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Elderly individuals are at an increased risk for Caries due to many factors

- Many older individuals have difficulty brushing and flossing their teeth. As individuals age, many are diagnosed with arthritis, and a lot of the time this arthritis is in their wrists. Due to this, many elderly clients cannot efficiently brush and floss their teeth, and many have totally given up on trying to floss.

- Due to improper brushing and flossing these clients are more susceptible to developing caries.

- As people age, so do there mouths, older clients generally have bone loss, recession, attrition, abrasion and the list continues. All these increase the risk for caries, especially root caries. Root caries are the most common cavity seen in elderly clients due to exposed root surfaces (Bowen, D. M., Pieren, J. A., & Darby, M. L., 2020).

- It is important that elderly individuals understand the important of proper oral self care.

- Elderly clients should visit their dental office every 4-6 months for cleanings and fluoride treatment.

Reference
Bowen, D. M., Pieren, J. A., & Darby, M. L. (2020). Darby and Walsh Dental Hygiene: Theory and Practice. Elsevier.

- Annie Roth
(200481952)

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- Salivary functionality naturally decreases with age, which will inevitably affect the integrity of a persons oral health. Furthermore, an infamous common oral side effect in medications is xerostomia. According to Statistics Canada (2021), 81% of Canadians within the ages of 60-79 take at least one prescribed medication regularly.

- Xerostomia, or "dry mouth", in itself seems like a small inconvenience. Some might notice bad breath (Halitosis) accompanied by dry mouth, but it has larger effects on a person's oral health. Xerostomia can limit the ability of saliva to naturally cleanse and flush food debris and bacteria from the mouth, which can increase the risk of developing periodontal disease and caries.

- The type of medication a client takes, as well as the reason, is also imperative to note. According to Kissell (2021), “Immunosuppressive medications can cause an increased risk of infection, tissue changes and elevated cancer risk, high risk of caries, and periodontal changes.” The use of immunosuppressive medication can also be a contraindication to invasive dental hygiene procedures like scaling and debridement for the reasons specified above. Contacting the client's physician is important to discuss and determine the safety and appropriateness of certain treatments included in the dental hygiene process of care.

References
Kissell, D. (2021, November 24). Effects of immunosuppressive medications on oral health - dimensions of Dental Hygiene: Magazine. Dimensions of Dental Hygiene | Magazine. Retrieved February 19, 2023, from https://dimensionsofdentalhygiene.com/article/effects-immunosuppressive-meidcations-oral-health/

Statistics Canada. (2021, June 28). Prescription medication use among Canadian adults, 2016 to 2019. The Daily. Retrieved February 19, 2023, from https://www150.statcan.gc.ca/n1/daily-quotidien/210628/dq210628e-eng.htm

- Miranda Bellefeuille (200454360)

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Immunosuppression increases with age, increasing the infection risk and therefore the likelihood of disease.

Diabetes is linked to overall inflammation from high blood glucose levels and therefore can increase susceptibility and severity of periodontal disease. CDHO (2017) further explains, "In turn, gum disease tends to be more severe among persons with diabetes, because suboptimal control of DM [Diabetes Mellitus] decreases the ability to fight infection and slows healing.".

Medications taken to treat diabetes and other systemic diseases may cause xerostomia which decreases saliva flow therefore increasing risk for bacterial infection that can cause inflammation associated with gingivitis and periodontitis.

As well, osteoporosis which is most common in elderly women frequently affects the alveolar bone. This decrease in bone mass and healing capacity increases the risk for periodontal disease and decreases the prognosis (Bowen, D. M., Pieren, J. A., & Darby, M. L., 2020).

References
Bowen, D. M., Pieren, J. A., & Darby, M. L. (2020). Darby and Walsh Dental Hygiene: Theory and Practice. Elsevier.

Factsheet Diabetes Mellitus. CDHO. (2017). Retrieved February 19, 2023, from https://www.cdho.org/Advisories/CDHO_Factsheet_Diabetes_Mellitus.pdf

- Brittany Beck
(200422511)

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Additionally, edentulousness (tooth loss) is common in older age so the elderly population is more likely to wear partial or complete dentures. Xerostomia, poor oral hygiene, and/or poorly-fit dentures can cause irritation to the mucosa resulting in denture stomatitis. (Bowen, D. M., Pieren, J. A., & Darby, M. L., 2020).

