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Taking the Bite
Out of Elder
Abuse:
Dental Issues in
Geriatric Care
Annual NICE Knowledge
Exchange
May 21, 2014
Hart House, University of Toronto
Workshops
Education
Tools
Awareness
Dr. Natalie Archer, DDS – Archer
Dental
Laura Tamblyn Watts, LLB –
Canadian Centre for Elder Law
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Overview
 What
is the link between oral health and
overall health?
 What
are the issues and challenges in
geriatric dental care?
 The
D.E.A.R Project: Dental Advance Care
Planning
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The Importance of Oral Health
 Link
between oral health and your overall
health
 The
mouth is the primary portal to the body
 Without
a healthy mouth the risk of chronic
diseases and health issues increase
dramatically.
 Diabetes
 Pneumonia
 Heart and Stroke
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The link to Diabetes
People
with diabetes are 15x more
likely than people without diabetes to
lose their teeth*
* Taylor, G. W., Loesche, W. J. and Terpenning, M. S. Impact of Oral Diseases on Systemic Health
in the Elderly: Diabetes Mellitus and Aspiration Pneumonia. Journal of Public Health Dentistry,
2000.
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The link to Pneumonia
 Pneumonia
is the #1 killer in long term care
homes. Mouth bacteria can be aspirated
into the lungs. Oral disease can increase
the risk for pneumonia 3-6 x.*
* Taylor, G. W., Loesche, W. J. and Terpenning, M. S. Impact of Oral Diseases on Systemic Health
in the Elderly: Diabetes Mellitus and Aspiration Pneumonia. Journal of Public Health Dentistry,
2000.
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The link to Heart and Stroke
 Periodontal
(gum) disease may increase
your risk 1-3 x for cardiovascular
disease.**
** Lux J, Lavigne S. Your mouth – portal to your body: CDHA position paper on the links
between oral health and general health. Part II. Probe. 2004
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Oral Health and Seniors
1/4
of folks 65-74 have severe gum disease
1/3
of seniors have untreated tooth decay
1/2
of seniors have serious root decay
+ Dental Challenges for Seniors
 Dexterity
issues
 Multiple
medications and medical
conditions complicate their oral health
 Financial
restraints and lack of dental
insurance
 Lack
of understanding of the importance of
oral health care
 Lack
of specialized equipment to treat
special cases
+ Seniors Not Getting the Dental
Care They Need
Highest
need, lowest served
1/5
of seniors in Long-Term Care:
surgery
1/2
of seniors in Long-Term Care:
restorative care
Seniors
access dental services least of
any group (over 4 yrs old)
+ Why Talk About Dental Abuse?
Neglect? Mistreatment?
 Sometimes
people don’t mean to cause or
stop harm – but it happens
 Sometimes
supporters of older people
don’t think about oral health as important
 Sometimes
 Sometimes
folks just don’t know what to do!
background and culture may
not place high value on oral health (“old
country”, “depression era” etc..)
+ What is:
Dental Elder Abuse & Neglect?
Dental elder abuse and neglect occurs
when a person or system fails to
provide necessary dental care for an
older adult.
+ Common Elder Dental Abuse
and Neglect Scenarios

Mouth is uncleaned by caregivers

Substitute decision-maker of incapable adult does not
want to spend money on the older adult – “I’m going to
inherit!”

