The Seattle Care Pathway for securing oral health in older patients

Abstract

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients

Frailty and oral health: Findings from the Concord Health and Ageing in Men Project

“…The ageing of the world's population has led to the World Health Organisation's call for public health action and an international symposium for securing the oral health of older people . In Australia, it is estimated that by 2061 more than 22% of the population will be 65 years or older with some 10 to 20 per cent of the older population being frail, suggesting the need for a comprehensive professional understanding of the oral health needs of frail older people.…”

An ageing population poses dental challenges

“…Those entering care facilities have more teeth but are less able to take care of themselves; their needs are more diverse. Recent attention has been focused on developing a more systematic, evidence-based approach to assessing and delivering care to older dental patients, using dental care pathways which are specific to particular levels of dependency [38]. Their use should improve the likelihood of consistent and predictable care because evidence-based and standardised levels of care are provided, but it is too early to be able to evaluate their effectiveness.…”

NHS dental service utilisation and social deprivation in older adults in North West England

“…Although this is a large dataset, this research is exploratory and provides an interesting insight into the dilemma relating to restore versus extract as treatment options for the older patient, for example restorability decreasing with age and also concepts such as the Shortened Dental Arch (SDA). It is complex to compare the current data to earlier studies due to the focus on older adults in residential care and the limitation of the current work is that the reasons for the dental treatments cannot be assumed that is, due to caries, trauma or periodontal conditions (although the concept of 'healthy survivors' in periodontal disease may suggest that the majority of disease is caries 40 ). Furthermore, the accuracy by which the FP17s are correctly completed is unknown.…”

“…Pretty et al have suggested a pathway in which this approach can be incorporated in dentistry to ensure effective prevention and treatment of the older adult population. 40 …”