Term Care Institutions Research Articles

Oral health in a long‐term care institution equipped with a dental service

The oral health and medico-dental status of 250 mostly elderly residents of a long term care institution were assessed by examination and a review of medical records. In addition, attitudes to dental care, dental experiences, and demands for care were solicited from those who could participate in an interview. There were no dental complaints from 70% of those interviewed. The complaints most frequently reported were difficulties with mouth dryness, hygiene, and chewing. Natural teeth remained in at least one jaw in 30% of the 245 residents examined. Dental caries was present in 78% of this dentate group, with coronal and root lesions equally prevalent. Gingival bleeding was also common in this group and 29% had deep periodontal pockets. Nearly 50% of the mandibular dentures and 25% of the maxillary dentures examined were inadequate. Mandibular dysfunction occurred in 25% of the population and was more frequent in the dentate group. Oral mucosal pathoses were rare. No correlation was found between the systemic health and the oral health of the residents. There was a need to improve the oral hygiene of most of those examined. Less than 20% of the denture wearers would have benefitted from treatment and 10% of those with defective dentures were considered unsuitable for treatment. In contrast, 60% of those with natural teeth required restorations and 36% needed one or more teeth removed. Very few urgent needs were seen. An inter-examiner accumulative inconsistency of 11% was measured between the three examiners, and a third of the assessments made of periodontal status were contradictory.

The care of paraplegics and tetraplegics in Singapore.

A brief description of the evolution of the spinal injury unit in Singapore is given. Based on statistics gathered between 1973 and 1983 on all of the 713 traumatic cases treated at this unit, the causes, pattern and effect of spinal cord injury in Singapore are analysed, and highlights on the other supporting services available in Singapore for paraplegics and tetraplegics, from long term institutional care and hostel accommodation to vocational assessment, training and placement are given.

Dental care for the patient with Alzheimer’s disease

1 ementia is the fifth leading cause of death in the United S ta tes .1 Among people who are older than 65, 15% are thought to have some degree of dementia or loss of cognitive function.2 Of these, less than a third are severely impaired.2 Representing roughly 65% of people with primary dementias, Alzheimer’s disease affects .5 to 1.5 million Americans.3 This disorder is the most common cause of se­ vere intellectual impairment in elderly individuals.3 In the past 15 years, there has been a growing concern for the older adults in our society. On social, economic, and health levels dictated by the geriatric im­ perative, society is facing the task of ad­ dressing the needs of its older citizens. In dentistry, we are beginning to train den­ tists, hygienists, and assistants— during school, through continuing education, and, in some instances, via postdoctoral programs— to recognize and meet the special needs of people older than 65. As their numbers increase, dental pro­ fessionals will increasingly encounter pa­ tients with Alzheimer’s disease in prac­ tice. Contacts with these patients in long­ term care institutions will become even more common. It is important that practi­ tioners become familiar with the signs, symptoms, and the clinical course of this disease. The purpose of this paper is to review briefly Alzheimer’s type of de­ mentia, propose an index for rapid evalu­ ation, and suggest approaches to dental care and treatment planning for patients with Alzheimer’s disease. Alzheimer’s type of dementia is a cere­ bral degenerative disease of unknown cause. It is characterized during postmor­ tem examination by the presence of extra­ cellular neuritic or senile plaques, intra­ ce llu lar neu rofibrillary tangles, and granulovacuolar degenerative changes in greater numbers and in different ana­ tomic sites from normal subjects.2-4 A significant decrease in the dendritic tree associated with a loss of large neurons in the cerebral cortex suggests that the po­ tential synaptic network fed by those neurons is decreased. Subcortical abnor­ malities include reduction of the num­ bers of neurons in the nucleus basalis of Meynert in the amygdala and in the locus ceruleus.2

PROFESSIONAL RECOMMENDATIONS FOR LONG-TERM CARE PLACEMENT:

This paper investigates client and service characteristics that differentiate placement recommendations in two groups of elderly who are vulnerable to institutionalization--community residents who have applied for nursing homes and acute care patients who were viewed as likely candidates for long term care facilities. The two groups differ considerably on measures of physical and mental well-being as well as service need and availability. The community applicants were in poorer overall condition except with respect to medical requirements. A separate discriminant analysis of placement recommendations (long term care institution versus community) was carried out for each group using the client and service need characteristics as the discriminating factors. The results suggested that some factors such as family care and ADL skills and requirements are important predictors of placement recommendations in both groups, but there were also a number of unique elements in each function. The authors stress the importance of population differences in institutional decisions.

Assessing the efficacy of ombudsman services for the aged in long term care institutions

Long term care ombudsman programs are a recently established component within the gerontological services continuum. Public policy in this area is not yet well defined and there is a conspicuous absence of systematic studies assessing the effectiveness of such program efforts. This research reports on the accomplishments of an urban based, volunteer nursing home ombudsman program. Survey findings show moderate levels of goal attainment in the policy and social relations domains and more promising results in the organizational/managerial sphere. The relationship between perceptions of program success and varying ombudsman role behaviors is underscored.

Why so Little Interest in Whether or Not Old People Talk: A Review of Recent Research on Verbal Communication among the Elderly

This paper is concerned with the spoken communication of chronically ill and aging residents of long term care institutions. Social gerontologists and speech pathologists have investigated areas related to spoken communication, however, there has been almost no investigation of communication from the patients' and staff perspective. Spoken communication is a vital component of social interaction and psychological well being and underlies such concepts as isolation, integration, and adjustment, and is a fertile area for investigation and analysis.

Management of group homes.

Since 1968 fourteen group homes for chronic patients from the Ararat Mental Hospital and Training Centre have been developed. These have been highly successful in that patients who otherwise would not have been able to leave hospital, have now been able to do so. Of the 58 patients who have been discharged to then, none have had to be readmitted permanently, and only four have been admitted for short-term care. Considering that the majority of patients have been transferred to us for long term institutional care we believe that the overall results are very satisfactory.