In practice - Elderly, chronically ill and people with physical disabilities

Depending on the condition and age, the patient's thinking and understanding may be slower or worse. The elderly may have difficulty doing two things at the same time, for example, putting on or taking off the jacket and talking or listening at the same time. Moving, hearing and seeing can also be limited. You are therefore extra alert to any problems with information processing, poor hearing and poor vision.

In practice - Elderly, chronically ill and people with physical disabilities
Depending on the condition and age, the patient's thinking and understanding may be slower or worse. The elderly may have difficulty doing two things at the same time, for example, putting on or taking off the jacket and talking or listening at the same time. Moving, hearing and seeing can also be limited. You are therefore extra alert to any problems with information processing, poor hearing and poor vision.

In practice

 

The general principles apply to your care for the elderly and chronically ill. In addition, there are specific points of attention and substantive points of attention.

 

 

Points of attention in the contact

Depending on the condition and age, the patient's thinking and understanding may be slower or worse. The elderly may have difficulty doing two things at the same time, for example, putting on or taking off the jacket and talking or listening at the same time. Moving, hearing and seeing can also be limited. You are therefore extra alert to any problems with information processing, poor hearing and poor vision.

 

In addition, you pay attention to whether your patient experiences discomfort when he sits down or lies down, takes off clothes, opens his mouth. See if you can offer support and reassurance or provide comfort in another way.

 

Points of attention in your contact with the elderly, chronically ill and people with physical limitations

Basic rules

 - Make contact

 - Match your communication to the person and what happens in the conversation

Appointments, calls

 - Schedule appointments at a time that is feasible for the patient

 - Show understanding when the patient is late due to transport problems; consult with the doctor as to whether the patient can still be helped

 - In the case of a no-show, preferably contact the patient; remind him of the appointment and ask why he did not appear; make a note in the file if necessary

 - Send an extra reminder after a (next) call; consultation with the patient or caregiver about how

 - In dental practice, also call on patients without their own teeth for a check-up

Reception

 - Ensure that the patient can walk and sit independently; go to a wheelchair patient if the counter is high; If necessary, guide the patient to a place in the waiting room and wait to ask questions until the patient is seated

 - Talk clearly, with the elderly being sufficiently loud and not too fast; in the treatment room of the dental office: switch off the radio

 - Ensure that the patient hears it when you call him up

 - Keep an eye on whether you can (again) help you to get up and possibly guide you when walking


 In the consultation room, treatment room, at the pharmacy counter

Position change

 - Help the patient to sit in the dental chair; use a hoist if necessary

 - Announce (in dental practice) a change in the position of the chair

 - Give a patient time after a position change, especially after standing up from a lying position, time to prevent dizziness


 Disease specific points for attention

Asthma / COPD  - Oral care when using inhaled corticosteroids in connection with the risk of fungal infection
COPD

 - Putting on and taking off a jacket, putting on a shirt or shirt over and over, sitting down and getting up can be strenuous and aggravate anxiety

 - Tightness when lying flat or when the head is tilted backwards

Coronary artery disease

 - With exercise or stress; sometimes dental examination and treatment is desirable prior to a planned heart surgery

 - Ask about the use of anticoagulation if the patient will undergo a dental procedure; if the patient has to stop according to the guidelines, say how many days in advance he must stop; before the operation, ask whether the patient has stopped taking anticoagulation (ACTA 2012)

CVA and other non-congenital brain injury (NAH)

 - Changes in movement, sometimes also cognitive changes, aphasia, emotional inhibition, change of personality

 - Ask about the use of anticoagulation if the patient will undergo a dental procedure; if the patient has to stop according to the guidelines, say how many days in advance he must stop; before the operation, ask whether the patient has stopped taking anticoagulation (ACTA 2012)

Heart failure

 - Put on and take off your jacket, sit down and stand up can be strenuous

 - Shortness of breath may occur when lying flat or when the head is tilted backwards

