The Correlation on How Asthma Medication and Poor Oral Hygiene Lead to Xerostomia in Elderly Patients

Introduction

Aging is a natural physiological process common to all living beings. According to the World Health Organization (WHO), a person is considered elderly from the age of 65 years old. The ageing of the population brings new challenges for oral health. Oral health is a state of being free from mouth and facial pain, oral infections, tooth decay and gum disease. As the elderly live longer and retain more of their permanent teeth than previous generations, they are more likely to be functionally dependent. Being functionally dependent means having experienced a deterioration of physical capacities due to advanced age and must rely on assistance of others. This is expected to increase dental treatment needs and place more demand on dental and health care systems.

As the population increases in age, the diseases of older age will have increasing prevalence and place a greater burden on the health system. Despite asthma being usually considered a disease of younger people, asthma mortality is currently greatest in the over 55 age-group. Symptoms and emergency presentations for health care due to asthma place a great burden on the quality of life of those over age 55 with asthma. Asthma in older people is under-diagnosed due to patient and physiological factors. Medication strategies for asthma have been dominantly derived from younger cohorts so that effective medication strategies have usually not been explored in older people. Older people with asthma are very concerned regarding side effects of medication so that adherence to therapeutic regimes is often poor.

Problem statement

Elderly people have poorer oral health status as compared to the general population due to functional challenges. This is worse in public clinics because patients who have been infected with asthma for 3-4 years are not aware of the oral manifestations that are caused by the medication that they’re taking and this is because the nurses lack knowledge and training in providing proper oral health care.

Literature review

Chronic conditions are often the catalyst for physical, psychological, and financial burden. Individuals suffering from asthma often demonstrate difficulties in managing their condition as well as altering their lifestyle to include factors such as healthy exercise routines and appropriate environmental surroundings. Asthma, which is a chronic inflammatory disease of the airways, has been on the rise over the past decade with increasing prevalence within children in the United States. It is estimated that a total of 22 million individuals suffer from asthma, with nearly 6 million of these individuals being children. Physical side effects of the condition include coughing, wheezing, shortness of breath, and chest tightness. These symptoms could greatly impact the quality of life experienced by the asthmatic individual due to restriction of activity, discomfort, embarrassment, and the constant concern for their condition. It is crucial to identify such conditions early on and implement appropriate treatment given that patterns of behavior developed during childhood serve as predictors of development of adult disease; thus, poor management of asthma in childhood and adolescence can lead to ineffective management in adulthood. According to the global World Health Survey, complete tooth loss affects approximately 30% of old-age people 65-74 years, however, prevalence rates are increasing dramatically in low- and middle-income countries, especially among poor and disadvantaged population groups. Poor oral hygiene, tooth loss and diseases from oral pathogens have been linked with other non-communicable diseases such as diabetes, pneumonia and respiratory diseases. Medications taken for control of these systemic diseases of the elderly may cause undesirable side effects, most common being xerostomia, which is dryness of the mouth. This may lead to the development of dental decay, demineralization of teeth, tooth sensitivity, and/or oral infections.

A combination of poor oral hygiene and xerostomia contribute to poor oral health status which may later affect nutritional status as well as general health and wellbeing. For this reason, poor oral health can have a significant impact on the quality of life and the ability of an individual to go about their daily routines. Xerostomia is the dryness of the mouth and it affects people physiologically because of the dry mouth that makes it impossible to maintain adequate oral health care as a result of cracks in the mouth. And it affects people psychologically especially if it is caused by medication because they do not have control over the drugs used to make medication. Most people are not aware of xerostomia until it is painful while some consider it as a normal oral condition and this is due to lack of information and knowledge. For example, individuals that are on asthma treatment, one of the side effects of their medication is xerostomia. In most cases people affected by xerostomia because of poor oral hygiene which is due to ignorance or lack of knowledge.

The intervention includes the patient, nurse and other institutional collaboration to ensure maximum oral health potential is attempted. Use of fluoride is effective in prevention of dental caries in elderly. Topical application and mouth rinsing with fluorides are shown to reduce the number of root surface caries lesions, both in active old-age people. According to Persson RE et al, rinsing with a chlorhexidine solution tends to reduce gingival inflammation, pocket depth, and incidence of denture stomatitis. Chewing xylitol gums may reduce denture stomatitis, xerostomia and angular cheilitis prevalence. And Schou L. states that clinical studies suggest that oral health education for elderly patients is effective. Materials & Methods:A qualitative research design was applied in this study. This was a cross sectional study that was conducted with the data from interviews and questionnaires. To assess the oral health status in the elderly, the Revised Oral Assessment Guide (ROAG) was used and to assess functional status and detect problems in performing activities of daily living, the KATZ scale was used.

The study was conducted at 2 clinics around Seshego, one being at Zone 4, the other at Zone 8. The sample size for the study was 68 participants and the population consisted of 23 males and 45 females between the ages of 60 or more. ResultsThe ROAG, Katz and BMI scales were used to assess the participants at the homes. Number of participants was 68, Zone 4 had 51 patients and Zone 8 had 17, therefore majority of the participants were from Zone 4 on 75%. Majority of the participants were female (66%). Average age was 77 years, with the youngest elderly participant being 60 and the oldest 99 years. Age mode was 85. Age of 6 participants were missing because files did not have their date of birth.

All the participants were black. 44. 1% of the participants were not on any medication, while 55. 9% were taking one to three types of medication. 44% of the elderly participants had chronic conditions with hypertension being the most commonly occurring condition (19%). 26% of the participants had more than one chronic condition.

Discussion

In this study, there were more females than males which is in contradiction with other studies which state that there are more males in old age homes. Forty-four percent of patients had medical conditions, with hypertension and dementia being the most common. Using the ROAG scale, oral health problems were a frequent finding among the elderly in the homes with a majority having gingivitis and periodontitis. The clinical findings of the oral health status indicated that 75 % of the patients required scaling and polishing and/or root planing, whilst a majority were in need of dentures. Although the patients in this study had a high intake of drugs, no association was between low saliva flow and increased number of drugs taken as seen in other studies.

Fifteen percent of the participants were underweight, 9. 68 was the lowest BMI obtained. This indicates that they may not be eating well. More than 50% of the patients were dependent in all 6 aspects of the Katz scale, though they required the assistance from their caregivers. In this study, comparisons between the genders cannot be carried out like in other studies since the findings are combined.

Conclusion

Asthma in the elderly is associated with significant morbidity and mortality and requires careful monitoring. People over age 65 with asthma have fewer symptoms of asthma and are less likely to report and present to medical care. The oral health of the elderly with asthma is generally poor, which has a negative effect on saliva secretion, masticatory function and oral health related quality of life. Dental health care needs should be encouraged at clinics on a daily basis. This can be achieved by educating the nurses and training them in providing proper oral health care education to patients and having dental mobile clinics visit the clinic at least 4 times a year.

Recommendations

Common among older people, dry mouth is a condition which has important effects on sufferers’ day-to-day lives. Appropriate and accurate measurement is critical for complete understanding of xerostomia and salivary gland hypofunction. Medications are the most important risk factor for dry mouth, and is common among older people. The management of dry mouth is challenging and needs to involve a multidisciplinary approach.