“Eight Items and Four Notes” for Seniors Watching Teeth
Eight items: obstacle, period, referral, cognition, simplicity, vision, hearing, medication.
Four notes: physical, psychological, social family, who should be responsible.
Let’s talk about “eight items”
- Obstacles: Accessibility to the dental clinic, barrier-free access to the clinic, or low-level obstacles and safety require special design considerations.
- Period: Appointment consultation in the morning or afternoon period, you need to consider the situation of the elderly. For example, some elders have stiff movements in the morning due to illness.
- Referral: establish the habit of regular referrals and reminders. For example, the clinic’s prior reminder, the elderly self-recorded in the calendar, or family and caregiver reminders.
- Cognition: Physicians need to pay attention to the cognitive status of elders when communicating; for example, when we explain the condition, try to approach from the front of the eyes, and use non-verbal communication, such as smiles and eye contact, is very important.
- Simple: Patients with cognitive limitations are prone to information overload, so instructions and instructions should be simple and sentences should be short, such as “open mouth”.
- Vision: Because the vision of the elderly is relatively aging, it should be noted that the visual materials given to the patient need to be adjusted appropriately. For example, the instructions for post-operative precautions should be designed for the elderly and easy to read.
- Hearing: Because the hearing of older people is relatively aging, we should speak clearly, loudly, and slightly slower.
For elders who can read lips, we can face the patient below the line of sight and the mask should be removed so that the elder can read our speech. You can use written, graphic, animated, or video instructions to help explain dental information.
If you have a hearing aid, you can minimize background noise and avoid sudden noise when speaking. It is recommended that the patient adjust or turn off the hearing aid during treatment.
Before speaking, you need to give elders a message or light contact to attract attention to your speech and reduce the use of proper nouns. When using different equipment, it is also necessary to let the elderly know.
- Medication: Response to the use and interaction of multiple drugs: The elderly may use some drugs more or less. Physicians, family members, and caregivers must bear in mind that these drugs reflect the disease of the elderly Problems and adjustments to the dentist’s medical decisions and treatment.
Four notes
Note 1: Physiological changes
No matter how advanced human technology and medicine are, aging is a fact that cannot be changed. Changes in the body are relatively easy to find, and degradation or disease is a subject we must face sooner or later. The aging of these physical functions will also make it difficult for the elderly to maintain their oral cavity.
Hearing loss, presbyopia, cataracts, joints, skeletal muscles, lungs, cardiovascular, digestive system, nervous system, metabolic system, etc., or related diseases, or already a disease condition, will often make self-oral cleaning more difficult.
For the elderly with limited mobility, we now think that simply walking to the toilet to brush their teeth is a barrier for them. Moreover, the skills of toothbrushes, interdental brushes, and flossing, which require the coordination of fine movements, hand-eye coordination, and proprioception, are not easy to achieve.
Older people often complain of dry mouth and less saliva. Part of this is the deterioration of the saliva line that produces saliva. Of course, dry mouth may also be because the elderly usually use many kinds of drugs, and their interaction. Or dry mouth may be caused by psychological factors. The advantage of saliva is that it can help you eat and talk. It removes food from teeth and reduces the impact of oral acid on tooth decay; saliva also carries minerals that keep teeth strong.
The general principle is to reduce the barriers for the elderly to maintain oral hygiene and health care on weekdays.
- The design of the moving line in the home and the design of the toilet. How to make dental cleaning tools suitable for the elderly to grasp and use, and even some compensation techniques (you can ask a functional therapist).
- Elderly with physical inconvenience may require caregivers to assist with oral cleaning. The caregiver’s oral cleaning skills and mentality also need to be learned and adjusted.
- The timing of teeth cleaning is also a part of our attention, and some elders or caregivers need to be reminded. Like using an electronic calendar, when time is up, it automatically pops up to remind you to clean your teeth.
- To combat dry mouth, you can take small sips of water from time to time. You can also chew sugar-free gum, but avoid alcohol and smoking. In addition, saliva substitutes may also help.
Note 2: Psychological changes
Psychological changes, because they are intangible and invisible, are often ignored by family members or caregivers, such as delirium, depression, and dementia. Especially cognitive impairment and dementia are common.
The change in cognition makes it easy for the elderly to take care of their oral cavity, which also makes dental intervention difficult.
- Self-cognition and understanding of oral diseases, as well as accepting the doctor’s advice or following the doctor’s orders after treatment, are all major challenges.
- Learning new techniques, or adapting to new things, becomes relatively difficult; for example, the use and adaptation of new movable dentures and fixed dentures are also a challenge for some elders. However, some scholars have expressed skepticism.
- I forgot to brush my teeth and when I had brushed my teeth; or after receiving a tooth extraction, I was unable to follow the instructions to take drugs or hemostasis principles.
- Even some of the pain that can’t find the reason, some parts may affect the physical feelings due to psychological factors. Or, a certain part is really a physical disease, which leads to psychological effects.
Therefore, serious psychological and cognitive problems must be consulted by psychiatrists, psychologists, and psychopsychologists.
We cannot label the elderly because it is difficult for them to communicate; we also don’t have any ability or power to say that they are mentally problematic, because this requires a rigorous mental and psychological expert assessment before they can be diagnosed.
Note 3: Social family
In addition to eating and talking, the function of teeth is another part of the appearance, which will affect the psychological level of the elderly. For example: seniors who have long missing teeth, the face looks relatively unenergized, or the factor of missing teeth is unclear, and the elderly may feel less beautiful, don’t want to talk, or don’t want to go out Socialization indirectly affects the mental health of the elderly.
On the other hand, social welfare, social insurance, and social care systems do play a considerable role in the dental intervention of the elderly. For example, some seniors of the ethnic group, even if they are physically self-sufficient, need to rely on the support of the family at the economic level; often because of economic factors, some seniors are worried about receiving dental treatment plans.
Note 4: Who should be responsible?
The focus of the field of long-term care, or social welfare and social insurance on senior dentistry, can be considered as assistance. The main body, mind, and soul roles are the family members and caregivers of the elderly.
Occasionally, after seeing family members or caregivers bring the elders to the clinic, they will drop a sentence. The doctor will decide if you want, or the doctor will leave it to you.
In this case, our doctors can really help. After all, the body is its own, and the patient himself is responsible for his or her mouth; if the patient is incapable, the family or caregiver must pay a large part of the responsibility.
What we hope is that the doctors, family members or caregivers, and the elders jointly formulate a treatment plan and do their best.
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