What Is Thrush in the Elderly?

Pseudomembranous candidiasis, commonly known as thrush, is a fungal infection that forms on the oral mucosa of the mouth and esophagus. In the elderly, it can be especially problematic because it becomes increasingly difficult to maintain good oral hygiene due to denture use, illness, impaired immune response, poor nutrition and mental impairment. If left untreated, this infection can become systemic, causing serious illness.

Identification

Thrush appears as a white film covering of the surface of the gums, tongue and inside of the mouth that cannot be removed with gentle scraping. Small lesions and fissures may form causing pain and difficulty swallowing. A physician diagnosis the condition by taking a cell culture from a lesion.

Dentures

Denture use poses a special risk for thrush. Many elderly people have difficulty achieving a good fit with their dentures and food can easily become entrapped between the dentures and gums. Additionally, poor hygiene allows bacteria to grow on the dentures themselves. Whenever thrush is suspected, it is important to take a break from denture use until the infection clears completely.

Contributing Factors

Many physical conditions common among the elderly such as diabetes mellitus and cancer can contribute to the development of thrush. Any elderly person undergoing cancer treatments such as radiation or chemotherapy should be monitored closely.

Warning

Many medications such as corticosteroids, antibiotics and immunosuppressants can alter the normal oral flora and reduce the body's ability to fight infection. Both of these actions combined can make standard topical treatments ineffective and may require much stronger drugs to combat the infection.

Considerations

Malnutrition and cognitive impairments such as Alzheimer's disease are also common problems for elderly people. An inadequate diet decreases the body's ability to fight infection, while dementia often hinders good oral hygiene, diagnosis and treatment. It's extremely important that people with these risk factors receive consistent monitoring and assistance from caregivers.

References

• The Merck Manual of Geriatrics