Special

Needs: the Older Adult

Janelle Urata, BA, RDH, Candidate for MS DH

Janelle.Urata@ucsf.edu

The Oral-
Systemic Link6

-Poor O H associated with chance of

pneumonia.
-Institutionalized residents without oral
care are 3-fold risk of pneumonia
related deaths.
-Xerostomia increases risk of caries.
-Poor OH common cause of malnutrition,
weight loss and poor quality of life.

The Myths of
Aging5
1.
2.
3.

Mucosal changes are not a function of

age in a non-diseased client.
Risk o f periodontal disease does not
increase with age.
Decrease in saliva is not a function of
age, most likely a side effect from
medications.

A Growing
Population
-The US population of people aged 6 5
and older is the fastest growing
population, growing quicker than the
rate of our total population.1
-By 2030, older adults will comprise
over 19% of the total population, due to
baby boomers w ho are turning 65.1-3
-Currently 43 million elderly live in US
and by 2050 this number w ill double.2, 3

Risks of Inadequate Care

Leading chronic health conditions in older adults are: arthritis,
cancer, hypertension/heart disease, diabetes, respiratory disorders.
-80% of older adults suffer from at least 1 chronic health condition.5
-14% of older adults live in poverty.2
-Most older adults lack dental insurance.2
-1 m illion older adults receive homecare, and 1.25 million are living
in assisted living facilities.4

References:
1.
2.
3.
4.
5.

6.

Oral Health in America: A Report of the Surgeon General (Executive Summary) Retrieved, 8/16/2014, 2014, Retrieved from
http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm
Profile of Older Americans Retrieved, 8/16/2014, 2014, Retrieved from http://www.aoa.gov/aoaroot/aging_statistics/Profile/2010/16.aspx
Minority Aging Retrieved, 8/16/2014, 2014, Retrieved from http://www.aoa.gov/aoaroot/aging_statistics/minority_aging/
Educational Objectives Retrieved, 8/16/2014, 2014, Retrieved from
http://www.smilesforlifeoralhealth.org/buildcontent.aspx?pagekey=80326&lastpagekey=80461&userkey=11603539&sessionkey=2318711&tut=66
7&customerkey=84&custsitegroupkey=0
Darby, Michele Leonardi, and Margaret M. Walsh. "Chapter 55: The Older Adult." Dental Hygiene: Theory and Practice. 4th ed. St. Louis, MO:
Saunders/Elsevier, 2015. 986-1005. Print.
Dharamsi, S., Jivani, K., Dean, C., & Wyatt, C. (2009). Oral care for frail elders: knowledge, attitudes, and practices of long-term care staff. Journal of
Dental Education, 73(5), 581-588. doi:73/5/581 [pii]

Atrophic
Glossitis

Ill-fitting Dentures
or Poor Hygiene

Results
in mucosal irritation & infection

Including:
-Denture Stomatitis or Candidiasis
-Denture-induced Fibrous Hyperplasia
-Denture sore mouth aka Chronic
Atrophic Candidiasis
-Occurs in 65% wearing dentures
Causes:
-Poor fitting prosthesis
-Wearing prosthesis overnight

-Caused from an iron deficiency

Appearance of tongue:
-Smooth
-Shiny
-Denuded
Symptom:
-Burning of the tongue
-Other Tongue Related Issues:
Can increase in size in edentulous
mouths or as a result of d isease i.e.
pernicious anemia

Special Considerations for

the Older Adult:

w During Dental Appointments:

-When assessing oral health, may be necessary
to increase recall appointments to h elp combat
plaque
formation.

-Considering use of topical fluoride in office. For

clients
who have difficulty swallowing, use
fluoride gel or varnish instead of trays.
-Reviewing medications to avoid adverse
reactions, contraindications and to review
possible side effects.

wRecommendations for xerostomia sufferers:
-Salivary substitutes: mouth rinses, xylitol, gels
- Increase water intake
-Consider consulting with MD
-Increase recall frequency to assess status

wOral Hygiene Routines:
-Important to review good homecare with
brushing, interdental picks, cleaning of prosthetics
and u se of chemotherapeutic agents.
-Dexterity, arthritis, difficulty seeing clearly and
other factors can change ability to complete
thorough home oral hygiene care. Consider
recommending larger handled toothbrush or
electric toothbrush.

wNutritional counseling is important:
-Frequency of snacking + soft diet + saliva

= Risk of dental decay
-Important to help educate about malnutrition

Angular
Cheilitis
Clinically appears as:
-Fissuring at the angels of the mouth
-Cracks
-Erythema
-Ulcerations
Causative Factors:
-Moistness from drooling
-Deficiency of vitamin B12 (riboflavin)
-Infection w ith Candida albicans

Mini Nutritional Assessment

MNA

Last name:

First name:

Sex:

Age:

Weight, kg:

Height, cm:

Date:

Complete the screen by filling in the boxes with the appropriate numbers. Total the numbers for the final screening score.

Screening
A Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or
swallowing difficulties?
0 = severe decrease in food intake
1 = moderate decrease in food intake
2 = no decrease in food intake
B Weight loss during the last 3 months
0 = weight loss greater than 3 kg (6.6 lbs)
1 = does not know
2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs)
3 = no weight loss
C Mobility
0 = bed or chair bound
1 = able to get out of bed / chair but does not go out
2 = goes out
D Has suffered psychological stress or acute disease in the past 3 months?
0 = yes
2 = no
E Neuropsychological problems
0 = severe dementia or depression
1 = mild dementia
2 = no psychological problems
2

F1 Body Mass Index (BMI) (weight in kg) / (height in m )

0 = BMI less than 19
1 = BMI 19 to less than 21
2 = BMI 21 to less than 23
3 = BMI 23 or greater
IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2.
DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED.
F2 Calf circumference (CC) in cm
0 = CC less than 31
3 = CC 31 or greater

Screening score
(max. 14 points)
12-14 points:
8-11 points:
0-7 points:
Ref.

Normal nutritional status

At risk of malnutrition
Malnourished

Vellas B, Villars H, Abellan G, et al. Overview of the MNA - Its History and Challenges. J Nutr Health Aging 2006;10:456-465.
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini
Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377.
Guigoz Y. The Mini-Nutritional Assessment (MNA) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487.
Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA-SF): A practical tool for identification
of nutritional status. J Nutr Health Aging 2009; 13:782-788.

Socit des Produits Nestl, S.A., Vevey, Switzerland, Trademark Owners

Nestl, 1994, Revision 2009. N67200 12/99 10M
For more information: www.mna-elderly.com

All information on this page provided by Reference 5.