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

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

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

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)

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

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

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

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)

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)

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

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

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

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….

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

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

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)

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)

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)

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

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

Slide of Oral Cancer Goes here

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

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?

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)

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

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

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

If you have been ... Thank you for listening kenneth.a.eaton@btinternet.com