Oral Healthcare and the Frail Elder (eBook)

Michael I. MacEntee, Frauke Müller, C. Peter Owen, W. Murray Thomson (Herausgeber)

eBook Download: EPUB

2025 | 2. Auflage
789 Seiten
Wiley (Verlag)
978-1-394-18215-2 (ISBN)

Infos

Fully updated reference to clinical knowledge and strategies for effective oral healthcare in frail older adults

Taking an evidence-based approach, with theoretical and clinical knowledge underpinned by the literature, Oral Healthcare and the Frail Elder provides a comprehensive reference to management strategies for dental diseases as noncommunicable diseases in older populations. The book presents a global perspective with current guidance for clinicians, addressing the particular challenges of providing dental care for people who are confronting frailty in old age. Reflecting the numerous developments in the discipline since the previous edition was published, this Second Edition has been thoroughly updated throughout with 15 new chapters.

The first section covers background information, including demographics, social considerations, and factors affecting oral health in this population. The second half of the book is devoted to clinical management strategies.

Some of the new topics discussed in this edition of Oral Healthcare and the Frail Elder include:

• Theories and significance of oral health in frailty and oral health-related quality of life, and the influence of the life-course on oral health
• How sugar, tobacco, and alcohol initiate and sustain oral diseases, as with other noncommunicable diseases, into old age
• Mitigation of dental caries, periodontitis, gingivitis, mucositis, and other non-communicable diseases of the mouth
• Infection control, communications and tele-dentistry, mobile dental services, and strategies to appraise the usefulness of community-based oral healthcare programs

With an emphasis on population and public health in the context of non-communicable disease, the Second Edition of Oral Healthcare and the Frail Elder is an important resource for clinicians dealing with the geriatric population, including dentists, dental hygienists, dental therapists, denturists and dental technicians, nurses, and geriatricians.

The Editors

Michael I. MacEntee, LDS(I), Dip Prosth, FRCD(C), PhD, FCAHS, FFDRCSI, is an Emeritus Professor of Prosthodontics and Dental Geriatrics at the University of British Columbia in Vancouver, British Columbia, Canada.

Frauke Müller, Dr med dent habil, Dr hc (University of Thessaloniki), is Professor and Chair for Gerodontology and Removable Prosthodontics at the University Clinics of Dental Medicine at the University of Geneva in Geneva, Switzerland.

C. Peter Owen, BDS, MChD, MScDent, FCD(SA), is an Emeritus Professor of Prosthodontics at the School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand in Johannesburg, South Africa.

W. Murray Thomson, BSc, BDS, MComDent, MA, PhD, FRSNZ, is an Emeritus Professor of Dental Epidemiology and Public Health at the University of Otago in Dunedin, New Zealand.

Textauszug

1
Demography of Aging and Frailty, and the Epidemiology of Oral Conditions

W. Murray Thomson1, Moira B. Smith2, Fernando Neves Hugo3, and Philippe Mojon4

1 Faculty of Dentistry, University of Otago, Dunedin, New Zealand

2 Department of Public Health, University of Otago, Wellington School of Medicine, Wellington, New Zealand

3 Faculty of Dentistry, New York University, New York, NY, USA

4 Faculty of Medicine, University of Geneva, Geneva, Switzerland

This chapter covers the population aspects of aging and oral health. First, we consider the demography of aging and frailty, followed by a look at the aging process itself. Multimorbidity and frailty, including the notion of oral frailty, are described. We also provide an epidemiological overview of the common oral conditions, including tooth loss, dental caries, periodontitis, dry mouth, oral mucosal lesions, and temporomandibular disorders.

Demography of Aging and Frailty

The Aging Population

Worldwide, increased life expectancy and falling birth rates, which are largely a consequence of improved public health actions, have meant that the number and proportion of older people in many countries have increased. This rise has been rapid and is expected to continue. By 2050, 2.1 billion people, or 1 in 6, will be aged over 60 years, which is double the current older population. Within that group, the oldest‐old (≥85 years) will increase the most, tripling current levels by 2050. While the age‐related demographic changes up to now have predominantly occurred in high‐income countries, it is the low‐ and middle‐income countries where growth is expected in the future; by 2050, two‐thirds of the global older population will reside in low‐ and middle‐income countries.

Conceptualizing Aging

Aging is an inevitable feature of the human experience. Efforts to understand it have resulted in a plethora of explanatory biological and social theories (Table 1.1). No single theory fully explains aging, which underlines its complex and multifactorial nature. Moreover, the biological events involved in aging take place within social norms and societal contexts, which themselves show considerable variation.

Table 1.1 Theories of aging.

Theory	Brief description

Biological theoriesa

Replicative senescence

Somatic cells are capable of a finite number of divisions.

Accumulated mutation

Accumulation of somatic damage from “wear and tear” and compromised repair of DNA.

Antagonistic pleiotropy

Genes favoring survival in youth at the cost of harm in old age.

Disposable soma

Biological priority to perpetuate the species is followed by ineffective repair and maintenance of somatic cells when reproduction is complete.

Social theoriesb

Activity theory

Participation in enjoyable social activities promotes health and satisfaction in old age.