Reference
Bowen, D. M., Pieren, J. A., & Darby, M. L. (2020). Darby and Walsh Dental Hygiene: Theory and Practice. Elsevier.

- Brittany Beck

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Elderly clients are more likely to face physical limitations which ultimately affect the quality of oral self care they can conduct.

- As we age, hearing loss is inevitable, and poor oral care can even aggravate further hearing loss. 'When bacteria in the mouth spreads throughout the body, it can cause inflammation that prevents the healthy flow of blood and may result in clots. Because the hair cells in the cochlea require healthy blood circulation, they may become damaged or even permanently destroyed if blood circulation is low, causing hearing loss' (Sound Relief Hearing Centre, 2023). In addition, hearing loss in itself may become a barrier to effective oral care. Communication between the clinician and client will be more complex. If the client can not properly hear OSCI from the hygienist, then there won't be adequate at home self care by the client. To prevent this, demonstrations/visual aids will become much more useful for the client to learn and understand OSCI.

-Along with hearing loss, clients face visual impairments. 'Barriers to treating patients who are visually impaired include negative attitudes because of their guide dogs, physical issues in the buildings, lack of transportation, dental phobia, and lack of dental professionals willing to provide dental treatment' (Cloet, W., 2022). Alternatively to clients with hearing loss, clients with vision loss require more speech and touch rather than visuals. This may create complications to client understanding of OSCI. Especially since OSCI is super visualization based with most clients.

- Older clients commonly are challenged with dexterity issues. This could be due to muscle weakness, arthritis, carpal tunnel, broken bones/fractures (more common from falls), etc. 'Decreased hand functioning can affect your senior’s independence, self-confidence, and ability to care for him- or herself safely. All of these can affect your senior’s ability or motivation to maintain proper oral hygiene' (Black, W., 2019). That being said, dexterity impairment can make it more complex for senior clients to participate in their oral self care. More specifically, brushing teeth and flossing will become a hardship for the client.

References
Black, W. (2019, August 27). Five tips for proper oral hygiene for seniors with manual dexterity issues. Personal Care Services MidSouth. Retrieved February 19, 2023, from https://www.personalcarellc.com/elderly-care-covington-tn-five-tips-for-proper-oral-hygiene-for-seniors-with-manual-dexterity-issues

Cloet, W. (2022, August 31). Oral Health Status and dental care for individuals with visual impairment. PracticeUpdate. Retrieved February 19, 2023, from https://www.practiceupdate.com/content/oral-health-status-and-dental-care-for-individuals-with-visual-impairment/140535#:~:text=Patients%20who%20are%20visually%20impaired%20are%20more%20prone%20to%20caries,of%20homecare%20and%20fluoride%20use.

Sound Relief Hearing Centre. (2023, January 25). The link between Oral Health and Hearing Loss. Sound Relief Hearing Center. Retrieved February 19, 2023, from https://www.soundrelief.com/the-link-between-oral-health-and-hearing-loss/

- Kylie Bester
(200450451)

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Saige Via, a caregiving supervisor at Chestnut Knoll assisted living community in Boyertown, Pennsylvania, knows a few things about being a caregiver. She shared her expert advice on personal care for seniors, which can help you accomplish these essential tasks while maintaining your loved one's dignity.

Discuss body hygiene needs for elderly loved ones

Lack of hygiene is one of the important signs an aging parent needs help with daily living tasks. However, relying on others' help with personal care can feel invasive and even humiliating for many seniors. It's important to have honest discussions about what your loved one feels comfortable with to relieve stress and create trust, explains Via.

"Providing care to someone is a very personal and private thing," she said. "Some people may not want to accept help from you. It's best to have these kinds of conversations ahead of time."

Have a conversation with your senior loved one to learn more about their preferences and abilities. Ask them the following questions:

Incorporate their regular routine

Following your aging parent's normal routine will help them feel more comfortable, Via explains. For example, if your parent showers in the morning, maintain that routine, if possible. If they use specific items - such as certain washcloths, soaps, or shampoos - keep their favorite items consistent, too.

"There's no need to add confusion by changing their routine," Via said. "Try to stick to their normal schedule. You have to remember that you're entering their space. It can help you build a better relationship."

