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Homeostasis of fluid balance is an important prerequisite for healthy aging. The high prevalence of disturbances of fluid balance among older adult patients has triggered clinical research on age- and disease-related changes in water homeostasis. Empirical findings on risk factors of dehydration and on diagnostic and therapeutic strategies are reviewed in this paper. No single measure has proved to be the gold standard in the diagnosis of dehydration. Diagnosing dehydration and monitoring fluid balance requires repeated measurements of weight, creatinine, and physical signs such as tongue hydration. Rehydration and prevention requires fluid on prescription (> 1.5 litre/day), and the route of fluid administration depends on the acuteness and severity of clinical signs.
Keywords: older adults, dehydration, fluid therapy, risk factors, diagnosis.
The oral cavity is a frequent site of head and neck cancer. The population most commonly afflicted with cancer of the oral cavity is older adults. Tobacco and alcohol are often implicated as associated preventable factors for oral cavity cancer--when used in combination their effects are synergistic. Malignant lesions may present as a persistent ulceration, mass, or red or white irritations in the oral cavity. They tend to be painful and cause difficulty with chewing. It is not uncommon for patients to complain of a neck mass. Investigation of suspicious lesions mandates a biopsy. Diagnostic imaging involving CT and MRI are important components of staging the primary tumour, and determining the extent of loco-regional and distant metastases. The treatment of early cancers is primarily surgical, while the treatment of advanced disease involves a multimodal approach incorporating a combination of surgery, radiation, and chemotherapy. However, the situation of each patient is unique, especially in the older adult, and other factors such as comorbidities often dictate the specific treatment approach.
Key Words: oral cancer, head and neck cancer, cancer in the older adult, oral malignancies.
Due to the increase in the older population, the management of individuals with dementia in long-term care settings will continue to present a challenge to the health care team. Many individuals with dementia will have some or all of their teeth upon admission due to improved dental care throughout their lives. Oral hygiene and oral care for individuals with dementia is generally poor in long-term care; however, the continuance of good oral health is essential both to maintain the demented individual’s quality of life and to prevent infections that may affect his/her general health. The maintenance of good oral health has the potential to reduce the incidence of long-term care-acquired pneumonia. This article presents an overview of the relationship between oral and general health in the demented patient and then provides an overview regarding oral assessment, treatment, and prevention of dental disease.
Key words: dementia, dental caries, dental plaque, aspiration pneumonia, oral hygiene.
Joel B. Epstein, DMD, MSD, FRCD(C), University of Illinois, College of Dentistry, Department of Oral Medicine and Diagnostic Sciences and Chicago Cancer Center, and Advocate Illinois Masonic Medical Center, Chicago, Il.
Harvey Wigdor, DDS, MS, University of Illinois, College of Dentistry, Department of Oral
Medicine and Diagnostic Sciences and Chicago Cancer Center, and Advocate Illinois
Masonic Medical Center, Chicago, Il.
Oropharyngeal cancer is a disease of adults and has a higher risk of occurrence with increasing age. In addition, oral complications of cancer therapy are more frequent and may be more severe in older patients. The prevention and treatment of oral complications of cancer therapy, with an emphasis on older adults, are reviewed in this report.
Key words: oropharyngeal, cancer, palliation, radiation, side effects.
Jonathan A. Ship, DMD, Department of Oral Medicine and the Bluestone Center for Clinical Research; New York University College of Dentistry, New York, NY.
Saliva is critically important for oral and pharyngeal health. Xerostomic complaints and salivary hypofunction are common in older adults, producing impaired nutritional intake, host defence and communication. Salivary function remains remarkably intact in healthy older persons. Systemic diseases, medications and head and neck radiotherapy for cancer account for the majority of salivary disorders in the elderly. Diagnosis of the underlying phenomenon is critical before implementing therapy. Management strategies include replacement therapies and gustatory, masticatory and pharmacological stimulants. Prevention of the oral and pharyngeal sequelae of salivary hypofunction requires a multidisciplinary approach to stomatological care.
Key words: xerostomia, saliva, Sjögren's syndrome, salivary glands, radiotherapy.
Tooth Loss has Profound Effects on the Wellbeing of Elderly Individuals
Dr. David W. Matear
Associate Professor
Director of Clinics
Faculty of Dentistry
University of Toronto
Fayaaz Jaffer
Faculty of Dentistry
University of Toronto
David Lam
Faculty of Dentistry
University of Toronto
Introduction
Teeth are supported by the surrounding peridontium, which is composed of both soft (periodontal ligament and lamina propria) and hard connective tissue (cementum and bone).
It is the periodontium that provides attachment of the teeth to the jaw and, when the periodontal tissues become diseased, the resultant lack of support results in tooth loss. Age is a definite factor in such loss, although other obvious causes are decay and physical trauma.
The loss of teeth decreases the preservation of an individual's dentition and also detracts considerably from a socially acceptable appearance. In such cases, the replacement of missing teeth is accomplished by the fabrication of either a complete or partial denture, or both. Regrettably, dental care in the elderly population is often neglected. This may be due to other physical handicaps, which may restrict the patient's ability to travel or in situations where the patients are confined to their homes.
