Discuss about the Aged Care Oral Health And Dentistry In Australia.
Stewart, & Wild, (2017) the main dental care challenges among the elderly in Australia range from edentulous individuals, periodontal disease, having a dry mouth which is also known as xerostomia, oral cancer and tooth wear. These has caused occasional oral health problems such as difficulties in chewing, avoidance of several foods, development of sores in the mouth and increased dryness. Avoidance of several foods may cause challenges of malnutrition or under nutrition which also makes it difficult for healing of the dental related problems. Teeth related problems also affects interpersonal relationships as elderly edentulous people have complained of challenges when communicating and stomatitis which refers to the inflammation of the oral mucosa that also heightens the difficulties.
The prevalence and risk of infection of dental diseases among the elderly increase as they age which rather insinuates that the condition is accumulative as opposed to susceptibility with age. Research has also proven that in overall health care data, the number of people whose teeth needs to be extracted due to dental diseases increases with age which also indicates that the problem increases with time. This can be proven by the fact that as people age, they have deteriorating efforts to maintain their teeth which requires more attention with ages due to wear and tear. Carelessness in handling teeth and continuous drug use such as alcohol and smoking has also increased susceptibility of teeth related infections. Prevalence of lifestyle diseases such as diabetes and other chronic illnesses among the elderly also sums up to the difficulties that old people encounter in maintaining dental hygiene.
Dental related problems have profound impacts in the health and lives of aging Australians. These challenges and difficulties in eating communication are more in the edentulous that in the dentate individuals. Oral ulcers and fractured femurs are also some of the impacts that result from poor dental care. These challenges impact in the overall health of the elderly especially as they become choose on foods due to dry mouths conditions and difficulties in chewing and swallowing of food. They may opt to consume more fibers and vegetables as opposed to proteins and fruits.
Smylie, et al (2016) has confirmed that more elderly people have visited the private health facilities as opposed to government facilities. This has shifted the focus of the Australian government into focusing more on the service delivery in the private facilities and also increased knowledge on the various dental related problems and ways of handling the dental problems. Improving the quality of services in the government facilities is also being observed to see to it that more individuals are able to access care in the government facilities which are considerably cheaper as opposed to the private institutions.
Pradhan & Gryst, (2016) aged Australians have shown preference to private institutions whatsoever due to the increased mobility of service delivery. It is possible and much easier for private institutions to deliver services to the people’s homes and work places as opposed to government health officers. This they have said helps them conserve more time they spend on appointments and checkups for other personal work. This has been more effective for people who have other difficulties in mobility due to being handicapped, bedridden or other difficulties in accessing health care services in public institutions.
Some people have blamed poor weather and other obstructions to accessibility of public dental services as an explanation as to why they opt private health services that have increased mobility. Cost subsidy in public institutions have been efficient as more people with insurance cover are able to access these dental services without having to encounter a lot of cost. However dental care is still expensive for people with low social economic status. Lowering the cost in the public institutions has its disadvantages too in that too many people try to access it which ends up resulting in congestion in the health facilities.
Congestion in the public health facilities is very unsuitable for the aged and worse when it is full of bureaucracy and chronic queues for patients wishing to access services if there are no specialized care centers specifically for the aged. For people with low socioeconomic status in the society, neglect of dental care services is evident even amidst cost subsidy. Visschere, et al (2015). confirms that on average, people with low social economic status attend the dental clinics for specific problems and not frequent checkups. However enough sensitization needs to be done to make the people aware that dental health does not necessarily infer to lack of a disease but regular checkup is necessary to also prevent possible infections.
amidst all these challenges, The Australian Society of Special Care in Dentistry which ensures that relevant information is provided to people with special needs and that they are accorded relevant help to overcome these challenges.
