
1980 0.745 5.7
1991 1.032 5.9
2000 1.398 6.3
2010 2.251 7.9
2020 3.44 9.9
(estimate)
2030 (UN 5.284 15
estimate)
1) Selangor – 334,269
2) Perak – 280,118
3) Johor – 278,028
4) Sarawak – 211,191
5) Kedah – 184,067
6) Pulau Pinang – 159,235
7) Sabah – 138,386
8) Kelantan – 135,935
SOURCE: BANCI PENDUDUK & PERUMAHAN 2010
MALE FEMALE
71.7 76.6
1980 – 66.4
2000 – 70.2
2020 – 77.5
SOURCE: JPM
 Olderwomen outnumber older men
 Worldwide
• 2005 – 83 men for every 100 women >60
 Developing countries
• 2005 – 91 men for every 100 women
• 2015 – 89 men for every 100 women
• 2030 – 86 men for every 100 women
 Gerodontics
Delivery of oral health care to older adults
Involves diagnosing, preventing, & treating problems
associated with normal ageing & age related diseases
Part of interdisciplinary team with other helath care
professionals
 Functionally Functionally
independent Frail elderly dependent
elderly elderly
• 70% • 14% • 5% & the rest
• Able to get to • Chronic • homebound/
dentist conditions with institutionalised
impaired
mobility
 Seniors who have 1 or more physical/ mental
disabilities
 Predominantly females > 75 yo
 Alone/ widow
 Dependent in ADL
 Incontinent
 Cognitively impaired
 Economically disadvantaged
 Self rated health (SRH):
• 58.1% perceived themselves as having good health
• Better among elderly male
 Functional status (dependency):
• Female, young old, non Bumi, rural, no spouse (Mental
Health Data 2005)
 Cause of death:
55 – 64 yo: neoplasm
65 – 74 yo: circulatory system
75+ yo: respiratory system
 Socioeconomic
issues
-Financial
-Disability

Medical & health

issues Oral health
-Diseases related issues
-Behaviour
 Poverty/ financial
 Older widows mostly live in poverty
 Primary carer of orphaned & vulnerable
children = elderly
 Increase in per capita cost of healthcare
 Dependent on social care system
 Improved public health, sanitation
 Carrying diseases of middle age
 Cancer, CVD, neuro disorders etc
 Most >65yo have at least one chronic health
condition (increased burden on health care
system)
 Diagnosed, undiagnosed & misdiagnosed
diseases
 More retaining teeth at 65 yo
 Remaining teeth heavily restored
 Increase in dental service utilisation
 Root caries vs. coronal caries
 Perio disease (change of inflammatory
response with age)
 Understanding impact of fast growing elderly
population to dental profession
 Patient’s expectation
 Cost implications: RCT vs extraction with/
without implant
 Medical health
 Post op healing & resilience
 Availability of appropriately trained
professionals
 Thorough exam: soft & hard tissues incl
denture
 Perio disease, caries & common oral health
problems in elderly: be alert
 Oral systemic linkage
 Consult appropriate professionals
 Intercollaboration with family members & LTC
staff
 Transdisciplinary care
3keys area:
1. Patient education, carer/ family
member training
2. Integration of oral health care into
ADL
3. Periodic preventive professional care
 Diet & nutrition
• Frequent sips of water
 Oral hygiene
• Brushing teeth
• Use fluoridated toothpaste
• Mouthwash
 Denture care
• Remove dentures
 As often as possible during day while
undergoing treatment
 Before sleep
 When using mouthwash
 When denture is causing pain
 Denture care
• Rinse dentures after meals with water
• Brush dentures daily with soft brush & mild
soap (not toothpaste)
• Soak dentures with water at
night or when not in use
• Soak denture with vinegar &
water (1:1) for 1 hr/ wk
→ disinfection
Patient’s need

Beyond practitioner’s skill

Appropriate referral

OVERALL HEALTH
 DR NORJEHAN BT YAHAYA
 Hospital Kuala Lumpur

 DR SITI ZALEHA BT HAMZAH

 BDS (UWA), DClinDent (SND) (Otago)
 Hospital Serdang
Geriatric patients with special needs is
defined as
• 60 years & above
• Present with at least 3 of conditions as
the following:-
 Frail & functionally dependant (rely on
carers for ADL)
 Neurologic & cognitive impairment
 Communication & behavioural problem
 Increased chronic medical conditions incl.
polypharmacy
 Chronic psychiatric/ psychological condition
 Nutritional/ swallowing problem
 Poor motivation towards oral health care
 Elderly ASA III / ASA IV
 Require dental tx under conscious
sedation/ GA
 • Consultation
REASON FOR
• Urgent treatment
REFERRAL
• Further management

RESPONSIBILITIES • Complete patient’s details

OF REFERRING • Relevant document incl. valid OKU card/
CLINICIAN photocopy of guarantee letter

RESPONSIBILITIES • Prioritising patients

OF REFERRAL • Review referrals according to guidelines
CENTRE • Advice for referred patient
Majority of elderly with a mild or
moderate disability or medical condition
can & should be treated in GDP
Not everyone with disability requires
SND, as not all disability limits oral health
Those that can express need & able to
easily access mainstream dental services,
despite disability do not need SND
SND relates to patient complexity, rather
than complexity of dentistry being
provided
 Access
• No stairs (ramp/ elevator)
• Safe parking
 Reception furniture
• Not low to floor
• Firm
• With arms
 Reducing risk of fall, flooring should be
• Consistent
• No rugs or clutter on floor
• No slippery surface
 Lighting to reduce age-related vision
• Without glaring
• Consistent level of lighting
• Avoid small print
• Use contrasting paper & ink colours for written
material
 To adjust age-related hearing loss
• Stand closer to patient
• Remove mask
• Maintain face-to-face, eye contact, eye level
• Touch appropriately
• Drop pitch, speak distinctively
• May increase volume but do not yell
• Minimise background noise
• Use quiet location for interaction
• Turn off any music
• Turn off dental equipment whenever possible
 Other communication enhancement
• Use titles & surnames unless asked specifically asked to
use first name
• Provide written instruction
• Communicate with caregivers but do not ignore
patient
Outreach dental service for those who
cannot reach it themselves
Incl oral health & dental treatment
Incl residential care & nursing homes,
hospitals, day centres & patient’s homes
Incl preventive oral
health care but not
dental screening
 Aims:
• To deliver appropriate oral healthcare to those who
cannot access dental care facilities
• Can be provided by primary dental care/ hospital
dental service
 Needs:
• Institutionalised elderly more likely to have poor oral
health (Fiske & Griffith 2000)
• Routine vs last resort
 Frail elderly & Functionally dependent elderly
>90 yo benefits the most (Helgeson et al 2002)
Use less energy to travel
 Younger population who are homebound
 Dental team
 Equipments
 Preparation
 Training
 Referral system
 Health & safety issues
 Mix & match care
THANK YOU