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The golden years: Considerations for our geriatric patients

Oct. 12, 2023
Bethany Montoya, BAS, RDH, looks at the geriatric population and suggests ways dental professionals can support their physical and emotional well-being.

Today is your 81st birthday. While everyone expects you to be excited about this special day, it doesn’t feel very special. Your spouse passed away four years ago after 58 wonderful years together, leaving you alone in the home the two of you raised your family in. Your children urged you to stop driving last year, which has severely limited your independence and has made you feel like a burden now that you fully rely on them for transportation to the grocery store and your appointments. There have even been discussions about moving you out of your home to live with one of them, as they worry about your safety when you’re alone.

Your mind doesn’t cooperate the way it used to. Sometimes you try to express something important, but the words just don’t come out right. It frustrates you and worries your family even more. In terms of self-care, you take it one day at a time. There are days when you don’t have the energy to change your clothes, and gripping a toothbrush is hard on your joints. Overall, life is good, but there are challenges. Your income is limited, your body is not as strong as it once was, and your freedoms are in limbo. You wish more people understood that although you might forget simple things occasionally, you’re still with it and want to be treated with dignity and respect.

Defining the geriatric community

According to most health-care organizations, a geriatric individual is defined as a person who is 65 years or older.1 While the minimum age may seem young, the criteria used to define this population is based on the risk for developing disease, physiologic response to medication dosages, cognitive performance, and overall physical condition. “Older adults” is an interchangeable term that is also used to describe this age group.

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Aging is an inevitable part of life, and part of our role as oral health-care professionals is to support our patients through their golden years with understanding, compassion, and options for individualized care. We must remember the following truths when serving our elderly patients:

Oral care supports healthy aging

Research over the years has powerfully communicated that oral disease is linked to a variety of systemic conditions: specifically, cardiovascular disease, diabetes, pneumonia, Alzheimer’s disease, and certain cancers.2 Age is also considered to be a risk factor for these ailments, so when age is compounded with uncontrolled oral conditions such as periodontal disease, the likelihood for an elderly individual to develop systemic complications is significantly amplified.

As oral health advocates, we have a crucial position in keeping our elderly patients as healthy as possible. Simple things we can do to promote healthy aging in a clinical setting include dietary counseling, performing airway assessments, discussing sleep health, providing individualized oral hygiene instruction, and maintaining a consistent appointment frequency that is appropriate for the patient’s lifestyle and oral condition. Remember that many of the groundbreaking developments concerning nutritional science, the oral-systemic connection, and airway health have only occurred within the past decade or two, and many elderly patients lack access to this information.

Compassionate care is best

A meta-synthesis conducted by Clancy and others in 2020 stated that “older adults do not feel valued as people or for their contribution to society and strive to tone down their illnesses in an attempt to become more visible and acknowledged as people.”3 This leaves many elders going unheard, unseen, and unrecognized in our culture. This perceived lack of meaning and inclusion can significantly threaten one’s sense of self-worth. The same study found that a person’s feeling of dignity is largely relationship-based.

When it concerns clinical care provided by health-care professionals, acts that promote acceptance, understanding, and appreciation with our elderly patients go a long way. A simple way to accomplish this in the dental setting is to spend some time actively listening to patients’ needs, concerns, and fears. By repeating these concerns back to the patient, we communicate a high level of compassion and respect, which will yield a trusting relationship. Additionally, making every effort to minimize pain during appointments is critical, as older adult patients tend to associate suffering caused by treatment with feelings of disrespect, humiliation, and inferiority.

Be realistic and get creative

It can’t be emphasized enough that the in-office and at-home recommendations we provide for our pediatric and younger adult patients may not adequately suit our geriatric patients. With a higher likelihood of salivary dysfunction as well as potential physical and cognitive limitations, special considerations must be taken so care can be provided as appropriately and comprehensively as possible.4 Instead of assuming that patients with consistently heavy amounts of plaque on their teeth are indifferent or lazy, it would be beneficial to ask questions to find the root cause of this issue.

In instances where physical limitations prevent the patient from removing plaque effectively, an electric toothbrush or wide-handled manual toothbrush may be helpful. For patients with cognitive impairment, recruit the help of the patient’s caregiver in performing daily oral hygiene. Another option for managing biofilm is to increase the patient’s appointment frequency to allow the clinician additional opportunities to assist in plaque removal. For interdental care, many elderly individuals struggle to effectively use string floss. Alternative aids such as interdental brushes, water flossers, or toothpicks may be more applicable.

Managing xerostomia can be a daunting task, but there are many options that can meet the patient’s individual needs. Aside from traditional recommendations—such as increasing water intake, using sugar-free gums and candies, and avoiding caffeine, alcohol, and tobacco—oral care products that contain carboxymethylcellulose, hydroxyethylcellulose, xylitol, calcium phosphate, synthetic mucin, and olive oil have been shown to be very effective in managing dry mouth symptoms.5 As with any product recommendation, health history and allergies must be considered.

The geriatric community has stories to tell. They’ve experienced full lives and lived through unforgettable moments in history, and have made important contributions to the world we know today. When it concerns the care that we provide, we must make considerations to ensure effective outcomes and promote healthy aging for the whole human being in our dental chair. Although our immediate focus as oral health-care professionals is our patients’ mouths, compassionate, dignified service will encourage physical, mental, and emotional well-being, which makes our work worthwhile. Our elderly population is asking for our support, and we must answer the call. 

Editor's note: This article appeared in the October 2023 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

  1. Singh S, Bajorek B. Defining ‘elderly’ in clinical practice guidelines for pharmacotherapy. Pharm Pract (Granada). 2014;12(4):489. doi:10.4321/s1886-36552014000400007
  2. Evans CA. The connection between oral health and overall health and well-being. In: Institute of Medicine (US) Board on Health Care Services. The U.S. Oral Health Workforce in the Coming Decade: Workshop Summary. National Academies Press; 2009:chap 2.
  3. Clancy A, Simonsen N, Lind J, Liveng A, Johannessen A. The meaning of dignity for older adults: a meta-synthesis. Nurs Ethics. 2021;28(6):878-894. doi:10.1177/0969733020928134
  4. Razak PA, Richard KMJ, Thankachan RP, Hafiz KAA, Kumar KN, Sameer KM. Geriatric oral health: a review article. J Int Oral Health. 2014;6(6):110-116.
  5. López Jornet P, Hernandez L, Gomez García F, Galera Molero F, Pons-Fuster López E, Tvarijonaviciute A. A clinical study on the efficacy and tolerability of a new topical gel and toothpaste in patients with xerostomia: a randomized controlled trial. J Clin Med. 2021;10(23):5641. doi:10.3390/jcm10235641
About the Author

Bethany Montoya, BAS, RDH

Bethany Montoya, BAS, RDH, is a practicing dental hygienist, editorial director of DentistryIQ's Clinical Insights newsletter and a key opinion leader. She has advanced knowledge and training in complex cosmetic dentistry, dental sleep medicine, and implant dentistry. Recently, she has devoted her time to dentistry’s personal and interpersonal aspects through her social media brand, @humanrdh. Contact Bethany at [email protected].

Updated February 6, 2024