India is ageing, and dental chairs are filling with older patients. Many of them take several medicines, live with long-term conditions and depend on family for decisions. Caring for them well is a clinical skill; doing it lawfully needs attention to consent, capacity and the duty of care.
Consent and capacity
An adult is presumed able to decide for themselves. With older patients, especially those with memory problems, the dentist should be satisfied that the patient can understand the proposed treatment, weigh its risks and benefits, and communicate a choice. If they can, their decision stands, even when the family disagrees.
If a patient cannot decide, consent should come from a person legally entitled to decide for them, and the file should record who that was and on what basis. Treating on the word of a relative without checking their authority is a common and avoidable risk.
The standard of care
Older patients bring particular risks: medicines that interact, blood thinners, diabetes, heart disease and slower healing. The standard of care expects the dentist to know these from the history, to adapt the treatment plan, and to consult the patient’s physician when needed.
The right to say no
A patient with capacity may refuse treatment, even treatment the dentist believes they need. Respect the refusal, explain the consequences plainly, and record both the advice and the decision.
Signs that need attention
The dentist is often among the few professionals who see an older person regularly. Unexplained injuries, sudden neglect of oral hygiene or untreated infections can signal neglect at home. They deserve a gentle question and, where appropriate, a word with the family or the patient’s doctor.
Good geriatric dentistry rests on the same foundations as all good practice: a careful history, honest conversation, clear consent and a complete record.