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PubMedDate not supplied

Portable dentistry: a part of general dentistry's service mix.

Portable dentistry is a service that is easy to provide and profitable; the demand is expected to increase as the population ages. The author encourages incorporating portable dentistry as a methodical and planned service, alongside traditional fixed practice, to benefit the patient and the profession. The profession of dentistry is challenged to consider its ethical and moral obligation to homebound and institutional patients, citing instances worthy of consideration. Barriers that prevent access to care are discussed and some are reduced to manageable components of business such as finances or concerns with treating the medically complicated patient. Opportunities and possibilities for personal, professional, and financial growth through the provision of portable dentistry are cited.

Aged↗
PubMed2003

Who will provide dental care for housebound people with oral problems?

There are currently 9(1/2) million people in England and Wales over retirement age and nearly 4 million of these are over 75 years. Age itself is not a disease and 70% of the population over 65 are functionally independent. However, ageing is associated with an increase in the prevalence of chronic disease and disability and 20% of people over 65 years are frail and a further 10% are functionally dependent, either homebound or institutionalised. The implications of this demographic change on oral health has been investigated. Reports show oral health for the well elderly is improving, creating a demand for dental services, which this group are able to access, but maintenance of oral health and access to dental treatment is a problem for disabled elderly people, who, for their daily activity are dependent on carers.

Activities of Daily Living↗
PubMed1996

Characteristics of rural homebound older adults: a community-based study.

OBJECTIVE: To determine the frequency and characteristics of homebound older adults in a rural community. DESIGN: An epidemiological survey of an age-stratified random community sample. SETTING: The rural mid-Monongahela Valley in Southwestern Pennsylvania. PARTICIPANTS: A total of 878 noninstitutionalized persons aged 68 years and older, fluent in English, and with at least grade 6 education. MEASUREMENTS: The frequency with which subjects left their homes, the Mini-Mental State Examination (MMSE) score, and additional information on demographics, self-reported health problems, health services utilization, IADLs, depression, and social support were measured. RESULTS: 10.3% of the sample was classified as homebound. In univariate analyses, being homebound was found to be associated significantly (P < .001) with being older, female, and widowed and with MMSE and IADL impairment, with more depressive symptoms and worse social supports, fair to poor self-rated general health, weight loss, and histories of stroke, angina, arthritis of the spine, and falls. In a multiple regression model, variables associated independently with homebound status were gender (odds ratio = 9.4, 95% confidence interval = 3.6 - 24.9), weight loss (OR = 3.7, CI = 1.7 - 8.2), IADL impairment (OR = 2.6, CI = 2.1 - 3.1), and depressive symptoms (OR = 2.1, CI = 1.3 - 3.2). Being homebound was also associated with recent acute hospitalization and use of home health and social services. CONCLUSIONS: These data provide evidence that homebound older adults have a disproportionate share of morbidity and disability and suggest a sociodemographic and clinical profile to help identify those older people at risk of being or becoming homebound. They also point to the need for home-based health services for the older adults, particularly in medically underserved communities such as rural areas.

Activities of Daily Living↗
PubMed2005

The health status and health promotion behavior of low-income elderly in the Taipei area.

The purpose of this study was to understand health promotion behaviors and their correlated factors among low-income elderly in the Taipei area. This study used a cross-sectional design with a descriptive correlation approach. A total of 89 low-income elderly from Peitou District of Taipei participated in the study. Structured questionnaires, the primary sources of measurement, were read to study subjects by a trained research assistant. The mean age of low-income elderly in the study was 76.85 year-old. A plurality were single (41.6%) and 31.5% lived alone. Subject IADLs (instrumental activities of daily living) were not as good as their ADLs (activities of daily living). Their psychosocial health status was worse than their physical health status. Among health promotion behaviors, regular exercise appears to be the most prevalent. The most significant factor among subjects for failing to follow health-promoting behaviors was their IADLs. Homebound elderly who lived alone and had poor IADL were less likely to have health promoting behaviors. A proposal to encourage health promotion behaviors for low-income elderly derived from study results is the initiation of formal personal assistance programs to remedy the inability of many elderly, especially those living alone, to leave the home due to ADL-related or other limitations.

