In addition to an increasing number of chronic conditions, older adults
The oral health care professional of today and tomorrow will treat an
ever-increasing number of older adult patients who differ from older
will reach their dental professional taking more medications for these
various chronic conditions. Thus these conditions may require more
The 'new' elderly have more of their own teeth, visit the dentist more
often, and demand more sophisticated care.
frequent consultations with their physicians. Communication between the provider and the patient is an
Three aspects of human communication have been identified in the literature:
essential component of all clinical work. At the core of all clinical dental practice is the interpersonal interaction between dentist and patient.
Effective communication is an important factor for patient satisfaction and
These three factors co-influence the communication outcome, and any barriers
to them can result in ineffective communication.
It is necessary for dentists to understand older patients’ communication barriers and acquire better communication skills and attitudes. Studies have identified several communication barriers: AGE-RELATED COMMON CHANGES Studies have identified several communication barriers: Hearing: gradual loss of ability to hear certain sounds such as "S, SH, and CH" and high frequencies Vision: reduced ability to see distant objects, objects that are too close (even
faces) and certain colors; loss of ability to see to the sides (peripheral vision) is
- excessive use of medical terminology,
- presenting several subjects at one time, - speaking without eye contact,
Smell and Taste: reduced ability to smell and taste (both good and bad things) Touch: reduced ability to feel touch in general; also reduced ability to feel hot, cold, and pain may be experienced Reaction time slows: more time is needed to "process" the information and come up with "the answer" DISEASE AND DISABILITY Hearing difficulties are encountered by 75% of individuals between 75 and 79 Hearing impaired older adults may be labeled as "confused" because they Many different types of disease, illness, and even medication side-effects
didn’t hear the question and then responded "inappropriately."
years of age; 10% of people in their sixth decade exhibit tinnitus. may alter the person's abilities to communicate.
Sometimes patients are ‘pretending to understand and not telling the
Hearing problems involve loss of discrimination of high-pitched sounds so that
caregiver about being hard of hearing’. This barrier is categorized as
lower pitched noises are preferentially heard. Natural death of irreplaceable
Dysarthria: A medical term that is used to mean that a person has difficulty speaking
because they aren’t able to form (articulate) the words; speech may be slurred or difficult
neurones in the acoustic nerve and in its environment occurs.
In the cochlea, receptors for soft sounds degenerate more than those for hard
Oral Health: Loss of teeth may impair speech; medication side-effects that decrease saliva and cause “dry mouth” may interfere
sounds; thus while the normal voice becomes inaudible, shouting causes
Dementia Lung disease: Inadequate "wind" or respiratory capacity to speak can make the Receptive aphasia: involves the loss of ability to understand the spoken word
is a general term used to describe a cluster of cognitive changes, most often in older
person difficult to hear or understand; e.g., emphysema, asthma, COPD
adults. It refers to the deterioration of cognitive functions such as memory, speech and
Stroke: Cardiovascular accident (CVA), commonly called stroke, destroys brain cells in Brain Injury:
thought processes, and may be accompanied by changes in personality and behaviour.
Several different types of brain disease and injury may result in loss
specific areas of the brain; losses tend to be stable; may create either receptive or
Alzheimer’s Disease, a degenerative brain disorder, is the most common form of
dementia in adults. It can progress slowly or rapidly in a person. Aphasia: The medical term that is often used for disease-related loss of language; Head trauma: Injury that causes brain cell death; losses tend to be permanent and
may be either receptive and expressive; type of impairment include the loss of ability
to name items, put together sentences, understand and act on what is heard and read or write
Emotional memory persists for those with cognitive loss; feelings are often stronger, more
Dementia: Alzheimer's and other types of dementia destroy brain cells gradually with
loss of language occurring over time; losses are permanent and interfere with every
Expressive aphasia: involves the loss of ability to express oneself through
aspect of person's ability to communicate
Many older patients have no remaining teeth and are termed edentulous.
These patients may or may not be wearing full or complete dentures and complete denture wearing may be rendered more difficult with the advent of dementia.
Cognitive impairment is no longer considered a normal and inevitable change
The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems or when a diagnosis of
The reason for this is that successful (complete) denture wearing depends to
a great extent of what is termed neuromuscular control (much like riding a
of aging. In older patients, cognitive functioning is especially likely to decline
during illness or injury. The assessment of an older adult’s cognitive
It is an 11-question measure that tests five areas of cognitive function: orientation, registration, attention and calculation, recall, and language.
It is not uncommon, therefore, for carers of edentulous patients who are
status is instrumental in identifying early changes in physiological status,
The maximum score is 30. A score of 23 or lower is indicative of cognitive
suffering from dementia to request that new dentures be made for such
patients. In reality, new dentures may not result in an optimal outcome,
ability to learn, and evaluating responses to treatment.
although the concept of template or copy dentures makes it easier for patients to adapt to new dentures.
