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Geriatric Dentistry: Before You Call 911

Course Number: 586

Discharging the Patient

There are some precautionary steps that need to be followed even after completion of the dental procedure. At the completion of the appointment, regardless of its duration, the elderly patient should not be allowed to sit erect from a supine posture and walk straight out of the operatory. Taking into consideration their medical diagnosis and medications, the elderly patient may have a higher tendency for orthostatic hypotension when moved from one posture to another in quick succession. This can lead to dizziness and a potential fall either inside or outside the clinic that could lead to serious injury and in rare circumstances even death. These ill-fated situations are avoidable, but unfortunately there have been innumerable cases registered against dental professionals for being negligent in providing care to the elderly resulting in physical injuries of all magnitudes.51

The best practice approach would be to change the patient’s posture very slowly from supine to erect and continuously confirming the comfort levels of the patient. The patient in most cases will inform the clinician regarding any discomfort, but in cases where patients have cognitive decline or communication problems, their facial expressions should continuously be monitored to analyze any concerns. For body equilibrium to re-establish, they should be asked to sit at least for a couple of minutes before helping them to stand or shift. Any sudden or abrupt motion should be avoided in all circumstances.

As for post-operative instructions, they should preferably be given both verbally and in writing. The instructions regarding any potential swelling, post-operative bleeding, post anesthetic trauma or any other dental/medical emergency should be communicated in simple English. The contact number for the clinic during and after hours should be provided in a clear and readable form. It’s advisable to have a staff member go through the instructions with the patient (and caregiver if present) to ensure they clearly comprehend the instructions.

Every elderly patient should be thoroughly evaluated before discharging them from the clinic. Their speech, balance and basic understanding of simple instructions should be carefully observed. Any deviation from the baseline vitals should immediately be brought to the attention of the dentist. The patient should be under constant supervision, and in some cases emergency contacts can be requested to pick up the patient after the appointment. These patients in most cases can be expected to have an uneventful recovery after operative or surgical procedures. In cases of severely frail patients, those on anti-coagulants or anti-platelet therapy or with histories of delayed healing may require a follow up call either the same evening or the next morning to check on their status. This is not only vital in ensuring the well-being of the patient but also goes a long way in securing the patient’s confidence in the dental staff. All interactions with the patient, and if applicable, their caregivers, and family members as well as any observed changes should be documented in the patient’s records for future reference.