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PubMed1982

An analysis of onsite versus offsite dental care for an institutionalized population.

The Job Corps is a program for disadvantaged youths between the ages of 16 and 22 in need of general education and vocational training. During fiscal 1978, 61 residential centers had a total enrollment of 33,732. Despite differences in size, location, and organizational structure of the centers, uniform requirements for health services have been established. The administration at each center must ensure emergency dental care, arrange for examination of all corps members, and make routine treatment available on a priority basis. Because of uniqueness of local situations, various mechanisms are used to accomplish these goals. The most fundamental difference is the provision of care by means of onsite clinics with salaried dentists as opposed to offsite arrangements with fee-for-service in private dental offices. An analysis of cost and utilization data for the 1978 FY indicated that onsite care ($96.19/CMY) was significantly more expensive than offsite care ($72.24/CMY). The difference in the mean number of visits, however, was also statistically significant. Onsite care resulted in 4.78 visits/CMY; corps members made 2.24 visits/CMY when offsite care was provided. Furthermore, even taking into consideration the initial expenses involved in establishing clinical facilities, the cost of an onsite visit, $22.30, was less than an offsite visit, $33.62. The cost and utilization patterns were the same at small centers as large centers.

Adolescent↗
PubMed1991

Predicting concerns for the mouth among institutionalized elders.

There is a widespread belief that old people do not have healthy mouths, although the reason for this neglect is not clear. A random sample of 41 long-term care facilities in Vancouver was selected--653 residents were examined and about three-quarters of them were interviewed--to find associations between variables that might influence a concern for oral health and to assess the effectiveness of multivariate models for predicting this concern. A bivariate analysis of the data, using chi-square tests, assessed any significant associations between the variables, and three classification techniques--discriminant analysis, logistic regression, and CART (classification and regression trees)--were used to assess the usefulness of the multivariate models. Complaints of oral problems were heard from half (53%) of the sample. Most (85%) of the participants expressed a desire for treatment, while fewer than half (44%) of the participants had used a dental service since entering the facility or in the previous year. The complaints were associated significantly with the subjects who had been to a dentist recently, with those dissatisfied with the cost or quality of previous treatment, and with women. The desire for treatment was associated significantly with the recent use of dental services, and with a lack of concern for the cost of dental treatment, while the use of services was associated significantly with subjects who were younger, dentate, or from the higher socioeconomic groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMedDate not supplied

Tobacco and the institutionalized mentally retarded: usage choices and ethical considerations.

Patterns of tobacco use were observed among 749 people diagnosed with mental retardation residing in a state-operated facility. Specifically, individual preference for tobacco products and frequency of use were documented. Subjects were observed using several types of tobacco products: cigarettes, cigars, chewing tobacco, snuff, and cigarette butts. Approximately 7% (n = 52) used at least one form of tobacco; ten individuals used more than one tobacco product. Interestingly, 20.5% of the individuals diagnosed with mild or moderate mental retardation (n = 122) consumed tobacco products, a pattern of behavior that closely approximates that of the general population (20-24%). Ethical considerations pertaining to the availability of tobacco products to this special population are presented.

Adult↗
PubMedDate not supplied

Respiratory pathogen colonization of the dental plaque of institutionalized elders.

Although it has been established that aspiration of pharyngeal bacteria is the major route of infection in the development of nosocomial pneumonia, colonization of the pharyngeal mucosa by respiratory pathogens has been shown to be a transient phenomenon. It has been suggested that the dental plaque may constitute an additional, possibly more stable, reservoir of respiratory pathogens. The purpose of this study was to assess the prevalence of oral colonization by potential respiratory pathogens in a group of elderly (mean age = 75.9 yrs) chronic-care-facility residents (n = 28) and a group of age-, gender-, and race-matched outpatient control subjects (n = 30), with specific attention to plaque present on tooth, denture, and oral mucosal surfaces. Plaque scores on teeth and dentures were significantly higher in the chronic-care-facility (CCF) subjects than in the dental outpatient control (DOC) subjects (PII 2.3 vs. 1.2 and denture plaque 1.4 vs. 0.3). While no subjects in the DOC group were found to be colonized with respiratory pathogens (> 1.0% of the cultivable aerobic flora), 14.3% (4/28) of the CCF subjects were found to be colonized. Oral colonization with respiratory pathogens in CCF subjects was associated with the presence of chronic obstructive pulmonary disease (COPD) and higher plaque scores. These results suggest that deficient dental plaque control and the presence of COPD may be related to respiratory pathogen colonization of dental plaque in chronic-care-facility residents.

Aged↗
PubMedDate not supplied

Factors affecting denture use in some institutionalized elderly people.

This study was conducted to assess which factors were related to the ability of elderly residents of nursing homes to use dentures. For 205 patients in two nursing homes in Chuou-ku, Tokyo, dentists and caregivers examined oral status (caries, status of restoration, missing teeth and occlusal support) as well as denture use, Activities of Daily Living (ADL), ability to rinse the mouth, and degree of dementia. Fifty percent of subjects lacked dentures. Seven items were selected for variance in factor analysis. There was a significant relationship between denture use and all analyzed items except age. The items which proved to be significant, included the number of remaining teeth, the ability to rinse, communication, ability to dress/undress, ability to transfer, and eating (Fisher's exact test). A multiple stepwise logistic regression analysis showed that the nonuse of dentures was significantly related to dressing (p<0.01), the number of remaining crowns (p<0.01) and the ability to rinse the mouth (p<0.0001). The nonuse of dentures was also related to the number of remaining teeth and to the disability of hand and oral functions.

Activities of Daily Living↗