L2 - part 1

Question 1

homebound vs nursing home

Answer 1

homebound (almost 2 million over age 65) outnumber the 1.4 million residents of nursing homes

Question 2

why homebound

Answer 2

result of physical or cognitive impairment

no access to dental care

Question 3

scope of practice in homebound

Answer 3

assessments
simple extractions
denture fabrication and repairs
simple fillings

Question 4

ADL’s *

Answer 4

eating 
bathing 
dressing 
toileting 
transfer 

*patients who need help with 2+ ADL’s need at home help or long term care

Question 5

case study take aways

Answer 5

1. importance of good communication with medical primary care providers
2. be wary of ageism (treat if can tolerate- not by age)
3. centenarians need dental care too *

Question 6

100-104?
105-109?
110+

Answer 6

centenarians

semi-super-centenarians

super-centenarians

study of these began in 1994 by thomas pearls – in new england

Question 7

compression of morbiditiy and mortality

interesting about centenarians?

Answer 7

morbidity (illness)
mortality (life-span)

have delayed onset or absence of most common age-related systemic diseases (hypertension, diabetes, CVD)
- most dont have these

live long suprinsingly good health

then at very old get something and die

Question 8

oral health of centenarians?

Answer 8

important for eating, talking, socializing, self-esteem and had not yet been studied

Question 9

fastest growing segment of US population? **

Answer 9

people aged 85+ constitute the FASTEST GROWING SEGMENT OF THE US POPULATION

PERCENTAGE WISE

Question 10

Perferred term for 65+

Answer 10

older adult

Question 11

defining geriatric today

Answer 11

a person’s FUNCTIONAL status more than chronological age defines geriatric today

AGE ALONE IS NOT ENOUGH TO DEFINE THIS POPULATION

Question 12

functional status can be

Answer 12

affected by cognitive and / or physical impairments

Question 13

Geriatrician

Answer 13

primary care physcians either FAMILY OR INTERNAL medicine, plus geriatric trianing

Question 14

1 issue geriatricians deal with

Answer 14

polypharmacy

all the different rx’s and their interactions

Question 15

IADL’s *

Answer 15

instrumental activities of daily living

1. managing money
2. shopping
3. preparing meals
4. heavy housework
5. light housework
6. using the telephone

Question 16

geriatric core competency (5 M’s)

Answer 16

1. mind
2. mobility
3. medications
4. multi-complexitiy
   - someone to support them? vision? hearing? oral hygeine adequate?
5. matters most

Question 17

mild cognitive impairment

Answer 17

slight but noticeable decline in cognitive abilities, including memory and thinking skills

may or may not interere with daily life and fucntion , may be stable for years

MAY BE RREVERSIBLE ** - Increased risk for dimentia

Question 18

mentation / mind that may be reversible

Answer 18

mild cognitive impairment

delirium

depression

Question 19

delirium

Answer 19

reversible
- altered mental status from baseline; disorientation to time place, person

causes include inappropriate medication and / or untreated infection (UTI’s), dehydration; up to 50% of hospitilized older adults

Question 20

depression

Answer 20

reversible

geriatric depression scale (15 questins)

Question 21

dimentia

Answer 21

NON REVERSIBLE
- AD’s, vascualr dimentia- daily function affected
progressive decline

rate of decline varies

Question 22

matters most / goals of care

Answer 22

adapting tx plans and sites of tx

aesthetics(family never saw this pt wthout dentures in mouth)

function

pain free

Question 23

what to consider with dimentia patients

Answer 23

dentures – careful bc if lose them they can get out of whack and wonder where you are to help and where they are

Question 24

risk factors for dental disease

Answer 24

age
retaining natural dentition – edentulous rate dcreasing over time

funcitonal impairment – physical and or cognitive

resistance to oral hygeine assistance

Question 25

risk factors for caries

Answer 25

dentin layer thickens over time and pulp recedes decrease in saliva increase in sugar consumption gingival recession exposing caries prone cementum and larger gingival interdental areas -- food traps

Question 26

caregivers

Answer 26

``` unpaid / paid person wo helps another individual with his/her ACTIVITIES OF DAILY LIVING (ADL's) - bathing - dressing, toileting, transfers, continence feeding ```

Question 27

patients who need assistance with ADL's ...

Answer 27

USUALLY REQUIRE help with oral hygeine

Question 28

oral hygiene guidelines for patients at high risk for careis

Answer 28

inform patient/ caregiver hygeine is inadequate ask caregiver to scub teeth for 2 minutes rx prevident or 1.1 NaF gel for daily use mouth carriers (like beaching trays) + prevident for 5 minutes / day 3-4 mouth hygience recall for patient with caregiver

Question 29

* communicating effectively with older adults

Answer 29

TAKE MASK OFF - ask if they can har - stay eelevel, close to patient speak slowly and in lower frequency do not screm or increase pitch never be backlit -- may be trying to read lips

Question 30

visaul impairments

Answer 30

large font help patient in and out of chair keep floor clean elder friendly hallways, etc

Question 31

elder abuse

Answer 31

AFFECTS PEOPLE OF ALL RACES, ETHNICITIES, SOCIAL CALSSES AND AGE MANDATED TO REPORT SUSCPISION Actions of omission or commission that potentially or actually threatens the well being of the adult patterns of assaultive and coercive behavior inluding inflicting injury, psychological abuse, deprivation, progressive social isolation, intimidation and threats behaviors perpetrated bby someone able to establish control over another

Question 32

most common elder abuse

Answer 32

FINANCIAL -- under reported often due to co-dependency of abuser and victim - physical - emotional - caregiver neglect - self -neglect-- not paying bills, not eating properly, refusing assistance - sexaul many times emotiona abuse, financial abuse and neglect go together

Question 33

caregiver who insists on giving the history of a traumatic injury

Answer 33

like broken front tooth, back eye, lip laceration - suspect possible to abuse

Question 34

what can dentist do to help in abuse cases

Answer 34

dentist are mandated reporters of SUSPECTED ABUSE - can initiate an appropriate investigation and intervention provide supportive evidence and documentation MA abuse hotline and online information