Broken or ill-fitting dentures – not fitted or replaced

Very limited dental care in Long Term Care

Dentist is too difficult to get to – just stopped going

Fear that dentist will report the abuse or neglect

Oral cleaning not performed due to lack of mobility

JUST DON’T CARE – They can’t complain anyway
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Broken Teeth
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Dentures
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Plaque Build-up
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D.E.A.R Goals
 Educate
and create awareness on the issue
of dental elder abuse and neglect
 Encourage
people to think about dental
advance care planning with the help of our
tools
+ Basic Education: Seniors must
go to the Dentist
+ Advance Care Planning:
In General
Planning now, while you are capable,
for what you would want in the future, if
you could not make that decision
yourself.
Another person will always make a
decision for you – do they know your
values, wishes and beliefs?
+Planning Ahead for my Teeth? Why?
Myths:
My
family will know what I want.
They
know who my dentist is.
I
will get the same dental care in a
nursing home as I do now.
I’ve
already got a Power of Attorney –
so I don’t need dental advance care
planning.
My
dental care is covered by when I’m
older – you know – by CPP and OAS...
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Capacity to Consent
Capacity
is Assumed
for Capacity is
“understand &
appreciate”
CAPABLE INCAPABLE
Test
YOU
DECIDE
22
SOME ONE
ELSE
DECIDES
(SDM)
Who Gets to Decide – Order of
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Substitute Decision-making – Health
and Personal Care
1.
Court ordered Guardian for Personal Care (rare)
2.
Valid Power of Attorney for Personal Care (common)
3.
A Person appointed by the Consent and Capacity Board (rare)
4.
The incapable person’s spouse or partner. (common)
5.
A child or parent of the incapable person (or organization if
they are the decision-maker – like Children’s Aid)
6.
A parent of the incapable person who has only a right of access.
7.
A brother or sister of the incapable person.
8.
Any other relative of the incapable person
9.
Public Guardian and Trustee (last resort)
Who Gets to Decide – Order of
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Substitute Decision-making – Financial
Decisions and Property Decisions
1.
Court ordered Guardian for Property (rare)
2.
Valid Power of Attorney for Property (common)
3.
A Person appointed by the Consent and Capacity
Board
4.
The Public Guardian and Trustee (last resort)
*Note – there is NO default list for $!
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“Super 6 Checklist” Tool
+ W.I.S.H.F.U.L Thinking:
Advance Dental Planning Tool
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W – “Worried”
Specific
tooth?
Something
Shape
bothering you?
of your teeth?
Anxieties
or fears?
Concerns
now about future care or
cost?
Who
will take you to the dentist?
What
care will I get if in Long-Term
Care or if I have a mobility challenge?
+ I – “Ideal”
 What
is your best possible scenario for
you and your teeth as you age?
 The “blue
sky” – values, wishes and
beliefs explored…
 How
 To
often would you come?
which dentist?
 What
 What
would you look like?
quality of life issues are important
to you? Eating certain foods? Speech?
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S – “Strengths”
What
do you bring to the “table”
Good
genetics?
Good
personal care?
Strong
teeth?
Excellent
Great
What
knowledge of denture care?
appearance?
is working? Now ? Will it still
work in future?
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H – “Health”
How
is your health right now?
What
What
are my current health concerns?
prescriptions or treatments am I
taking?
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F – “Financial”
 How
much money do you have put aside, if
any, for dentistry?
 What
insurance do you have?
 Where
are your insurance documents?
 Who
takes care of your finances? You or
someone else?
 How
much are you willing to financially
prioritize your teeth?
 Do
you qualify for any free or low cost
programs?
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U – “Understand & Appreciate”
 Do
I have enough information (or does
my substitute decision-maker if I am no
longer capable of this decision) to give
informed consent?
 Can
I understand and appreciate the
dental or financial decision being asked
today – assuming capacity always
 What
might I need to support my
capacity to make a decision?
Translation? Blood sugar supports?
Visual aids? Hearing aids? Glasses?
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L – “Law”
Do
I have an up-to-date power of
attorney for personal care?
If
so, who is my attorney (substitute
decision-maker) or attorneys?
If
no POA, who is my “default” SDM
according to the Substitute Decisions
Act?
Does
my dentist have the current
documents?
+ Further Practical Resources

How to Care for Someone Else’s Teeth? (20 Minute video)
https://www.youtube.com/watch?v=vc4hG_8t9nA

Video Series (www.archerdental.ca, www.nicenet.ca,
www.bcli.org/ccel )

W.I.S.H.F.U.L. Tool

SUPER 6 Tool

Advance Care Planning and Ontario Substitute Decisions Act
http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/p
gtsda.pdf

Canadian Dental Association:
http://www.cdaadc.ca/en/oral_health/cfyt/dental_care_seniors/
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Questions?