Tan, et al (2015) defines community health as a collection of health related services that revolve around early disease detection, preventive measures such as vaccination, assessing the health needs, modes of treating the illnesses and the maintenance of the overall health of the community. In community health, both the social and clinical directives are identifies and dealt with in order to provide a freer society from disease and control environmental causatives of disease. Dental care as part of community health is no different. It encompasses all the dental care services of prevention of disease, maintenance of hygiene, continued care to prevent worsening of already complex conditions and curing already existing diseases.
The community addressed health care and provision of service has for decades been considered as a very cheap way and affordable by many individuals. It is cost efficient and effective at the same time as opposed to hospitalized care since it favors the persistent long term and recurrent conditions that are not suitably offered in the hospitals. Community based care has however not been at the Centre post of dental service delivery since it has lacked support from the concerned stakeholders. The society also tends to undermine the community based dismissing it as lacking efficiency as opposed to hospital based health care.
Kisely, et al (2015) suggests that the role of clinical health team in community health among the aged revolves around demystifying the idea of viewing the aged are an economic social burden. This has been achieved through the enactment of policies favoring the aged such as the Living Longer Living Better reforms which brings together health care providers and the community to looking at the aged as an important resource of social and economic prowess. This has increased the attention of the community to focusing on dental health for the aging as a priority. Advanced technology, learning and increased social mobility of Australians have continued to ensure penetration of dental health services into the communities and it has also seen increased people seeking these health services.
The oral health for older people have however continued to be considered as insufficient. This is because service delivery has been inhibited by several barriers deterring the efficient delivery of services to the aged people in the communities. (McKechnie, & McKechnie, 2017) rural ageing being one of the contributing factors which forms a basis of neglect. This is also associated with rural-urban migration, brain drain and lack of collaboration between health care providers and policy makers. This presents the clinical health team with a challenge of stretching themselves beyond their limit in order to accommodate specific needs of the aged by adopting a palliative and long term care for the elderly who are sometimes living with several chronic conditions.
HealthInfoNet, (2014) reports has proven that one of the root causes of adverse clinical outcomes results as a results of use and misuse of sedative and anticholinergic drugs. The drug burden index-a method formulated and developed to assess continued exposure to such medications and impact in the cognitive and body’s physical and physiological functioning-has been effective in explaining impacts of drugs and research on continued use of drugs, their advantages, disadvantages and limitations on the elderly unlike other pharmacologically devised ways of measuring the dangers associated with long term and high risk drug usage.
The pharmacological burden has made drug prescription and management for older individuals quite challenging. This is due to increased threats to their health. On average, 40 percent of Australians who are above sixty five years of age uses about three different types of drugs weekly for various health conditions and 35 percent are living with chronic illnesses (HealthInfoNet, (2014). These factors have increased polypharmacy. Use of many drugs exhibit different reactions as some drugs react with other drugs while others trigger different reactions in the body. Drug administration for older patients becomes even quite challenging due to the summation of all these factors.
Murray (2014) explains that establishing a balance between the risks and benefits of medication is important in determining the choice of medication among the aged. Anticholinergic drugs which are commonly administered to adults have increased deterioration of cognitive functioning of the individual. Other adverse effects of prolonged use of these drugs include drying of the mouth, confusion, constipation and visual acuity problems. Sedative medication in older adults also cause incontinence of urination, mental illness, pain disorders and dementia among other conditions. These conditions make it difficult to treat certain condition in the elderly due to such health risks of continued medication.
Making treatment decisions on people with various oral problems especially in such a heterogeneous context like that of Australia has all the same proved difficult due to a number of associated challenges and conditions which range from time available and willingness of the patient and the social economic power of the patient which influences the choice of treatment they seek. For instance, the level of finances may influence the patient choosing whether to fill a cavity or to remove a tooth. Finances will also influence the choice of materials a patient opts to use to fill the cavity (Brennan, & Teusner, 2015).
