A MINIMALISTIC MANAGEMENT APPROACH FOR THE COMPROMISED ELDERLY PATIENT
who appear to have dementia suffer from pseudosenility syndromes and have in fact communication
disorders. Therefore, ageism often contributes to
the over-diagnosis of dementia.
It is essential to have good knowledge of the
cognitive status, namely speech, hearing, and
language difficulties and also to know how to
evaluate a patient who is suspected of suffering
from dementia.
The FROMAJE test is a quick easy mental evaluation
test. The FROMAJE--an acronym for Function,
Reasoning, Orientation, Memory, Arithmetic,
Judgment, and Emotion--Mental Status Guide
(FMSG):
m Function: Mental function adequate or
inadequate;
m Reasoning: Understanding test about the abillity to explain the meaning of a proverb;
m Orientation: Timing dysfunction;
m Memory: Distant, recent and immediate memory;
m Arithmetic: Counting, addition and subtraction;
m Judgment: Appreciation of cause effect relationship;
m Emotional state: Patient behavior during
the interview.
A total score will give information about the risk to
deliver a successful treatment.
Oral status
Aging is characterized by important changes
of the human organs. The conjunction of these
changes with age-related pathologies leads to the
need of multiple medications in order to maintain
their quality of life.
There is a danger when using a great number of
drugs as the elderly do, as that could also result in
undesirable side effects.
Mouth dryness or Xerostomia is one of the
common phenomena.
Xerostomia has numerous consequences which
affect eating, swallowing, and taste reduction, thus
impairing the nutritional status.
The diminution of the saliva flow will result in the
poor retention of the removable prosthesis and a
burning mouth pain.5
Symptoms such as a burning mouth, dry lips and
altered speech and an ulcerated mucosa are the
consequences of hypo salivation and xerostomia.
It has been estimated that actually about 30%
of the elderly suffer from hypo salivation and
xerostomia.6
Taste alteration, mouth dryness and teeth staining
are often side effects of the medication taken by
the elderly. A survey in Helsinki demonstrates
there is a relationship between the drug intake
and xerostomia; that the great the number of
medication, the greater the probability of mouth
dryness. Taste reduction influences dietetic habits
with an important consumption of salt or sugar.
Oral Cancer has high morbidity and mortality.7
Commonly the 5 year survival rate is 75 % for
local lesions, but in the case of lesions with distant
metastasis only 17%. The direct causes are;
tobacco, alcohol, infections, and chronic irritation
due to very sharp teeth or prosthesis.
The indirect causes are nutritional deficiencies,
poor oral awareness, and poor access to oral care
for prevention and early detection.
Oral diseases are frequent and there is a need
for an integrative approach concerning the
understanding and management of the oral
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