- 1. KESIHATAN PERGIGIAN WARGA EMASDR HIRZI B KAMALUDIN KP TG
TUALANG
2. JKM Person that is over 60 years of age (as used by UN World
Assembly on Ageing in 1982 at Vienna Austria) 3. Processof gradual
maturation Constant process growth & development ofliving
organism Depending on genes, environment, lifestyle 4. 65 74
yoYoung old Impairment 75 84 yo Old old Disability Oldest 85+ yoold
Handicap 5. YEAR ELDERLY POPULATION %(MILLION)19700.546
5.219800.745 5.719911.032 5.920001.398 6.320102.251 7.9 20203.44
9.9(estimate) 2030 (UN5.28415estimate) 6. 1) Selangor 334,2692)
Perak 280,1183) Johor 278,0284) Sarawak 211,1915) Kedah 184,0676)
Pulau Pinang 159,2357) Sabah 138,3868) Kelantan 135,935SOURCE:
BANCI PENDUDUK & PERUMAHAN 2010 7. MALE FEMALE71.7 76.6 1980
66.4 2000 70.2 2020 77.5SOURCE: JPM 8. 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 9. GerodonticsDelivery of
oral health care to older adultsInvolves diagnosing, preventing,
& treating problems associated with normal ageing & age
related diseasesPart of interdisciplinary team with other helath
care professionals 10. Functionally FunctionallyindependentFrail
elderlydependent elderlyelderly 70% 14% 5% & the rest Able to
get to Chronic homebound/dentistconditions with institutionalised
impaired mobility 11. Seniorswho have 1 or more physical/
mentaldisabilities Predominantly females > 75 yo Alone/ widow
Dependent in ADL Incontinent Cognitively impaired Economically
disadvantaged 12. 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 (MentalHealth Data 2005) Causeof death:55 64 yo:
neoplasm65 74 yo: circulatory system75+ yo: respiratory system 13.
Socioeconomic issues -Financial -DisabilityMedical &
healthissuesOral health -Diseases related issues-Behaviour 14.
Poverty/ financial Older widows mostly live in poverty Primary
carer of orphaned & vulnerablechildren = elderly Increase in
per capita cost of healthcare Dependent on social care system 15.
Improvedpublic health, sanitation Carrying diseases of middle age
Cancer, CVD, neuro disorders etc Most >65yo have at least one
chronic healthcondition (increased burden on health caresystem)
Diagnosed, undiagnosed & misdiagnoseddiseases 16. Moreretaining
teeth at 65 yo Remaining teeth heavily restored Increase in dental
service utilisation Root caries vs. coronal caries Perio disease
(change of inflammatoryresponse with age) 17. Understandingimpact
of fast growing elderlypopulation to dental profession Patients
expectation Cost implications: RCT vs extraction with/without
implant Medical health Post op healing & resilience
Availability of appropriately trainedprofessionals 18. Thorough
exam: soft & hard tissues incldenture Perio disease, caries
& common oral healthproblems in elderly: be alert Oral systemic
linkage Consult appropriate professionals Intercollaboration with
family members & LTCstaff Transdisciplinary care 19. 3keys
area: 1. Patient education, carer/ familymember training 2.
Integration of oral health care intoADL 3. Periodic preventive
professional care 20. Diet & nutrition Frequent sips of water
Oral hygiene Brushing teeth Use fluoridated toothpaste Mouthwash
21. Denture care Remove dentures As often as possible during day
whileundergoing treatment Before sleep When using mouthwash When
denture is causing pain 22. Denturecare Rinse dentures after meals
with water Brush dentures daily with soft brush & mildsoap (not
toothpaste) Soak dentures with water atnight or when not in use
Soak denture with vinegar &water (1:1) for 1 hr/ wk
disinfection 23. Patients needBeyond practitioners skill
Appropriate referralOVERALL HEALTH 24. DR NORJEHAN BT YAHAYA
Hospital Kuala Lumpur DR SITI ZALEHA BT HAMZAH BDS (UWA), DClinDent
(SND) (Otago) Hospital Serdang 25. Geriatric patients with special
needs is defined as 60 years & above Present with at least 3 of
conditions as the following:- 26. Frail & functionally
dependant (rely oncarers for ADL) Neurologic & cognitive
impairment Communication & behavioural problem Increased
chronic medical conditions incl.polypharmacy 27. Chronic
psychiatric/ psychological condition Nutritional/ swallowing
problem Poor motivation towards oral health care Elderly ASA III /
ASA IV Require dental tx under conscioussedation/ GA 28.
ConsultationREASON FOR Urgent treatment REFERRAL Further
managementRESPONSIBILITIES Complete patients details OF REFERRING
Relevant document incl. valid OKU card/ CLINICIAN photocopy of
guarantee letterRESPONSIBILITIES Prioritising patientsOF REFERRAL
Review referrals according to guidelinesCENTRE Advice for referred
patient 29. Majority of elderly with a mild or moderate disability
or medical condition can & should be treated in GDPNot everyone
with disability requires SND, as not all disability limits oral
health 30. Thosethat can express need & able to easily access
mainstream dental services, despite disability do not need SNDSND
relates to patient complexity, rather than complexity of dentistry
being provided 31. Access No stairs (ramp/ elevator) Safe parking
Reception furniture Not low to floor Firm With arms 32. 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 writtenmaterial 33. 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 34. Other
communication enhancement Use titles & surnames unless asked
specifically asked touse first name Provide written instruction
Communicate with caregivers but do not ignorepatient 35. Outreach
dental service for those who cannot reach it themselvesIncl oral
health & dental treatmentIncl residential care & nursing
homes, hospitals, day centres & patients homesIncl preventive
oral health care but not dental screening 36. Aims: To deliver
appropriate oral healthcare to those whocannot access dental care
facilities Can be provided by primary dental care/ hospitaldental
service Needs: Institutionalised elderly more likely to have poor
oralhealth (Fiske & Griffith 2000) Routine vs last resort 37.
Frail elderly & Functionally dependent elderly>90 yo
benefits the most (Helgeson et al 2002)Use less energy to travel
Youngerpopulation who are homebound 38. Dental team Equipments
Preparation Training Referral system Health & safety issues Mix
& match care 39. THANK YOU