Activities of Daily Living↗
PubMed2003

Angels of the night: evening and night patrols for homebound elders in Sweden.

PURPOSE: The purpose of this study was to describe the work of evening and night home care patrols in Swedish old-age care by examining how staff members view their work and the specific work content. DESIGN AND METHODS: The authors developed two questionnaires: one that was to be answered jointly by the patrol teams, and one to be completed by each individual member of a team. All patrols in the municipality of Jönköping, Sweden, were asked to participate. RESULTS: The most frequent kind of help provided by evening and night patrols involves personal care, but help with medications and injections are also frequent. The staff reported that it is becoming more common for the patrols to assist people with terminal illnesses. The patrols also increasingly assist people with psychiatric problems. The staff feels that the job may be becoming too diverse and that they need further education for the range of tasks they are asked to perform. IMPLICATIONS: The patrols are very flexible in the services provided. Without the patrols, the staff members believe that many persons would have to leave their homes to go to institutions.

Adult↗
PubMed2000

[Home chronic illness and consumption of psychopharmaceuticals].

OBJECTIVE: To assess the consumption of psychiatric drugs by chronic homebound patients. DESIGN: Descriptive, longitudinal study. SETTING: Raval Nord Health District, Barcelona. PATIENTS AND OTHER PARTICIPANTS: All 243 chronically ill homebound patients registered on the home care programme in May 1996. After three years 16% had gone into a home, 9% had moved residence, 38% had died, and 37% remained active. MEASUREMENTS AND MAIN RESULTS: Of the 90 patients still active, 40% took some psychiatric drug in May 1999. 8% of the patients who said they had taken psychiatric drugs did so by self-medication. The most commonly consumed pharmacological group of the psychiatric drugs were benzodiazepines at 64%. Women took more psychiatric drugs (45%), as did persons living alone or who had been bereaved (50%). The proportion of patients taking psychiatric drugs was greater when there was worse autonomy according to the Katz index (67%), a cognitive deficit on the Short Portable Mental Status Questionnaire (SPMSQ) of Pfeiffer (62%), and in the presence of comorbidity (56%) (p < 0.01). CONCLUSIONS: There is high consumption of psychiatric drugs by chronic homebound patients, especially when there is physical-cognitive deterioration and presence of comorbidity.

Aged↗
PubMed2001

Control beliefs of the frail elderly. Assessing differences between homebound and nursing home residents.

Previous age-related sense of control studies have largely focused on active, community-dwelling aged individuals and have excluded elderly persons who are frail. This study compares sense of control and life satisfaction as determined through rating scale administration between two frail, dependent samples: nursing home residents and homebound elderly. Differences in control scores were statistically significant for those who were homebound expressing higher perceived personal control than nursing home residents (p < .001). Sense of control has no correlation with either life satisfaction or length of stay in the nursing home cohort.

Aged↗
PubMed2005

The effect of the presence of others on caloric intake in homebound older adults.

BACKGROUND: Undernutrition in homebound older adults is a significant problem. The purpose of this study was to investigate the effect of the presence of others, both within the household and during meals, on caloric intake in homebound older adults. METHODS: In-depth interviews and three 24-hour dietary recalls were obtained from 50 older adults who were receiving home health services. Descriptive statistics were used to characterize participants, and hierarchical linear modeling was performed to evaluate predictors of caloric intake per meal. RESULTS: Participants' mean age was 77. Females composed 65% and African Americans composed 42% of the sample. Analyses are based on 553 meal observations. The majority (84%) of participants consumed all meals for each of the 3 days of data collection; however, they consumed an average of only 1305 calories per day. Hierarchical linear modeling analysis indicated that persons who had others present during meals consumed an average of 114.0 calories more per meal than those who ate alone (p =.009) and that women consumed 76.7 fewer calories per meal than did men (p =.045). The presence of others within the household had no effect on caloric intake. CONCLUSION: This research suggests that a simple and inexpensive way to increase caloric intake in homebound older adults is to make arrangements for family members or caregivers to eat with them.