Sadly, in the case of patients with dementia, the only way a
The edentulous patient is also prone to other oral conditions in addition to the
functionally acceptable outcome may be achieved is by the use of denture
fact that the status of her/his gums will gradually deteriorate with time. One
adhesives. These come in a variety of forms from powders to pads and from
of the most common is mouth ulcers as a result of rubbing of the
pastes to strips. It must be said that in the case of adhesives, a degree of trial
denture against the soft tissues overlying the jaw bones. Most of us will
and error is required as factors such as taste and consistency of the material
appreciate how even small ulcers in our mouth can be painful. For this
will influence their usage as well as the need for carers to apply these
reason, carers should be aware of the need for denture-associated ulcers to
is common in late life. Both major and minor depression are reported in 13%
adjuncts. In addition, all adhesives need to be removed and this may also prove
be seen by a dentist; an analgesic paste may work short term but will certainly
of community dwelling older adults, 24% of older medical outpatients and 43% of both
distasteful to the carers yet may be clinically necessary if the patient is going to
not cure the problem! Some ulcers, however, do not cause pain and this must be
acute care and nursing home dwelling older adults. Contrary to popular belief,
be able to eat and speak with some degree of comfort.
viewed with suspicion and a dentist consulted immediately.
depression is not a natural part of aging. Depression is often reversible with prompt and appropriate treatment. However, if left untreated, depression may result in the onset of physical, cognitive and social impairment as well as delayed recovery from medical illness and surgery.
Depression is associated with poor dental health habits.
While there are many instruments available to measure depression, the Geriatric
It has been estimated that one in every five patients who visits a dentist experiences
- Subjects with a high number of depressive symptoms had lower
Depression Scale (GDS), has been tested and used extensively with the older population. It is a brief questionnaire in which participants are asked to respond
clinically significant symptoms of depression.
toothbrushing frequency and lower frequency of dental visits than other
to the 30 questions by answering yes or no in reference to how they felt on the
subjects, although they perceived more commonly dental treatment need
Depression and depressive symptoms have been shown to associate with unfavorable
health behaviors, for example smoking, drinking and lack of regular
- reduced saliva secretion among subjects receiving antidepressant
10 - 19 indicate mild depression 20 - 30 indicate severe depression
medication may lead to increased caries activity, also reported in
Tricyclic amitriptyline, imipramine, doxepin
Selective serotonin reuptake inhibitors sertraline, paroxetine, fluoxetine
It is important to make clear that one does not need to be a trained psychologist or psychiatrist to detect signs of emotional upset.
The people bearing this burden of mental illnesses also go to the dentist in
The primary data about the patient’s mental and emotional status would come
nearly universal numbers. It is especially noteworthy to observe that it is
from well-established and easy-to-use screening questionnaires.
primary care physicians, not mental health service providers such as
Identification of depression can help maintain and potentially improve health and
psychiatrists or psychologists, that make about 50 percent of all major
Patients, of course, are always free to not answer sensitive questions if they so choose.
Dentists should consider taking on screening for early detection of mental
disorders, principally depression and dementia in elderly.
It seems reasonable to assert that screening for the most common mental
The general approach for using these questionnaires would be for the dentist
dentists gather information about the physical disease status of their patients.
to determine if the patient is currently experiencing or perhaps at risk for
Psychological factors significantly influence denture satisfaction.
Such screening is not hard to do. The idea is not that dentists would diagnose
experiencing common mental or emotional disorders.
Questionnaires may provide useful in predicting potential difficult
depression, anxiety or dementia, but that they would screen for it, using
relatively simple questionnaires that all their patients would fill out.
Methods of human communication are often classified as verbal, nonverbal, and written.
The way that the words are spoken, including the look on your face, your tone
The majority of patients express satisfaction with dentures that
of voice, the posture of your body, and gestures that you use.
are well designed and constructed yet there are
a group of patients who remain dissatisfied in spite
of the clinical perfection of their prostheses.
- head nodding, - hand gestures, - postural positions (open or closed body posture and forward to backward
- paralinguistic speech characteristics such as speech rate, loudness, pitch,
General communication strategies for use with elderly.
Nonverbal behavior is widely recognized as conveying affective and emotional
Nonverbal behaviors often accompany words and thereby give words
information, although it has other functions as well (such as regulating turn
Verbal Communication strategy
meaning in context. So, the interpretation of a verbal message of
Speech construction - use short words and simple sentences
As examples, a frown may convey disapproval or a smile may convey approval
agreement: ‘‘Sure, that’s fine’’
- be clear and concise; avoid long, wordy
or agreement. A blank expression may also convey an affective message to a
perceiver, such as aloofness, boredom, or dismissal.
may be interpreted differently depending on whether the statement is
- use words that are familiar and understandable;
accompanied by a frown or a smile or a blank expression.
- begin each conversation by identifying
I frown when I am thinking and sometimes people think I'm mad at them.
yourself and using the person’s name/title
Others - the presence of a carer is helpful Communication strategy Non – verbal - stand in front/side of person in line of
- break tasks/activities down into steps
Speech style - speak slowly, clearly and lower voice tone
- give them time to answer your questions or
tell you what they have to say (Remember: reaction
- maintain patience and a reassuring attitude
- wait for a response to a question, and ask
- decrease the number of people in the room
- never talk as though the person is not there assume the person understands more than
- make sure that glasses are ON the person!
- talk while cares are being provided, and not
ANAL CUNT Boston, Massachusetts. Seth Edward Putnam vive nella casa dei suoi genitori col suo fratellino. Lavora in una stazione di servizio di gas. Si sintonizza sulle frequenze delle peggiori radio locali. Si nutre di rumore e di alcool. Entra a far parte di una Noise band, ma ben presto decide di abbandonarla perché stava diventando fin troppo musicale. Ciò che ha in mente è u