Useful bathing tips for elderly adults

Helping your loved one bathe can feel overwhelming without the right tools and techniques. Follow these tips for a smoother and safer experience.

Consider bathroom safety accessories

If your elderly parent has poor balance or can't stand for long periods of time, you may need to make the shower or bathtub more accessible.

Consider the following to help ensure safer practices for hygiene:

Adjust bathing frequency

Hygiene needs for the elderly may be different than you expect. Bathing twice a week is typically sufficient for an elderly person unless accidents occur, Via said.

Let our care assessment guide you

Our free tool provides options, advice, and next steps based on your unique situation.

"When someone is incontinent, I will give a quick wash and dry when changing them to avoid any skin breakdown from occurring," she said. "I also wash them with soap and water thoroughly every night before bed and every morning when they get ready for the day."

Organize their bathing items

Preparing and organizing items is one of the simplest ways to help ensure bathing goes smoothly. Have these basic materials ready before you begin:

"It's important to have everything you need in one spot, so you can focus on the senior," Via said.

Respect your aging parent's privacy and comfort level

Some seniors may feel more comfortable holding towels over their private areas during bathing. Although the towels will need to be worked around to clean those areas, that bit of privacy might make your loved one more comfortable.

Remember to clean under skin folds

Bacteria grows under skin folds - therefore, it's important to clean under every fold and wrinkle, including:

Dry these areas with a towel to avoid fungal infections. Rinse away soap completely so your loved one's skin doesn't become too dry or agitated.

Remember skin care

Skin becomes more sensitive with age, so it's important to pat dry with a towel instead of rubbing. Applying a moisturizer will also help prevent dryness and can even be a bit therapeutic for your senior loved one if you gently massage it into their skin.

The American Academy of Dermatology has these additional skin tips for the elderly:

Maintain their oral hygiene

Maintaining dental hygiene as part of personal care for seniors is important for long-term health. Seniors need to see their dentist every six months or more often, depending on their medical conditions. Dentures should be checked regularly for proper fit, and gums need to be checked for gum disease or cancer.

Via recommends practicing good oral hygiene in the morning and before bed. She prepares toothbrushes with toothpaste for seniors who can brush their teeth on their own. If someone can't brush their teeth on their own, Via will either guide their hand with hers or brush for them.

The American Dental Association recommends these additional oral hygiene practices for seniors:

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Help them remain independent in daily tasks

Your involvement with hygiene-related tasks depends on your loved one's needs and abilities. Do your best to help them remain in control, Via recommends.

"I help with shaving, dentures, brushing teeth, and washing faces, and I approach all of these types of care the same way," she said. "I ask if they need me to get the items ready or physically assist them. Sometimes they just need items laid out. I try to let them do as much as possible to help them feel independent."

Be patient and don't be afraid to ask for help

It's natural to have good and bad days as a caregiver, especially when helping with personal care for seniors. When you're feeling frustrated, Via suggests putting yourself in your family member's shoes to understand how they may be feeling.

"It's a new and sometimes scary experience for seniors," she said. "Always be patient, understanding, and communicative."

She also said you need to know your limits when providing personal care for seniors. When you're caring for a family member, there may be times when you need to ask for help. It's best to learn your personal limits, as well as your loved one's limits. Boundaries can help you develop a healthy and functional caregiving dynamic.

"If your mom won't shower, take a step back," Via said. "Maybe someone else can get her to do it, or maybe someone else has an idea to help."

Consider Senior Living

Remember, you're not alone in your caregiving journey. If your loved one relies heavily on receiving personal care, it might be a good idea to consider full-time senior living arrangements. Senior living communities provide a variety of personal care for seniors through assistance with daily living activities such as bathing, dressing, grooming, and more. Communities also offer a range of living accommodations, activities, and dining options so that your loved one can be as comfortable as possible.
Sources:
Interview conducted with Via, S. Chestnut Knoll. June 1, 2020.

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Saige Via, a caregiving supervisor at Chestnut Knoll assisted living community in Boyertown, Pennsylvania, knows a few things about being a caregiver. She shared her expert advice on personal care for seniors, which can help you accomplish these essential tasks while maintaining your loved one's dignity.