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Geriatrics > L1 - 1/13 > Flashcards

L1 - 1/13 Flashcards

1
Q

definition of long term care

A

range of services and supports provided to older and other to help meet their PERSONAL CARE needs

LTC is NOT only a medical care (in some instances), but also assistance with the basic personal tasks of everyday life, sometimes calles ACTIVITIES OF DAILY LICING (ADLS)

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2
Q

activities of daily living need help with

A
  1. bathing
  2. dressing
  3. using the toilet
  4. transferring (to or from bed or chair)
  5. caring for incontinence
  6. eating
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3
Q

LTC

A

long term care facilities

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4
Q

baby boomer

A

entering 65+ adult
began in 20ll
by 2029 they will be 20% of total population

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5
Q

future of geriatrics

A

busy
financially rewarding

*all going to eventually be treating this population

greater demand of services

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6
Q

T/F the baby boomers beenfited from fluoride and sanitation?

A

True

- more people have been able to maintain their dentitioon and health into their older years

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7
Q

other common long term care services and supports are

A

ASSISTANCE WITH EVERYDAY TASKS

  • called INSTRUMENTAL ACTIVITIES OF DAILY LIVING
  • IADL’s
    1. housework
    2. managing money
    3. taking medication
    4. preparing and cleaning up after meals, etc.
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8
Q

INSTRUMENTAL ACTIVITIES OF DAILY LIVING

- IADL’s

A
  1. housework
  2. managing money
  3. taking medication
  4. preparing and cleaning up after meals, etc.
  • part of other common assistance of long term care ervices
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9
Q

long term care facilities? + provide?

A

nursing homes, skilled nursing facilities, and assisted living facilities

provide both medical and personal care, to people who are unable to manage independently in the community

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10
Q

LTCF and dentist - what is federally mandataed?

A

nursing homes that receive medicare or medicaid reimbursemnt are requiered by law to perform an ORAL EXAMINATION as part of comprehensive physical exam whena new resident is enrolled

examination is part of a aminimum data set that is supposed to be performed WITHIN DAYS OF resident being admitted to a facility and then ANNUALLY thereafter

  1. prepare a resident assessment protocol that requires automati referral for dental care if any of the follwoing conditions are found
    - mouth pain
    debris in mouth prior to going to bed at night
    -natural teeth lost and no entures
    - broken
    - loose or carious teeth
    - infections
    - no daily cleaning of teeth or dentures
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11
Q

referral to dentist in the long term care facilities when

A 
prepare a resident assessment protocol that requires automati referral for dental care if any of the follwoing conditions are found 
- mouth pain
debris in mouth prior to going to bed at night
-natural teeth lost and no entures
- broken
- loose or carious teeth
- infections 
- no daily cleaning of teeth or dentures
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12
Q

why does LTC population needs special dental attention?

A

decreasing ability to care for one’s self

stroke, arthritis, – co-morbidities

oral hygeine seems secondary worries

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13
Q

what basics are needed in these LTCF?

A

COMPELTE DENTAL EXMAINATIONS

  • Charted
  • carious teeth
  • perio conditions
  • lesions
  • seen periodically and at least annually

hygeine program started and manitnianed

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14
Q

why do we need a protocol for thsi?

A

inadequate dental training of the facilities staff results in apathy and disregard of the residents dental needs

culture (last resort for teeth health)

ABSENCE OF ON SITE DENTAL FACILITITES

money / monetary resasons not to seek care

shortage of dentist willing to care for the LTC / geriatric population

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15
Q

statsitcs on nursing homeutalization?

A

less than 5% of elders are in a nursing home at a given time

35-50% of all elders spend some time in a nursing home

40% of all admissions to a nursing home are 90 days or less (90 day window) ***

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16
Q

hebrew senior life

A

seen site system of senior housing and helath care in the greater boston area serving more than 3,000 seniors

700+ bed long term care

train 300+ students in field of geriatrics – more than any other LTCF in country

stable work force – more than 1/3 staff have worked for 10+ years

only one providing russian speaking senior

17
Q

largest provider- based geriatric research facility in the US?

A

hebrew senior lie – dedham, roslindale mass

18
Q

nurse turnover rate at hebrew

A

low — 6% compared with 52% nationwide

19
Q

main three dental needs of these patietns

A
  1. oral hygeine
  2. prosthodontic **
    - removable, partials, implants
  3. restorative
20
Q
  • clinical procedures done in this setting
A
  1. preventative - exam, rx’s , fluoride
  2. hygeine appts - 6 monthly
  3. emergency
    - falls, fractures, abscesses, pain, oroffacial pathology
  4. removable prosth
    - dentures, traditional , digital (CAD/CAM), and implant retained **
  5. oral surgery
    - referrals - post op care
21
Q

procedures NOT covered at HRC

A
  1. implants
  2. crown and bridge
  3. endodontics

average age = 88 currently

22
Q

why not endo usually

A

calcified canals

23
Q

not crown bridge . implants why?

A

comprehensive tx / procedure and medical

24
Q

length of time

A

15- 20 minutes to provide quality of care

why not providing some of the procedures

25
Q

total visits per year at Hebrew

A

1613

roughly 134.4 per month

26
Q

*edentulous rate over past decades at HRS?

A

GOING DOWN – more potential for dental issues

2019 - 17%

1989 = 57.5%

27
Q

role of dentists here

A

integration with general medicine

collaboration of care - communicating procedures and what was done

continuing ed programs

electronic med records! – communication between RN’s and MD’s

28
Q

in addition to dental care– services?

A

dog therapy

interprofessional relationships

29
Q

interior design essentials for a geriatric dental office?

A

large / wide hallways –> ability of wheelchairs, beds, etc to get through

  1. bars / handles
  2. restrooms
  3. door buttons at wheelchair level
  4. NO handles on the chair – so can transfer patients easily
  5. suction cups – to bring right to mouth
  6. room with NO CHAIR – so those on beds or wheelchairs that cannot get into dental chair
30
Q

implant placement?

A

no – but implant fixing!!!

31
Q

case with 90+ year old
- implant retained denture that is now broken - fractured segment

+ outcome

A

scale, polish, simple salt and pepper technique
- stabalize in occlusion using wax

patient was now able to chew her food
(prior to repair - reported difficulty chewing and biting)

32
Q

two common medical complications

A
  1. anti-coagulants

2. severe malnutrition

33
Q

case 2 - implant retained FPD / bridge
fractured implants and prostheses repair

presented with exposed and broken custom abutments and with traumitized tissues + peri-implantitis

A

complex med history and medications

did NOT fit well with #5 implant fractured – so sectioned #5 implant crown from bridge

**cemented bridge back in patients mouth temporarily with zinc phosphate cement and vasaline – to allow for subsequent retreivability

advised pt on soft diet and to chew slowly to avoid bridge dislodgment

post op follow up with nutritionist was ideal (increse in feeding and BMI)

34
Q

similarities in patients being treated

A

medication induced bruxism – often ant- anxiety medication can cause this

no information available on previous dental treatment

simple procedures performed chair side at no cost to patient

35
Q

goal of tx

A

provision of end of life dental care – palliative measures have shown to improve /maintain quality of life for this demographic

Geriatrics (6 decks)

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