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Josephine by Mind Map: Josephine

1. What are her options for her dental treatment?

1.1. Need for Dentures?

1.1.1. For her mandibular teeth, because she has 10 of her 16 teeth there is no indication for complete dentures like her maxillary teeth.

1.2. Periodontitis

1.2.1. She should check with a dentist and measure her gingival sulcus to see the extent of periodontal ligament and attachment loss.

1.2.2. To treat her periodontitis, typically surgical procedures such as pocket reduction surgery, soft tissue grafts are less preferred than scaling, root planning or topical antibiotics.

1.2.3. Because Josephine likely has trouble with her daily activities, she might want to see a dentist or have someone help maintain her oral health.

1.3. Dysphagia

1.3.1. Treatments can be managed speech-language pathologists (SLPs) that can assess function with endoscopy and fluoroscopy.

1.3.2. Adjustments can be made to diet (foods and liquids), swallow maneuvers and postural adjustments.

1.3.3. Although it might not help with her perceived "lack of taste", thickened liquids are most frequently used to compensate.

1.4. Information about Josephine

1.4.1. Full maxillary dental extractions 10 years ago and uses a maxillary denture

1.4.2. 10 Remaining mandibular teeth (No denture)

1.4.3. Complaints of dysphagia as well as not using her denture

2. What factors increase fall risk in this patient?

2.1. Intrinsic Factors

2.1.1. Medical, Neurological and Psychiatric conditions

2.1.2. Impaired vision and/or hearing

2.1.3. Age-related changes in neuromusclar function, postural reflexes, and gait

2.2. Extrinsic Factors

2.2.1. Medications Antidepressants Antiparkinsonian Diuretics Sedatives Antipsychotics

2.2.2. Unsafe Footwear

2.2.3. Poorly fitted or improperly used assertive devices

2.2.4. Environmental Factors Old, stable and low-lying furniture Beds and toilets of inappropriate height No grab bars Throw rugs, frayed carpets, cords, wires Slippery floors

3. Other mental assessment/screening tools?

3.1. Katz Index of Independent in the Activities of Daily Living

3.1.1. 6 questions asking about daily activites possible maximum of 6 points

3.1.2. 6=patient is independent and 0 means patient is very dependent

3.2. Lawton Instrumental Activities of Daily Living Scale

3.2.1. 9 Questions with 3-1 points per question Lower is worse

4. When does a patient lose their autonomy? Legal Implications?

4.1. Legal Implication

4.1.1. As we learned, decisional capacity is an important factor of informed consent

4.1.2. Without it, the patient cannot consent to procedures, release of information, etc and needs a health advisor

4.2. Medical decision-making capacity

4.2.1. Medical-decision-making capacity is the ability of a patient to understand the benefits and risks of a proposed treatment or intervention

4.2.2. Usually assessed intuitively at every medical encounter and is usually readily apparent

4.2.3. However, if there is reason to question decision making capacity, a more formal capacity evaluation should be considered Several formal assessment tools available to help Examples include the Aid to Capacity Evaluation or the Hopkins Competency Assessment Test

5. Depression and dementia overlap and manifestations in the elderly?

5.1. Depression

5.1.1. Older adults are at increased risk of depression

5.1.2. 80% of older adults have a chronic health condition (50% have two or more); This increases risk of depression

5.1.3. However, the incidence is fairly low (1-5% in the community), but rise to 13.5% in those who require home healthcare and 11.5% in older hospital patients

5.2. Dementia

5.2.1. The chronic or persistent disorder of mental processes

5.2.2. Four major forms of degenerative dementia: 1) Alzheimer's 2) Vascular 3) Parkinson's 4) Pick's Disease Also Lew Body dementia, Creutzfeldt-Jakob and Huntington's

5.2.3. Prevalence of dementia among individuals aged 71 and older was 13.9%