Aged↗
PubMed1994

Delivering dental care to nursing home and homebound patients.

The growing life expectancy has created a number of challenges for society and for the dental profession. One of these challenges is the increasing number of people, particularly those over age 85, who are considered frail and functionally impaired, who no longer can live independently or participate in the community. If the impairment is severe enough, the older adult may become home-bound or unable to leave the home without assistive aids or, less commonly, institutionalized in a nursing home. The characteristics of the homebound and nursing home resident represent a dramatic contrast from those who are the same age and living in the community: They are older, predominantly female, and have more physical and mental disabilities. In addition, there are differences in oral health characteristics, of which dentists and other health professionals need to be aware. Although there are a number of obstacles and barriers that make providing dental care more difficult for these patients, federal mandates and a growing professional response to develop initiatives for outreach and access are beginning to have an effect. Still the challenge for providing dental care to these groups remains great, and it will take a tremendous effort from many oral health professionals before significant change is evident. There are many professional and personal rewards for providing this care, and we as dental professionals must be committed to seeing that the oral health needs are met for all underserved populations in our society.

Aged↗
PubMed1996

Provision of free and discounted dental services to selected populations: a survey of attitudes and practices of dentists attending the 1996 Dallas Midwinter Meeting.

An attitudes and practices survey of dentists attending the Dallas Midwinter Meeting in January 1996 in Dallas was conducted as a collaborative effort between the Dallas County Dental Society and the Baylor College of Dentistry. The survey was developed to help determine participating dentists' attitudes and practices in the area of provision of dental services on a discounted or free basis to disadvantaged patient groups. A total of 225 dentists responded to the survey. Of these surveyed dentists, 213 (94.6%) were in private practice and 199 (88.4%) described themselves as general dentists. A considerable amount of charitable dental services, discounted and free, was reported to be provided by the group of respondent dentists. A total of 152 (67.6%) of the dentists surveyed reported providing discounted or free care to elderly patients with low income, 125 (55.6%) provided such care to low-income patients without age restriction, and 137 (60.9%) cared for patients of record with temporary financial hardship. In other patient categories, 79 (35.1%) of the dentists provided free/discounted services to handicapped persons and 47 (20.9%) provided care to homebound patients. These findings concerning charitable practices by dentists were similar to those found in a comparable survey conducted by the American Dental Association in 1994. Dentists were fairly evenly split as to their preference where to volunteer services. Of the total respondents, 84 (40.6%) preferred providing services in their own office and 91 (44.0%) preferred to do so at a community health clinic that hosted volunteers.

Attitude of Health Personnel↗
PubMedDate not supplied

Using the GOHAI to assess oral health status of frail homebound elders: reliability, sensitivity, and specificity.

A pilot study assessed the clinically determined and self-reported oral health status of 50 randomly selected homebound patients served by Boston's Home Medical Service. The sample was largely female, low-income, and edentulous. The median age of the patients was 81 years (range, 64-101). While 76% deemed themselves to be in good to excellent oral health, 80% of the patients had not seen a dentist within the last two years, and 80% were found to be in need of routine dental care. To assess whether the Geriatric Oral Health Assessment Index (Atchison and Dolan, 1990) could be used by non-dental health professionals to determine the need for requesting dental consultation, the study physician repeated the administration of the GOHAI for 23 of the 50 subjects within eight weeks of the initial examination. For the 23 subjects having both dentist- and physician-administered GOHAI scores, the intraclass correlation coefficient was r = 0.61 (p = 0.002), indicating good agreement between the dentist's and physician's administrations of the GOHAI. However, given the high prevalence of need for care, the GOHAI appears to be of less value than an examination for identifying persons who need dental care in this population. Future research is needed to examine the GOHAI's sensitivity and specificity in populations with low to moderate prevalence of treatment need.

