Oral health care in private and small long-term care facilities: a qualitative study

Objective: Elderly people who are institutionalised receive qualified care. Among the services supplied, oral health care has not always been a priority. The aim of this study was to identify the characteristics of oral health care provided to the elderly residents in long‐term care facilities (LTC) in Porto Alegre/RS city. Methods: Twelve private and small‐size LTCs (less than 20 residents) participated in this study. All supervisors and 36 carers were interviewed. The data obtained were organised according to the offer of oral health under the following categories: responsibility for oral care, oral care routines, difficulties carrying out oral care routines. Results: The procedures used most often in order of frequency were tooth brushing, prostheses cleaning, use of mouthwashes, soaking of prostheses and cleaning of the tongue. Among the difficulties mentioned were the high cost of dental assistance, the lack of co‐operation both by family members and by the elderly themselves, the oral and general health status of the elderly and the limited time available for carers to carry out the tasks. Oral care is conducted empirically, and the responsibility is left to the carers. Conclusions: Analysis of the statements given reveals that oral care does not follow any kind of protocol or standardisation. The persistence of this situation could lead to unsatisfactory oral health care in private and small LTC facilities.     

Abuse of elderly people by their carers.

OBJECTIVE--To assess the prevalence of abuse of elderly people by their carers and the characteristics of abusers and the abused. DESIGN--Information on abuse and risk factors was collected over six months from carers and patients. Risk factors were identified in the abused group and compared with those in a non-abused control group. SETTING--Carers were interviewed at home; patients were examined in the wards of Putney and Barnes geriatric hospitals, London. SUBJECTS--All patients referred from any source for respite care to the geriatric services over a six month period and their carers. MAIN OUTCOME MEASURES--Amount of physical and verbal abuse or neglect. Quantification of risk factors and correlation with the presence or absence of abuse. RESULTS--45% Of carers openly admitted to some form of abuse. Few patients admitted abuse. The most significant risk factor for physical abuse was alcohol consumption by the carer (p less than 0.001). Other significant risk factors were a poor pre-morbid relationship and previous abuse over many years. Abuse was often reciprocated and was associated with social dysfunction in many patients. Service delivery, respite care, and level of mental and physical disability were not significantly associated with abuse. CONCLUSION--The high level of abuse found in elderly patients in respite care was particularly associated with alcohol abuse and long term relationships of poor quality, which are difficult to change. Even with increased provision of services, care in the community may not be the best solution for these people.     

Oral health care in long‐term care facilities for elderly people in southern Brazil: a conceptual framework

doi:10.1111/j.1741‐2358.2009.00280.x
Oral health care in long‐term care facilities for elderly people in southern Brazil: a conceptual framework Objective: To present a theoretical model for understanding oral health care for the elderly in the context of long‐term care institutions (LTCI). Methods: Open‐ended individual interviews were conducted with the elderly residing in LTCI, their carers, nursing technicians and nurses, directors of care, dental surgeons and managers of public health services. A grounded theory methodological approach was adopted for data collection and analysis. Results: The emerging core category revealed a basic social process: ‘Promoting oral health care for the elderly based on the context of LTCI’. This process was composed of two contradicting yet correlated aspects: the oral health care does not minimise the poor oral epidemiological condition, and at the same time, there was a continued improvement in the oral care expressed by better care practices. These aspects were related to the: attribution of meaning to oral health, social determination of oral health, the ageing process, interactions established in the oral health care practices, oral health care management in LTCI, inclusion of oral health care into the political–organisational dimension and possibility of conjecturing better oral health care practices. Conclusion: The core concept of ‘Promotion of oral health care for elderly people based on the context of LTCI’ is capable of explaining the variations in the structure and process of LTCI, as well as in helping to understand the meaning of the oral health care practices for the institutionalised elderly.     

Old people's homes: the relatives' view.

On 1 April new arrangements came into force for arranging and funding residential care for elderly people in Britain. From now on those who seem to need full time care will be assessed first by care managers employed by local authority social services departments. This may lead to admission to an old people''s home or a nursing home. Local authorities have been told to consult both users and carers about such decisions. But what about relatives who have not actually been giving care directly? The Relatives Association was set up last year as a voluntary organisation for the relatives and friends of older people living in residential homes. Below, its vice president, Mavis Nicholson, a journalist and broadcaster whose mother died of Alzheimer''s disease in a residential home last year, gives her personal view of being such a relative. And Dorothy White, the association''s founder, explains what the future may hold for elderly residents and their relatives.     