Cancer treatment with chemotherapy and / or radiotherapy

 - Tiredness, reduced immunity, reduced clotting, vulnerable or broken mucosa / gums

 - Be alert to risk of infection and infections: herpes simplex and herpes zoster often occur

 - Sometimes dental treatment is desirable before starting chemotherapy or before starting radiation therapy in the head and neck area; Sometimes consultation is required about delaying dental treatment

Movement problems due to rheumatic or neurological disorders

 - Think of: rheumatic diseases (osteoarthritis, rheumatoid arthritis) and other disorders that cause difficulty with movements, such as stroke, Parkinson's disease, diseases with involuntary movements

 - Pay attention to difficulty walking, standing or sitting, opening a door, putting on and taking off clothes, grabbing a cup and drinking, difficulty opening medicine strips

 - Pay attention to dental treatment: difficulty or pain when opening the mouth (due to rheumatism in the jaw joints); difficulty placing the head on the headrest or keeping the head still; possibly provide a cushion; reassure the patient who has difficulty keeping his head still: the dentist will help him with that

 - Pay attention to pain or difficulty when spreading the legs before making a smear (with rheumatism in hip joints)

Difficulty hearing and seeing  See here for more information

 

Substantive points for attention

In addition to the practical points for attention, there are substantive points for attention

 

Requesting a complaint

You often have years of regular contact with an elderly person or a patient with a chronic illness or disability. You know him, his history, his health problems, his way of doing things. This has advantages, but also disadvantages. If you have known a patient for a long time, there is a danger that you will see all his symptoms as part of the disease, as part of a pattern. The trick is to stay alert and objective. It is important that you question the symptoms in the same way as with any other patient. Make sure you do not interpret too quickly.

 

Multipathology

You are also aware that the elderly and chronically ill often have or develop more disorders. Old age and illnesses can cause social and emotional problems (loneliness, depression). The risk of depression is high with a number of chronic diseases: after a stroke, with diabetes and COPD.

 

In addition, you are alert that kidney function may have deteriorated over the years (http://www.denieuwepraktijk.nl) and that medicines can cause more side effects due to higher blood levels.

 

Tax

You have an eye for what the (independent) living at home of the elderly or chronically ill requires, especially when the social network becomes smaller. You also pay attention to the caregiver. It is possible to make a note in the HIS who provides or receives informal care (ICPC code Z14). Show interest. Ask the caregiver at an appropriate moment about his experiences and assessment of the situation. Also ask how he is doing. Tell them that he can go to the practice with questions and concerns. If necessary, alert him to local support options (Mezzo, organization for caregivers www.mezzo.nl; via neighborhood teams, Social Support Act). Be alert to any overloading and derailed care.

 

Children and young people who offer informal care to a chronically ill parent deserve extra attention. There are special support sites for them.

 

Oral care

Three categories of elderly people are distinguished in oral care: vital elderly people (independently living elderly people with mild health problems), vulnerable elderly people (independently living elderly people with some vulnerability) and geriatric elderly people (usually in multimorbidity care institutions, polypharmacy). With the increase in vulnerability, the emphasis in treatment is increasingly on the proper functioning of the mouth and the preservation of the condition of oral tissues, precisely with a view to the future of the patient. It is also referred to as "life course-resistant oral health". Attention to good oral care (by the elder, caregiver or caregiver in an institution) and regular visits to the dentist is important for all groups. Ultimately, it is about mouth health contributing to the quality of life of vulnerable patients. This means that the dentist sometimes chooses not to treat, to place a prosthesis, or to rebase instead of placing a new prosthesis.

 

Support own direction

The general principles apply to supporting one's own management. For the elderly and the chronically ill, it is important to reinforce positive factors (self-confidence, undertake activities, take initiatives, have a social network).

 

Make sure that you are aware of the (digital and physical) facilities for the elderly, the chronically ill and people with disabilities (regular help, shopping service, DIY service, meal provision, neighborhood meal, transport arrangement, buddy projects) and the local social map.