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Dentists and the institutionalized elderly : issues in long term care dental services Weiss, Rachel Tobiasz

Abstract

A recent survey of the oral health of the institutionalized elderly in Greater Vancouver revealed that despite a number of dental problems amongst the chronically ill, few had been seen by a dentist since their admission to the facilities. A major issue in establishing dental services is the willingness of dentists to provide services in the long term care facilities. Three theoretical models were developed to predict dentists' interest in long term care dental practice. The socio-cultural model, which emphasizes cultural prejudices towards the elderly, was based on a number of attitudinal studies of the profession(eg.the belief that the elderly are uncommunicative and ungrateful or the aversion to depressing atmospheres of facilities). The professional model focused on professional training and socialization and the ideological focus of dentistry on reparative therapy(eg.undergraduate training with the disabled, or the perception of limited treatment options for the chronically ill). The economic model predicted that opportunity costs, that is, private practice and leisure time, would be critical in the decision to treat the institutionalized elderly. Questions relating to each of these models were included in a survey questionnaire. The survey, mailed to 603 dentists in the greater Vancouver area, asked dentists about their experience and interest in working with both the well and disabled elderly. Over half the population responded to the survey, and the results were analyzed to determine which model best predicted interest in institutional dental delivery. In the findings, 37% of the dentists indicated definite interest in practising at a facility if called upon by the administrator, and 19% of the survey respondents had practised at a facility previously.lt was concluded from a multiple classification analysis that both professional and economic, but not socio-cultural, forces guide the servicing decisions of dentists with respect to long term care service. Professional satisfaction in treating the elderly was the most significant predictor of interest. This satisfaction was linked to several enabling factors, such as the availability of a dental operatory at an institution, and experience and training with medically compromised patients. Those dentists who had extensive institutional experience, and young dentists who were beginning a practice and who were not busy, were the dentists most likely to be interested in extending their practice to long term care facilities. Conversely, those dentists who were busy in their private practice, and who had little training in treating the chronically ill, were the least likely to show interest in this area. The findings indicate that in order to extend dental services to those elderly in nursing homes and hospitals, an appropriate education, both didactic and clinical, and an acceptable financial arrangement for such specialized services should be introduced into the dental community.

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