Technology Acceptance for an Intelligent Comprehensive Interactive Care (ICIC) System for Care of the Elderly: A Survey-Questionnaire Study

The key components of caring for the elderly are diet, living, transportation, education, and safety issues, and telemedical systems can offer great assistance. Through the integration of personal to community information technology platforms, we have developed a new Intelligent Comprehensive Interactive Care (ICIC) system to provide comprehensive services for elderly care. The ICIC system consists of six items, including medical care (physiological measuring system, Medication Reminder, and Dr. Ubiquitous), diet, living, transportation, education (Intelligent Watch), entertainment (Sharetouch), and safety (Fall Detection). In this study, we specifically evaluated the users' intention of using the Medication Reminder, Dr. Ubiquitous, Sharetouch, and Intelligent Watch using a modified technological acceptance model (TAM). A total of 121 elderly subjects (48 males and 73 females) were recruited. The modified TAM questionnaires were collected after they had used these products. For most of the ICIC units, the elderly subjects revealed great willingness and/or satisfaction in using this system. The elderly users of the Intelligent Watch showed the greatest willingness and satisfaction, while the elderly users of Dr. Ubiquitous revealed fair willingness in the dimension of perceived ease of use. The old-old age group revealed greater satisfaction in the dimension of result demonstrability for the users of the Medication Reminder as compared to the young-old and oldest-old age groups. The women revealed greater satisfaction in the dimension of perceived ease of use for the users of Dr. Ubiquitous as compared to the men. There were no statistically significant differences in terms of gender, age, and education level in the other dimensions. The modified TAM showed its effectiveness in evaluating the acceptance and characteristics of technologic products for the elderly user. The ICIC system offers a user-friendly solution in telemedical care and improves the quality of care for the elderly.     

Assortative Pairing Based on Contact Call Similarity in Budgerigars, Melopsittacus undulatus

A trait typical of parrots, but rare in other groups of birds, is the acquisition of new learned calls (acquired by copying conspecifics) throughout an individual's lifetime. The significance of this distinctive psittacid trait is not understood. In budgerigars, females preferentially affiliate with unfamiliar males whose contact calls resemble their own during brief dyadic choice trials; also, in forced‐pair situations, contact call similarity of members of pairs increases as a result of a male tendency to imitate his mate's call type. The functions of budgerigar call imitation and preference for pre‐pairing similarity are currently unknown. Moreover, as budgerigar pair formation occurs over a span of days or weeks, it is important to determine whether birds in breeding colonies assort and proceed to breed on the basis of pre‐pairing contact call similarity, and whether high levels of call similarity are maintained after pair formation is complete. To explore these questions, we recorded contact calls of male and female budgerigars before and after they were placed into an aviary equipped for breeding. As predicted, birds paired assortatively based on pre‐pairing call similarity. Once birds had paired, their calls converged further in acoustic structure, as previous work had led us to expect. However, after eggs were laid and the males began to feed their mates, the calls of mated birds diverged, suggesting that there might be some cost to maintenance of shared calls. Male care‐giving correlated with the degree to which his pre‐pairing calls resembled those of his mate, but not with the similarity achieved through convergence. These results suggest that female budgerigars may use a male's pre‐pairing call similarity as a predictor of paternal investment. The questions of why such similarity predicts male care‐giving, and why calls converge following initial pairing activities, require further work.     

Social problems in geriatric dentistry: an overview

Many studies have reported on the dental status of elderly patients. The results demonstrate consistent differences between normative and perceived needs in addition to varying levels of awareness of dental education among carers. This review article attempts to integrate a range of social factors which must be considered if holistic and comprehensive care is to be delivered to elderly patients.     

