Older adults and frailty
Consider polypharmacy, dry mouth, cognition, function, nutrition and access. Agree a plan that is maintainable for the person and carers.
Understand
Frailty, cognition, polypharmacy and dependence can change the aim of care from complex reconstruction to comfort and maintainability. Oral health affects nutrition, speech and dignity.
Assess
Assess function, dry mouth, swallowing, carers, denture handling, home care and the patient's own priorities. Distinguish a transient illness from baseline capacity.
Apply
Simplify regimes where appropriate, coordinate support and document who will provide daily mouth care. Avoid a technically elaborate appliance the patient cannot use or clean.
Key distinctions
Polypharmacy can cause dry mouth, taste changes, bleeding or dizziness, and frailty can make routine mouth care difficult. A short simple intervention may deliver more benefit than a technically ambitious plan with high maintenance. Check swallowing and nutrition where relevant and include carers only with appropriate consent or legal basis. Review whether the plan works in the patient's actual environment.
Think through a case
A frail patient cannot remove a complex new partial denture independently. The design may be technically sound but functionally unsuitable.
The distinction to remember
Do not plan solely from the cast. Consider manual dexterity, carers, cognition and cleaning in the actual home setting.
Test your recall
Why may the technically ideal prosthesis be the wrong plan?
Show answer
It may be unusable or impossible to maintain.