Specificity of clinical examination in the elderly
Physiological aging, chronic pathologies and the psychosocial environment are sources of vulnerability in the elderly. These factors impact oral pathologies that oral diseases, on the other hand, can aggravate and lead the patient into a spiral of decompensation.
These elderly patients are complex. The first examination will not be enough to know them well enough. They may forget the main thing if they have memory problems. In addition, several diseases are intertwined and the biological standards are different from those of young adults.
This requires a diagnostic investigation methodology that highlights the need for interdisciplinary collaboration between medical professionals.
But the difficulty of gerodontology lies essentially in the absence of stereotypes of aging. Geriatric pathology is a polypathology whose particularities must be known.
- Definition :
A geriatric pathology is a polypathology, that is to say a pathology of summation of medical, social and psychological factors.
- Exam conditions:
- At home: the examination takes place at home when the person is disabled or infirm
- At the consulting room (private/hospital)
- In a hospital bed, emergency room (or nursing home): modesty and confidentiality must be respected. The clinical examination is not public
- Exam objectives:
It is about curing what is curable, preventing what is avoidable, and slowing down what cannot be improved. The clinical examination makes it possible to define the useful additional examinations.
- Clinical features:
- Skin: The skin of the elderly keeps the fold spontaneously, it is not a sign of dehydration
- Mouth: The snags and the condition of missing teeth should be noted, as this can be a significant source of infection. The masticatory coefficient must allow for proper chewing to allow for good nutrition.
Good hygiene, caries care and prompt replacement of missing teeth should improve oral health. - Heart and vessels: complete arrhythmia in the elderly should not be overlooked whether it is rapid or very slow.
- Lung: the respiratory system has no specific pathology but a common flu on an old lung carries a high risk of respiratory failure.
Specificity of clinical examination in the elderly
- Biological examinations in the elderly:
- Hematology: Hematological constants vary little with age.
- Sedimentation rate: often high in the elderly without any detectable condition.
- Fasting blood sugar: very often higher than 1 g/l without it being diabetes
- Uricemia: increases with age
- Kaliemia: increases with age
- Renal function: Glomerular function declines steadily with age
- Exploration of the senses: vision, hearing, taste…
- Drug prescription: Closer monitoring is necessary to reduce the risk of iatrogenic pathologies which are a direct cause of a large number of hospitalizations
- Examination method:
The examination of the elderly patient is particular because of its length. This patient takes time to answer questions. It is better to use simple methods of assessing each function.
During the first consultation , the dentist, together with other geriatric specialists, conducts the medical history as well as an assessment of environmental and behavioral factors. He identifies his needs and imperatives.
The practitioner records the gender, age, general pathologies in development, known medical history as well as the list and dosage of prescribed medications.
- Questioning: must be completed by that of the entourage in the event of inability to express oneself verbally or memory disorders. The questioning concerns first the reason for consultation and also what seems to you to be the patient’s main health problem.
- History : this should also be sought from relatives if they are present and from the treating physician if the patient is seen in the emergency room or at the hospital.
- Oral examination : exo and endo-oral
- Managing processing complexity:
The elderly patient may have several health problems. Some are unrelated. Others may interfere with each other (e.g. diabetes and hypertension). Others have a common origin (e.g. stroke and depression). The practitioner must be part of a real “geriatric team” of which he is one of the essential links . In addition, he must be aware of the particularity of the care related to this population which requires competence, attention and availability.
- Conclusion :
The clinical examination of the elderly patient takes time. It is delayed by the difficulty and slowness of movement and expression. It should ideally be done without time pressure or spread over several sessions.
At the end of the examination, additional biological or imaging information may be necessary, such as seeking specialist advice.
Problems related to the elderly are often underestimated in terms of oral health.
The dentist plays a key role in the diagnosis , prevention and treatment of oral pathologies , but also in the relationships between oral health and general health.