The emergence of the social‐ecological restoration concept

Many ecosystems in the world are the result of a close interaction between local people and their environment, which are currently recognized as social‐ecological systems (SoES). Natural catastrophes or long‐standing social and political turmoil can degrade these SoES to a point where human societies are no longer autonomous and their supporting ecosystems are highly degraded. Here, we focus on the special case of the restoration of SoES that we call social‐ecological restoration (SoER), which is characterized as a restoration process that cannot avoid simultaneously dealing with ecological and social issues. In practice, SoER is analogous in many ways to the general principles of ecological restoration, but it differs in three key aspects: (1) the first actions may be initially intended for human groups that need to recover minimum living standards; (2) the SoER process would often be part of a healing process for local people where cultural values of ecosystems play an essential role; and (3) there is a strong dependency on external economic inputs, as the people belonging to the SoES may be incapable of reorganizing themselves on their own and supporting ecosystems can no longer self‐recover. Although it might not be desirable or necessary to call all restoration projects with a social component an SoER, the use of this concept may help in defining early restoration targets that may prevent conflicts among users in the long term. From the perspective of other disciplines, SoER would be more appropriately perceived as programs of “social‐ecological recovery” in the long term.     

CAD/CAM treatment for the elderly--a case report

doi: 10.1111/j.1741‐2358.2011.00521.x CAD/CAM treatment for the elderly – a case report Background: When elderly develop signs and symptoms of Alzheimer’s disease they lose their independence and neglect dental hygiene. Dentists are increasingly confronted by seniors who are in need but who have limited access to dental care. Caretakers and family are also often confronted with behaviour problems besides the dental problems. Objective: To report the importance of shorter and lower impact treatment for seniors when caretakers and family are confronted with a behavioural problem in addition to the dental problem. Materials and methods: In this case report, the oral management of a patient with Alzheimer’s disease was described using chairside computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology while constructing a bonded bridge. Discussion: The case report emphasises the importance of interaction with the patient and added a treatment method for patients with limited cognitive skills who become easily agitated or aggressive. Conclusion: The fabrication of a full ceramic bonded bridge utilising the Cerec 3D chairside CAD/CAM technology in an Alzheimer patient has been shown to be a feasible, precise, aesthetic and durable solution. It added a technique for intervening with patients with limited tolerance for dental procedures, which improves the quality of life of both patient and family.     

Association between dental health behaviours, mental/physical function and self-feeding ability among the elderly: a cross-sectional survey

Objectives : The aim of this study was to determine the association between dental health behaviour, mental/physical function and self‐feeding ability among the elderly. Subjects : A total of 414 elderly dental patients aged 65 years and older participated in this study. Methods : A survey was carried out for three years and seven months starting in January 1998 at the Chubu National Hospital. The patients or their carers were examined/interviewed about the severity of senile dementia, dental health behaviour, ability to rinse their mouths, ability to manage dentures, and ability to sit at a table during meals. To assess the association with self‐feeding ability among the elderly, cut‐offs were given for these variables, and then the odds ratios were calculated. Results : The strongest association to self‐feeding ability was marked by inability to rinse their own mouth, followed by inability to manage dentures, inability to sit at a table during meals, severe senile dementia and less frequency of toothbrushing. Conclusion : Elderly who have lost the feeding ability often could not maintain their dental health by themselves. Carers must provide not only a feeding service with acknowledgement of aspiration but oral care to prevent dental disease and fatal pneumonia in the elderly.     

PACMANS: A bioinformatically informed algorithm to predict,design, and disrupt protease‐on‐protease hydrolysis

Multiple proteases in a system hydrolyze target substrates, but recent evidence indicates that some proteases will degrade other proteases as well. Cathepsin S hydrolysis of cathepsin K is one such example. These interactions may be uni‐ or bi‐directional and change the expected kinetics. To explore potential protease‐on‐protease interactions in silico, a program was developed for users to input two proteases: (1) the protease‐ase that hydrolyzes (2) the substrate, protease. This program identifies putative sites on the substrate protease highly susceptible to cleavage by the protease‐ase, using a sliding‐window approach that scores amino acid sequences by their preference in the protease‐ase active site, culled from MEROPS database. We call this PACMANS, Protease‐Ase Cleavage from MEROPS ANalyzed Specificities, and test and validate this algorithm with cathepsins S and K. PACMANS cumulative likelihood scoring identified L253 and V171 as sites on cathepsin K subject to cathepsin S hydrolysis. