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The concept of "rational dental care" was developed 20 years ago when it became clear that idealized treatment plans for frail and functionally dependent older adults were often inappropriate. This first in a series of 2 articles reviews the reasons for developing the concept.
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The inadequacy of access to oral health care is a complex problem facing society. Many in society who need care are unable to obtain it or do not seek it for a variety of reasons. Most commonly, these are the unfunded, who simply have inadequate resources; the "unaccepted," who may not have dental coverage or have types of coverage that are not accepted by private practitioners; the inaccessible, who may be homebound or live in sparsely populated or low-income geographic areas without dental providers; the unconvinced, who may have resources but do not believe in or recognize the need for treatment; and the unmotivated, who may realize that they need care but for them it is not a priority. While the oral health care professions cannot be expected to shoulder the entire burden to "fix" inadequate access to care, we believe that they have important responsibilities. True professions have a unique relationship with society that places them in positions of trust. With this trust comes the responsibility for public policy advocacy and to actively participate in identifying realistic ways to reduce the access problem. The leadership of organized dentistry, as well as educational institutions, and practitioners themselves must be committed to improving access and thereby the health of those currently underserved.
OBJECTIVES: World demographic changes show an increase in the elderly population worldwide. Due to increase in life span, the continuously growing elderly population requires extra attention. This has a great effect on private medical practice. A long term result is the necessity of training dentists in the practice of geriatric dentistry. Geriatric patients have problems that are age dependent, general health problems and specific dental problems. These problems require special skills on the part of the dentist. Yad Sarah has undertaken responsibility for this important task and provides dentists with a geriatric dental (gerodontology) training program. Elderly patients in need of geriatric dental treatment are served in both stationary and mobile clinics. The program includes both theoretical and practical studies. For this purpose, the Hebrew University-Hadassah School of Dental Medicine and Yad Sarah have created a three-year program at the end of which the dentists, working voluntarily, receive a diploma in geriatric dentistry. The purpose of the present study is to evaluate the teaching program in the past few years. METHODS: All the lectures given in the program from 2001 to 2005, both theoretical and practical, have been summarized and categorized by subject. RESULTS: In 2001-2002, the teaching program was theoretical only. Starting from 2003 practical studies were added to the program so that now it includes both theoretical and practical studies. The results presented do not include the many clinical teaching hours during supervised treatment that are given privately to the dentists, from the preparation of the dental treatment plan until the conclusion of treatment. The result shows a steady increase in teaching hours during the years 2001-2005. Not only has the quantity increased; the content has changed too, because of the changes in the needs and the character of work in the geriatric dentistry field. The increasing activity through the mobile dental clinic for homebound patients has led to stepped up teaching in subjects that are related to this kind of treatment, such as oral medicine, systemic disease and oral rehabilitation relating to at-home treatment. The increase in implant treatments created the need to train the dentists in the surgical and rehabilitative aspects of care. The area of oral medicine (26%) and oral rehabilitation (24%) received the most teaching hours, while endodontics (4%) received the least. CONCLUSIONS: The teaching program at Yad Sarah is need-dependent--needs of the patients and of the volunteer dentists as well. At Yad Sarah the dentists come to volunteer, to give needy people quality dental treatment that they cannot afford themselves at regular clinics. An additional motive of these dentists is to advance themselves professionally. The Yad Sarah Dental Clinic offers a unique teaching program that contributes to enhancing knowledge in gerodontology. As the needs at the clinic change, so does the teaching program.
The elderly population (people of 65 years and older), especially the compromised elderly, places an overwhelming demand on the health care system in the USA. Dentists must provide services to all segments of the elderly population, but the compromised elderly are labelled as 'poor' candidates for dental treatment because they are unlikely to cooperate, find it difficult to get to the dental surgery, or cannot pay for professional services. The authors of this paper have developed guidelines for on-site patient management using a team approach and a low-cost, portable treatment system for providing removable prosthodontic services using ligh-cured denture resin. The system is cost-effective, reduces chairside time and requires minimal patient cooperation but does not compromise the quality of care. Treatment can be provided in non-traditional settings with family members and support staff on-hand. The feasibility of this approach has been demonstrated by its use in hospitals, clinics, nursing homes and private residences.
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This article describes a federally funded nurse managed community health organization that treats the elderly. The innovative community-focused model uses the nurse as case manager to provide health promotion, screening, and early interventions to clients enrolled in the Community Nursing Organization (CNO). It explains the advantages of integrating advanced practice nurses into the nursing staff to provide both direct care to clients and teaching/conculation to the nursing staff. The CNO demonstrates that advanced practice nurses possess autonomous practice skills and are able to integrate preventive and curative care across practice sites.
Environmental change offers an attractive approach to falls prevention, particularly as part of multidimensional intervention strategies. This article reviews and summarizes prior research that has examined environmental factors in falls experienced by older people in community and long-term care settings. Limitations of this research as a basis for falls prevention activities also are discussed. Studies that focused on environmental hazards as well as those that examined the interaction of environmental conditions and environmental use activities from a situational perspective are included. The first group of studies suggests an approach to falls prevention centered on hazard removal; the second group suggests an approach centered on the provision of more supportive environments that reduce excessive environmental demands. Environmental change and falls prevention in long-term care and community settings, including common barriers to change among older individuals living in the community, are discussed.
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Clients with strokes, Parkinson's disease, multiple sclerosis, brain injury, or other conditions that are neurologic in origin abound in home care. Other clients may have neurologic deficits that are not so obvious. This article describes basic neurologic assessment and how it can be performed in the home setting with minimal inconvenience to the client and the nurse. Using a catchy mnemonic, the home care nurse can ensure that valuable information is obtained during the visit.
The oft quoted phrase, "There's no place like home," has no greater meaning than when long-term care decisions are being made. In the midst of ongoing late life changes, one's home is often the only anchor. Through carefully selected home care and nursing and care management services, living at home remains a viable option for older adults and their families. Physicians can serve as a vital link between older adults and the home care system by educating the patient where services can be obtained. Physician input into referral and collaboration with other care managers can help determine the best approach to home care.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To identify whether and how family physicians practising home care resolve ethical dilemmas in clinical management of homebound patients and to examine whether the self-reported, theoretical ethical positions of these physicians match their actual patient management. DESIGN: Cross-sectional survey. SETTING: Quebec community-based home care program. PARTICIPANTS: Quebec family physicians actively involved in community-based home care: 85 men and 65 women. MAIN OUTCOME MEASURES: Physician level of agreement with theoretical ethical statements about autonomy, caregiver needs, and resource allocation; management options chosen for a clinical case vignette; and mechanisms used for resolving conflicts. RESULTS: There were 209 respondents to the 279 questionnaires sent (75%). Of these, 59 who were not currently involved in home care were excluded, leaving 150 participants. Most (83.3%) physicians surveyed agreed with the ethical principle of patient autonomy; 88.7% agreed that the interests of family caregivers are important in decisions regarding patients, and 72.0% agreed that limiting home care services is reasonable in the context of limited resources. In managing a patient, 65.3% of physicians thought the patient should be placed in a nursing home against her wishes because of "danger to self," while 82.7% felt she should be placed if the caregiver is "exhausted." Three quarters of physicians did not limit or decrease home care services, despite noncompliance. CONCLUSIONS: Family physicians practising community-based home care in Quebec have practical views on various ethical principles guiding home care practice. Except in the area of limiting or discontinuing home care services, their ethical framework is reflected in a case vignette of patient management.