A Critical Nexus in Geriatric Care: Polypharmacy, Oral Dysfunction, and Emergency Department Utilization – An Interprofessional Framework for Integrated Assessment and Management
Abstract
Background: The expanding population of medically complex older adults is characterized by a convergence of polypharmacy and age-related oral health decline. Polypharmacy is a significant iatrogenic driver of xerostomia, oral dysbiosis, and mucosal injury, precipitating conditions such as severe caries, periodontitis, and oropharyngeal candidiasis. Aim: This narrative review synthesizes evidence across seven clinical and administrative disciplines to: (1) delineate the causal pathways linking polypharmacy to oral-systemic complications requiring emergency care; and (2) propose an interprofessional, systems-based framework for proactive assessment, integrated management, and safe care transitions for this vulnerable cohort. Methods: A systematic search of PubMed, CINAHL, Scopus, Web of Science, and Embase (2010-2024) was conducted. Keywords included polypharmacy, geriatrics, oral health, xerostomia, emergency department, and interprofessional collaboration. Grey literature from health administration and dental public health sources was also reviewed.
Results: The review identifies a high prevalence of medication-induced xerostomia among older ED patients, strongly associated with subsequent hospitalization for aspiration events and sepsis. Evidence demonstrates that structured oral assessment is rare in emergency and primary care settings. Conclusion: Mitigating polypharmacy-related oral health crises requires a fundamental shift from reactive, episodic emergency care to a proactive, interprofessional continuum. Implementing a standardized assessment and management framework within geriatric emergency care pathways is essential to reduce iatrogenic harm, decrease preventable admissions, and improve the quality of life for older adults.
Full text article
References
Adolfsson, A., Lenér, F., Marklund, B., Mossberg, K., & Çevik‐Aras, H. (2022). Prevalence of dry mouth in adult patients in primary health care. Acta Odontologica Scandinavica, 80(8), 605-610. https://doi.org/10.1080/00016357.2022.2069282
Affoo, R. H., Foley, N., Garrick, R., Siqueira, W. L., & Martin, R. E. (2015). Meta‐analysis of salivary flow rates in young and older adults. Journal of the American Geriatrics Society, 63(10), 2142-2151. https://doi.org/10.1111/jgs.13652
AlShaya, M., Farsi, D., Farsi, N., & Farsi, N. (2021). Accuracy of teledentistry in dental caries detection-a literature review. Annals of Dental Specialty, 9(2-2021), 66-71. https://doi.org/10.51847/xFIj1baqSE
Atchison, K. A., Fellows, J. L., Inge, R. E., & Valachovic, R. W. (2022). The Changing face of dentistry: Perspectives on trends in practice structure and organization. JDR Clinical & Translational Research, 7(1_suppl), 25S-30S. https://doi.org/10.1177/23800844221116836
Austregésilo, S. C., Leal, M. C. C., Figueiredo, N., & Góes, P. S. A. D. (2015). The Interface between Primary Care and Emergency Dental Services (SOU) in the SUS: the interface between levels of care in oral health. Ciência & Saúde Coletiva, 20, 3111-3120. https://doi.org/10.1590/1413-812320152010.12712014
Bridges, D., Davidson, R. A., Soule Odegard, P., Maki, I. V., & Tomkowiak, J. (2011). Interprofessional collaboration: three best practice models of interprofessional education. Medical education online, 16(1), 6035. https://doi.org/10.3402/meo.v16i0.6035
Chan, A. K. Y., Tsang, Y. C., Jiang, C. M., Leung, K. C. M., Lo, E. C. M., & Chu, C. H. (2023). Diet, nutrition, and oral health in older adults: a review of the literature. Dentistry Journal, 11(9), 222. https://doi.org/10.3390/dj11090222
