The ‘Sunset Age’ patients…Let’s know more about Geriatric patients!

- Dr Smita Athavale

The world is ‘Graying’ fast & so is India! Currently 10% of the population is more than 60 years old & it will be 22% by 2050. (1) That would mean a large number of Geriatric patients coming to dental clinics for treatment in the near future!

Geriatric patients, due to the age-related physical, physiological, psychosocial & dental problems, need special attention & care. Hence, it is extremely important for all the clinicians to know how to take care of our senior citizens in the dental chair.

What is Geriatric Dentistry?

Like pediatric dentistry, geriatric dentistry is also emerging as a speciality branch of dentistry.

Geriatric Dentistry can be defined as a science, that deals with diagnosis, management & prevention of all types of oral diseases in elderly population.(2)

Scope of Geriatric Dentistry

• Geriatric Dentistry emphasizes on dental care for the elderly population & focuses upon the elderly patients with chronic physical, physiological &/ psychological changes or morbid conditions / diseases.
• It is a speciality in dentistry that involves multi-disciplinary approach in evaluation of oral health, diagnosis, prevention & treatment planning for senior citizens (60 years and above)
• It involves dental treatment for elderly & / or medically compromised patients.
• It deals with providing palliative treatment and symptomatic relief from oral health problems like mucositis, xerostomia, dental caries and chronic periodontal problems.

The Elderly Age Segments

All geriatric patients can be divided into different categories depending on age and physical health status.

Categorization of elderly population according to age:

• The Young Old – 65 to 74 years old
• The Old Old – 75 to 84 years old
• The Oldest Old – 85 years old & above

Categorization of elderly population according to physical health status (3):

• Functionally independent elderly - 70% of the elderly patients. They are able to get to the dentist for treatment.
• Frail elderly – 14% of the elderly patients. They may have chronic conditions with impaired mobility.
• Functionally dependent elderly - 5% & the rest of the elderly patients. They may be homebound/ institutionalized.

Medical Problems of the Geriatric Patients (4)

Geriatric patients are hounded by various different medical health issues, and multiple medical issues in a single patient is also not uncommon. These medical problems include:

• Hypertension

• Ischaemic Heart Disease

• Constipation

• Chronic Obstructive Airway Disease

• Dyspepsia

• Diabetes Mellitus

• Cataract

• Osteo-arthritis

• Benign prostatic Hypertrophy

• Depression

• Cancers

• Parkinson’s Disease

• Osteoporosis

• Hearing Loss

• Degenerative Spine Disease

• Recurrent falls and Syncope

• Stroke

• Dementia

• Heart Failure

• Glaucoma

• Incontinence

Oral & peri-oral Problems in Geriatric patients.

Degenerative changes occurring in elderly population may lead to:

• TMJ Problems
• Attrition & Abrasion of teeth
• Root caries V/S Coronal caries
• Periodontal Degeneration
• Loss of Teeth

The ‘Giants’ of Geriatric Medicine ….(5)

The same medical issue found in the younger population can be more complex to manage in the elderly patient. This is because with increasing age, inherent obstacles block the way to good recovery. These include:

• Multiple Pathologies

• Atypical Presentation of Disease

• Immobility

• Instability ( Falls )

• Incontinence

• Intellectual Impairment ( Confusion )

• Late Presentation of Disease

• Silent Presentation of Disease

• Polypharmacy

Challenges in Geriatric Dentistry

1) Socioeconomic Challenges –

• Financial inability & physical disabilities/ limitations act as barriers for geriatric patients to undergo dental treatment.
• Older individuals in low socioeconomic strata have severe financial problems, making dental treatment difficult to obtain.
• Primary care-givers of dependent / disabled / vulnerable patients are overloaded with the overall responsibility, hence the dental treatment tends to take a back seat.
• Increase in per capita cost of healthcare has made dental treatment go beyond reach of an average Indian elderly patient.
• Patients who are dependent on social / government healthcare system may sometimes get delayed treatment.