by Sheri B. Doniger, DDS
One of the greatest pleasures of my day is to have a senior citizen in my chair. The wisdom of the ages does indeed shine through. As I approach my increasingly delayed senior status, I truly appreciate all they have to offer. The more we actively listen to these wonderful people, the better it is for all.
Seniors can come in with a variety of needs. Initially, we need to talk to them and assess their status. Each visit could be dramatically different from the last. Seniors are afflicted with a myriad of diseases and are dependent upon many medications. It is a rare patient over the age of 60 who has not had a change in medical status or medications.
At each appointment, we need to take time to question our elder patients to determine which medications they are taking. Many seniors take a variety of medications, sometimes from various practitioners. These patients can go to different pharmacies to get their prescriptions filled or they can fill them through mail order or online drug houses. Evaluating for adverse reactions is the next natural step in this process. Untoward effects can happen when two drugs potentiate. A seemingly innocuous drug may cause adverse reactions in susceptible individuals. Questioning the patient about any physical changes since starting a new medication is always wise. It is good that we can be another set of "eyes" to see which medications are being taken and which ones may cause a "red flag" for potential problems or associated symptoms that present themselves.
All seniors should have a list of current medications in their wallet. We would do well to advise our patients of this. Some practices have a card available for the patients to write in their pertinent medication data.
Nutritional counseling is also a consideration. Many times, these adult patients are alone, due to death of a spouse or other living conditions. To take a few minutes of our treatment time to discuss their diet could assist in our future treatment planning, as well as demonstrate another level of caring for this patient. The more socially active seniors may frequently eat meals out. However, there are dangers associated with frequent dining out.
Salt that is usually added to restaurant food is frequently greater than the amount added at home. An apparently innocuous meal of soup and salad may have more sodium and fat content than a senior citizen should ingest. Other considerations are blood pressure and water retention, which can be affected by a diet rich in salts. Additionally, the bread and rolls on the table, consumed with butter, present an increased risk for added fats. Portion size, which at some restaurants is huge, can work both ways. Some seniors only eat half, bringing the rest home for another meal. Others feel that all should be eaten, causing an increased amount of ingested calories.
At-home dining also is a concern for the elder adult, especially those living alone. Serving sizes can be a quandary. How much is too much? A cup of dry pasta is at least two cups of cooked pasta. Eating a lot of anything after the hour of 8 p.m. may cause gastric distress and discomfort, keeping the patient up during the night. On the other hand, due to many reasons — such as a lack of company, motivation, medication, or diminished sense of taste — they tend to eat less than they should.
While discussing diet with our patients, sometimes it is beneficial to discuss exercise as well. We are concerned with the general health and well being of our patients. It would follow that after a diet discussion, we could ask about their exercise. Are they walking at all? Do they utilize any senior fitness facilities? Even those who are incapable of exercising can do "chair aerobics."
Many times, our senior patients are in need of massive amounts of dental care. Other times, minimal care is required. Limitations due to medical concerns and restricted finances could have an impact on the comprehensive care to be given. We need to talk to our patients to assess the level of care to which they are willing to commit their time and money. A radical treatment plan of five implants and full mouth periodontal surgery may not be what the patient truly desires. It is our job to actively listen to our patients for their treatment goals.
Active listening to our seniors can be one of the best gifts of care we can offer, and it is free. In addition to assessing their personal dental goals, we can give them a social outlet for conversation they may not have in their day-to-day lives. On occasion, the only time a senior patient talks to someone who isn't family is during one of their dental or medical appointments. Yes, there are seniors and then there are "aging boomers," who do not consider themselves ready for the "AARP Generation" yet!
They are proud of their grandchildren and want to share all their happiness. They want to tell us about a trip they took or an upcoming graduation. Some want to talk about their past lives — where they lived, how the neighborhood has changed, or life events that occurred a long time ago. When they allow us to be a part of their lives by sharing their life stories, that is truly a gift. The appointments may take a few extra minutes, but it will be time well spent.
The time we spend actively listening to our senior patients, benefiting from the wisdom of their age, showing concern for their total welfare, will be valuable in helping them maintain their dental health. It will also be an invaluable asset to their lives knowing someone truly cares. So, make someone happy — give a listen.
Sheri B. Doniger, DDS, practices in Lincolnwood, Ill. She graduated from the University of Illinois College of Dentistry in 1983 and obtained her bachelor's degree in dental hygiene from Loyola University of Chicago in 1976. She can be reached at (847) 677-1101 or [email protected].