Walker, (2017) for the clinicians however, the choice of treatment option is influenced by different factors such as the skills and resources to conduct the appropriate treatment. For older adults and the aging population, factors such as the prevailing health conditions, chronic illnesses and the effectiveness of the treatment option is still relevant in influencing the choice of treatment plan that is considered as most appropriate. There are several paths of decision making depending on all these factors which can be known as rational care dentistry, minimal invasive and cost efficient. For the aged population however, the rational care dentistry has been chosen over the rest since it is centered on the best interests of the patient.
The aging population has been said to be facing numerous challenges that range from feebleness, poor vision which increases the risks of falls and fractures, neurocognitive delirium and decline, compromised sleep and rest, oral and dental problems among other challenges. Research has proven that all of these challenges if not well catered for may impact negatively on other parts. Gerontologists’ research has shown that among all these problems, dental related problems are the least adhered to. This has resulted the oral problems impacting negatively on other factors such as psychosocial problems which arise as a result of projection, teeth decay and various chronic periodontal infections.
According to Riggs, et al (2015) among the aging populations, edentulous individuals has been on the decrease. This has followed proper care. Nevertheless, there are several challenges that have continued to worsen amidst improved dental care which include loss of teeth, periodontitis, dryness of the mouth, and oral cancer. These have been considered as the major issues that relate to dentition among most elderly Australians since every six out of ten Australians have a problem with their oral health. Edentulism being a major phenomenon can be attributed to both poor health and cultural societal influences. Incremental loss of teeth as one becomes older has consequences in that the remaining teeth may drift. The individual may experience pain and problems with communication which in turn affects interpersonal relationships of the patient. Replacement of fallen teeth with dentures is then a better way of dealing with the challenge as it helps to solve some of these challenges associated with teeth loss.
Lee, et al (2015) dental caries have over the years been identified as the biggest challenge of older people in as much as oral health is concerned. These statistics have been arrived at through comparison of younger teens and adult population. The main cause of these dental carries have been identified as coronal carries and not necessarily root related issues. The problem has been also identified to be high among those old people with dementia as opposed to those who are healthy. This has in turn helped to conclude that people with dementia and other bad health conditions such as diabetes are at a higher risk of tooth infection than normal healthy individuals.
According to Willis, Reynolds, & Keleher, (2016) the chronic dry mouth among the aged is an equally big threat to their oral health as it presents profound challenges to their health such as difficulties in communication, chewing and swallowing of food. However, according to pharmacologists, dryness in the mouth can be attributed to certain types of drugs such as antidepressants, respiratory agents and antihypertensive drugs among other drugs. The risk of dryness in the mouth remains comparatively higher in older individuals than the younger adults and its effects lowers the quality of life for the aged population.
Oral mucosal lesions poses an equally great challenge as dry mouth and dental caries for the older population. Oral pre cancer and oral cancer which refers to squamous cell carcinoma with significant malignant transformations have profound challenges on the health of older people. Cases of oral cancer have been identified to be more in the less developed countries. Treatment of oral cancer is usually difficult since it poses serious threats to the lives of individual patients such as the risk of drying mouth (xeristosomia), affection of other organs such as the tongue, throat and the salivary glands and also pain caused by removal of cancerous cells and wounds. The risk of infection is equally high among the younger people who also wear dentures instead of natural teeth Chrisopoulos, Harford, & Ellershaw, (2016).
In conclusion, the management of oral infections and overall oral hygiene is considered a very important objective in the life of the elderly. This is because, apart from relieving pain and making the old people comfortable while eating, it also helps to minimize the risks and sources of pathogens especially the blood borne pathogens that may not only infect the mouth but also reach out to other parts of the body such as the lungs and the stomach. Prevention and control of psychosocial and behavioral problems associated with pain in the mouth and also management of side effects of various medication that have been found out to cause problems to the teeth. Easing the pharmacological burden, acknowledging the special needs of the aged in dentistry and involving the community in the health of the elderly are some of the key efforts required in ensuring oral health of the elderly has met estimated levels of improvement.
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