Aged↗
PubMed1989

Care of the homebound.

Explore the source record for details and available documents.

Dental Care for Persons with Disabilities↗
PubMed2003

Longitudinal change in left ventricular hypertrophy in the elderly on antihypertensive therapy.

Left ventricular hypertrophy is an independent risk factor for adverse cardiovascular events. Factors related to left ventricular hypertrophy progression or regression in the extremely elderly population including role of antihypertensive therapy, are not well recognized. We conducted a structured retrospective chart review analysis of a cohort of 100 homebound elderly, predominately female African American subjects. All persons had at least two 2-D echocardiograms interpreted by the same cardiologist prior to the initiation of this study. Information was collected on demographics, functional status, comorbid conditions, use of medication, and progression or regression of left ventricle hypertrophy between baseline and follow-up echocardiogram. At baseline and follow-up echocardiogram, 47% (n = 47) and 56% had evidence of hypertrophy, respectively. There was no association between treatment with beta-blocker, calcium channel-blocker, or diuretic therapy, and left ventricular hypertrophy at follow-up echocardiogram. Only angiotensin converting enzyme inhibitor therapy was associated with the progression of left ventricular hypertrophy in all subjects. Logistic regression analysis based on all subjects revealed that risk of left ventricular hypertrophy on follow-up echocardiogram was lower with increasing age (OR 0.95, CI 0.904-0.997) and higher with angiotensin converting enzyme inhibitor therapy (OR 3.27, CI 1.41-7.63). Among subjects with no evidence of left ventricular hypertrophy at baseline, only the presence of hypertension was associated with left ventricular hypertrophy (OR 4.4, CI 1.19-16.3). Treatment of hypertension in the elderly with angiotensin converting enzyme inhibitor seemed to worsen left ventricle hypertrophy in this patient population.

Adrenergic beta-Antagonists↗
PubMed1995

The determinants of walking velocity in the elderly. An evaluation using regression trees.

OBJECTIVE: To determine predictors of walking velocity in the elderly. METHODS: Five hundred thirty-two persons from 3 cohorts of elderly persons (retirement community, ambulatory care medical clinic, or chronically homebound population) performed a 10-foot (for the homebound subjects) or 50-foot (for all other subjects) walk time test and underwent a standardized interview, chart review, and clinical examination. The 73 independent variables that were evaluated included demographic, musculoskeletal, neurologic, psychologic, and other comorbidity items. Least-squares and least-absolute-deviation regression tree analyses were performed to determine the strongest predictive factors associated with walking velocity. RESULTS: Sampling cohort (homebound versus non-homebound), quadriceps strength, hip flexion strength, lumbosacral spine impairment, lower joint impairment, and education were found to be associated with walking velocity. Joint pain measures were not associated with walking velocity. CONCLUSION: Muscle strength variables are better predictors of walking velocity than are joint pain variables. Thus, clinical trials and observational studies using walking velocity as an outcome need to take into consideration the influence of muscle strength on this outcome variable.

Aged↗
PubMed1999

Pilot study of a visitor volunteer programme for community elderly people receiving home health care.

There is a need to evaluate community support programmes for elderly people. In this randomized control trial (RCT), we determined the effectiveness of 'friendly visitors' in a volunteer programme of a visiting nurses organization in Southern Ontario, Canada. The Volunteer Friendly Visitor Programme was developed to support elderly people receiving homemaking and nursing care in the community. Volunteers are screened, trained, interviewed and matched to homebound elderly clients for general interest, visit expectations and personality. Volunteers spend three to four hours on average per week with clients socializing in mutually agreed-upon ways. The nursing staff identified clients who were lonely for this additional support. These newly-referred clients were randomly allocated to receive a friendly visitor or not for six weeks. Those receiving the volunteer visitor improved in life satisfaction and two social support measures: worth and social integration. Thus, the addition of volunteer visitors to planned homemaking and nursing care made a difference for elderly in the community.

Journal Article↗