1. Oral Healthcare of the Elderly – A Growing Challenge
Professor Ken Eaton

2. Terminology
Elderly Older people Old people Old Political correctness v WHO?

3. Topics to Be Covered An Aging Population
General Health and Social Implications
Oral Health of the Elderly

4. An Aging Population Currently in the United Kingdom 10 million
people are aged 65 years or more
3 million are 80 years or older
By 2033 it is projected that 15.5 million will be 65 years or older
(Government Actuary’s Office 2013)

5. An Aging Population
No longer three score years and ten but four score years and ten
A quarter of children born today 1 November 2013 can expect to live to the age of 100

6. An Aging Population The economic consequences are considerable
In 2012, Some £100 billion from the budget of the Department of Work and Pensions went to the over 65’s
A large proportion of the budgets for the NHS and social care also went to over 65’s

7. Healthy and Unhealthy Picture of healthy active old person
and unhealthy inactive old person

8. General Health and Social Implications
More people working in paid employment after their 65th birthdays
Ideally family support for the elderly
But 25% live alone
Decreased quality of life (loneliness, ill health, poor care) for some
More and more elderly in care and nursing homes or hospitals)

9. General Health and Social Implications
400,000 over 65’s in Care or nursing homes in England in 2011
Over 18,000 such homes
Quality of care?
(CQC Report 2012)

10. General Health and Social Implications
Health problems of the over 65’s include:
arthritis, cancers, cardiovascular diseases, dementia, diabetes, poor eyesight, poor hearing, respiratory diseases
Many of these diseases are chronic and have the same risk factors as those for oral diseases
There is therefore a need for closer integration of oral and general health care

11. General Health and Social Implications
So what are the common risk factors?
Smoking
Excessive alcohol consumption
Poor diet
Low socio-economic status
Others

12. General Health and Social Factors
Most of the diseases suffered by over 65’s are chronic diseases
Often they are not the cause of death
Death may result from infection which is not combated because of weakened immune systems

13. General Health and Social Implications
Acquired infections whilst in hospital and residential care.
The commonest cause of death from hospital acquired infection is now pneumonia.
Good oral cleanliness prevents this
Who cleans the mouths of the sick?
A recent example….

14. General Health and Social Implications
Many diseases of the elderly could be prevented or ameliorated by healthier life styles before becoming elderly
A good example is healthy diet, exercise, not smoking and avoidance of excessive consumption of alcohol to prevent obesity

15. Oral Health of the Elderly
Over 65’s suffer from the same three groups of oral diseases as young people
Some are more at risk because of reduced salivary flow, poor diet, poor oral hygiene,
impaired resistance to infections
Even healthy mouths contain 100s of species of potentially harmful microbes

16. Oral Health of the Elderly
The three groups of oral disease are:
Dental Caries (tooth decay)
Periodontal Diseases (gum diseases)
Diseases of the soft tissues (inside of the mouth and tongue)

17. Oral Health of the Elderly
As far as retaining teeth and dental caries the oral health of adults, including the elderly, has improved significantly since 1968
When 37% of adults in England had no natural teeth
By 2009, this figure was 6%
(Adult Dental Health Survey 2009)

18. Oral Health of the Elderly
By 2009, only 15 % of 65 – 74 year-olds and 30% of 75 – 84 year-olds had no natural teeth.
However, 30% of 65 – 74 year-olds and 40% of 75 – 84 year olds had a partial denture or denture(s)
(Adult Dental Health Survey 2009)

21. Oral Health of Oral Elderly
The situation is not so “good” for periodontal diseases and diseases of the oral mucosa.
And in particular for oral cancer

24. Oral Health of the Elderly
A number of things can limit any individual’s ability to clean their mouths and control their diet
Poor eyesight, lack of manual dexterity,
forgetfulness, state of mind are more likely to occur after 65 years of age
Those living in care and nursing homes have little control of their diet

25. Slide of Oral Cancer Goes here

26. Oral Health of the Elderly
The elderly are far more at risk of xerostomia (dry mouth)
Causes may include:
Side effect of various medications
Damage to salivary glands
Sjorgren’s syndrome
Others

27. Oral Health of the Elderly
Many elderly people and a high percentage of those living in care or nursing homes and who are in hospital therefore need daily help with mouth cleaning and a balanced diet
Do they receive this help?

28. Oral Health of the Elderly
In Glasgow care homes in 2006:
Over 75% of residents needed attention to basic oral hygiene
33% needed fillings or extractions
73% of those with some natural teeth had tooth decay
38% showed signs of diseases of the oral mucosa (Sweeney et al. 2007)

29. Oral Health of the Elderly
So what is happening to address these problems?
In Scotland – National oral health improvement strategy for priority groups :frail older people, people with special care needs and those who are homeless
In England – A national group (Janet Clarke) and local initiatives

30. Oral Health of the Elderly
Promoting older people’s oral health – guidelines for support nurses and care staff…. (DH England 2011)
British Society for Disability and Oral Health – unlocking barriers to care (2004)
Surveys in Wales, Brighton, Medway, etc.
Residential Oral Care in Sheffield (ROCS)
Training programmes for nurses and carers

31. Oral Care of the Elderly
Good Practice in Europe
Denmark and Sweden (comprehensive oral care service for residents of care homes)
Netherlands and Flanders ( Dutch Associations of Nursing Home Physicians guidelines for carers)
France – UFSBD – Training programme for carers

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