Chang, A. K., Bijur, P. E., Esses, D., Barnaby, D. P., & Baer, J. (2017). Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial. Jama, 318(17), 1661-1667. doi:10.1001/jama.2017.16190
Estai, M., Kanagasingam, Y., Huang, B., Checker, H., Steele, L., Kruger, E., & Tennant, M. (2016). The efficacy of remote screening for dental caries by mid‐level dental providers using a mobile teledentistry model. Community Dentistry and Oral Epidemiology, 44(5), 435-441. https://doi.org/10.1111/cdoe.12232
Fujita, K., Masnoon, N., Mach, J., O’Donnell, L. K., & Hilmer, S. N. (2023). Polypharmacy and precision medicine. Cambridge Prisms: Precision Medicine, 1, e22. doi:10.1017/pcm.2023.10
Grace, S. (2021). Models of interprofessional education for healthcare students: a scoping review. Journal of interprofessional care, 35(5), 771-783. https://doi.org/10.1080/13561820.2020.1767045
Inglehart, M. R., Albino, J., Feine, J. S., & Okunseri, C. (2022). Sociodemographic changes and oral health inequities: dental workforce considerations. JDR Clinical & Translational Research, 7(1_suppl), 5S-15S. https://doi.org/10.1177/23800844221116832
Jaul, E., & Barron, J. (2021). Characterizing the heterogeneity of aging: a vision for a staging system for aging. Frontiers in Public Health, 9, 513557. https://doi.org/10.3389/fpubh.2021.513557
Jungo, K. T., Ansorg, A. K., Floriani, C., Rozsnyai, Z., Schwab, N., Meier, R., ... & Streit, S. (2023). Optimising prescribing in older adults with multimorbidity and polypharmacy in primary care (OPTICA): cluster randomised clinical trial. bmj, 381. https://doi.org/10.1136/bmj-2022-074054
Kern, L. M., Barrón, Y., Dhopeshwarkar, R. V., & Kaushal, R. (2012). Health information exchange and ambulatory quality of care. Applied clinical informatics, 3(02), 197-209. DOI: 10.4338/ACI-2012-02-RA-0005
Kotronia, E., Brown, H., Papacosta, A. O., Lennon, L. T., Weyant, R. J., Whincup, P. H., ... & Ramsay, S. E. (2021). Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Scientific reports, 11(1), 16452. Kotronia, E., Brown, H., Papacosta, A. O., Lennon, L. T., Weyant, R. J., Whincup, P. H., ... & Ramsay, S. E. (2021). Oral health and all-cause, cardiovascular disease, and respiratory mortality in older people in the UK and USA. Scientific reports, 11(1), 16452.
Langmore, S. E., Krisciunas, G. P., Warner, H., White, S. D., Dvorkin, D., Fink, D., ... & Moss, M. (2021). Abnormalities of aspiration and swallowing function in survivors of acute respiratory failure. Dysphagia, 36(5), 831-841. https://doi.org/10.1007/s00455-020-10199-8
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC geriatrics, 17(1), 230. https://doi.org/10.1186/s12877-017-0621-2
Royuela, A., Abad, C., Vicente, A., Muriel, A., Romera, R., Fernandez-Felix, B. M., ... & Zamora, J. (2019). Implementation of a computerized decision support system for computed tomography scan requests for nontraumatic headache in the emergency department. The Journal of Emergency Medicine, 57(6), 780-790. https://doi.org/10.1016/j.jemermed.2019.08.026
Sardellitti, L., Bortone, A., Filigheddu, E., Serralutzu, F., & Milia, E. P. (2023). Xerostomia: from pharmacological treatments to traditional medicine—an overview on the possible clinical management and prevention using systemic approaches. Current Oncology, 30(5), 4412-4426. https://doi.org/10.3390/curroncol30050336
Shekelle, P. G., Pane, J. D., Agniel, D., Shi, Y., Rumball-Smith, J., Haas, A., ... & Damberg, C. L. (2021). Assessment of variation in electronic health record capabilities and reported clinical quality performance in ambulatory care clinics, 2014-2017. JAMA network open, 4(4), e217476-e217476. doi:10.1001/jamanetworkopen.2021.7476
Sousa-Neto, S. S., de Arruda, J. A. A., Martins, A. F. L., Abreu, L. G., Mesquita, R. A., & Mendonça, E. F. (2022). Orofacial manifestations assisting the diagnosis of Cowden syndrome in a middle-aged patient: case report and literature overview. Head and Neck Pathology, 16(1), 304-313. https://doi.org/10.1007/s12105-021-01345-1
Stewart, C., Yrjana, K., Kishor, M., Soiza, R. L., Taylor-Rowan, M., Quinn, T. J., ... & Myint, P. K. (2021). Anticholinergic burden measures predict older people's physical function and quality of life: a systematic review. Journal of the American Medical Directors Association, 22(1), 56-64. https://doi.org/10.1016/j.jamda.2020.05.065
Tariq, M. H. M., & Abbas, U. K. (2022). Molecular detection of agglutinin-like sequence 1 gene in Candida albicans that is isolated from diabetic foot patients. Mustansiriya Medical Journal, 21(1), 72-77. DOI: 10.4103/mj.mj_37_21
Thomson, W. M., Smith, M. B., Ferguson, C. A., & Moses, G. (2021). The challenge of medication-induced dry mouth in residential aged care. Pharmacy, 9(4), 162. https://doi.org/10.3390/pharmacy9040162
Tokumoto, K., Kimura-Ono, A., Mino, T., Osaka, S., Numoto, K., Koyama, E., ... & Kuboki, T. (2022). Risk factors for root caries annual incidence and progression among older people requiring nursing care: A one-year prospective cohort study. Journal of Prosthodontic Research, 66(2), 250-257. https://doi.org/10.2186/jpr.JPR_D_20_00272
Ueno, Y., Iwasaki, M., Kimura, Y., Kakuta, S., Masaki, C., Wada, T., ... & Hosokawa, R. (2022). Periodontal status is associated with oral function in community‐dwelling older adults, independent of dentition status. Journal of Periodontal Research, 57(6), 1139-1147. https://doi.org/10.1111/jre.13051
van der Maarel‐Wierink, C. D., Vanobbergen, J. N., Bronkhorst, E. M., Schols, J. M., & de Baat, C. (2013). Oral health care and aspiration pneumonia in frail older people: a systematic literature review. Gerodontology, 30(1), 3-9. https://doi.org/10.1111/j.1741-2358.2012.00637.x
Wolfer, S., Von Hahn, N., Sievers, D., Hohenstein, C., & Kauffmann, P. (2022). Knowledge and skills of emergency physicians in managing traumatic dental injuries. European Journal of Trauma and Emergency Surgery, 48(3), 2081-2088. https://doi.org/10.1007/s00068-021-01808-8
Ye, L., Yang-Huang, J., Franse, C. B., Rukavina, T., Vasiljev, V., Mattace-Raso, F., ... & Raat, H. (2022). Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study. BMC geriatrics, 22(1), 841. https://doi.org/10.1186/s12877-022-03536-z
Yoshimatsu, Y., Melgaard, D., Westergren, A., Skrubbeltrang, C., & Smithard, D. G. (2022). The diagnosis of aspiration pneumonia in older persons: a systematic review. European Geriatric Medicine, 13(5), 1071-1080. https://doi.org/10.1007/s41999-022-00689-3
Zhang, J., Weng, Y., Qiao, M., Chen, W., & Zhang, L. (2023). Research status, hotspots and trends on oral care research in the elderly published from 2002 to 2022: A bibliometric analysis–A review article. Nursing Open, 10(8), 4907-4918. https://doi.org/10.1002/nop2.1798
Authors
Copyright (c) 2024 Husain Taha Kherd, Arif Mohammed Almotari, Khaled Salem, Fatema Ayesh Alhassan Aladeny, Adil Mohammad Alolaiwi, Jana Saleh Almeshary, Malika Mahzry Ghazwany, Omar Saeed Alzahrani, Fatimah Mustafa Ibrahim Alnakhli, Abdallh Mner Hlal Alotepe, Waad Rayhan Alquayqie, Hazim Ibrahim Ahmed Alhazmi, Amnah Ahmed Hussain Khudashi
This work is licensed under a Creative Commons Attribution 4.0 International License.