Disengagement theory

Gradual withdrawal from previously held roles benefits both the individual and society.

Continuity theory

Substitution of new roles for past activities and responsibilities as adaptation to age‐associated changes occur. This challenges both activity theory and disengagement theory.

a Adapted from Lipsky and King (2015).

b Adapted from Hasworth and Cannon (2015).

While we all age at the same rate chronologically, there is considerable variation in rates of biological aging. Elliott et al. (2021) recently characterized and described differences in the pace of aging among participants followed to age 45 years in the Dunedin Multidisciplinary Health and Development Study, a prospective study which (to date) has followed a complete birth cohort to midlife. Using a composite measure assembled from 19 different biomarkers representing the cardiovascular, metabolic, renal, immune function, oral, and pulmonary domains, the pace of aging in the cohort was found to range from 0.4 to 2.4 biological years per chronological year. Participants who were aging faster already had poorer cognitive and sensorimotor function, along with anatomical evidence of higher brain age and central nervous system degeneration assessed using magnetic resonance scans. That these differences were already apparent by age 45 means that noncommunicable disease (NCD) trajectories are already well‐established by midlife. They arise from individual differences in genetic endowment, cellular biology, life‐experiences and exposures. Such aging has usually involved decades of subclinical decline—in, variously, the cardiovascular, metabolic, renal, immunological, neurological, and pulmonary organ systems—prior to clinical manifestation, diagnosis, and management later in life. Thus, as people pass through late middle age and into old age, their ongoing decline manifests as a steadily accumulating number of chronic conditions requiring medical or surgical intervention (Thomson, 2023).

Multimorbidity

Multimorbidity is defined as the co‐existence of two or more conditions in the same individual (Jose et al., 2009). Conditions that commonly cluster include diabetes, hypertension, osteoarthritis, dementia, dyslipidaemia, depression, heart failure, and cancer (Ofori‐Asenso et al., 2018; Skou et al., 2022). Estimates of multimorbidity vary according to the data source and how it is defined (Gontijo Guerra et al., 2019; Johnston et al., 2019). Recent metaanalyses provide a global prevalence ranging from 37.2% in the community (Chowdhury et al., 2023) to 42.4% in a combination of community and healthcare settings (Ho et al., 2022). Disparities in the prevalence of multimorbidity by gender, socioeconomic status, and ethnicity are evident, with higher prevalence among women, those living in deprivation, and in indigenous and ethnic minority groups (Stanley et al., 2018; Quiñones et al., 2021; Alshakhs et al., 2022; Ho et al., 2022; Chowdhury et al., 2023).

The prevalence of multimorbidity also increases with age, a consequence of the slow progression of chronic conditions and longer life‐expectancy, and (in turn) the high prevalence of chronic conditions among older people. Most people aged over 60—and virtually all of the oldest old—live with two or more chronic conditions (Ofori‐Asenso et al., 2018; Ho et al., 2022; Chowdhury et al., 2023). The number of conditions also rises with age (Chowdhury et al., 2023). The combination of population aging and the rising prevalence of chronic conditions means that multimorbidity is a substantial global public health concern (Pearson‐Stuttard, et al., 2019).

Multimorbidity has considerable consequences for older people, including functional decline and greater disability, poor quality of life, a higher risk of hospitalization and longer hospital stays, polypharmacy, and premature death (Skou et al., 2022). There are also implications for their families, communities, health systems, and society. Individuals with multimorbidity rely on family members and others to support the usual activities of daily living (ADL), which can range from shopping and housework to full personal care. For the health system, the substantial expenditure associated with high health service‐use, including health and social care, is a considerable burden (Skou et al., 2022; Tran et al., 2022). Managing the care of someone with multimorbidity is complex, requiring a well‐coordinated, comprehensive, and person‐centered approach (Whitty et al., 2020; Skou et al., 2022). Treating each condition singly typically results in inadequate and inefficient care, and a high probability of iatrogenic damage through polypharmacy. Apparently, the cost of caring for someone with multimorbidity is greater than that for each single condition combined (Tran et al., 2022).

As the proportion of older people in the population continues to rise, so too will the demand on health and social services, along with associated financial costs (Prince et al., 2015). Given that most health and social services are underresourced, especially in low‐ and middle‐income countries, and inadequately prepared, it is challenging to appropriately addressing the future needs of people with multimorbidity.

Chronic conditions are patterned by exposure over time to a range of risks, such as environmental, social, and workplace influences, and the individual behaviors resulting from those exposures, including diet, physical activity, use of tobacco and alcohol, and poor access to health services (Marmot, 2005; Peters et al., 2019).

Frailty

Frailty is closely related to aging. It arises from a decline in functioning in multiple physiological systems, with a resultant higher vulnerability to stressors....

Produkt-Details

• Erscheint lt. Verlag: 28.1.2025
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: aging oral health • body image frail • commodities oral • dental canaries • geriatric oral health • Gingivitis • Mucositis • oral health management • oral health quality of life • oral health treatment • Periodontitis • senior oral health
• ISBN-10: 1-394-18215-5 / 1394182155
• ISBN-13: 978-1-394-18215-2 / 9781394182152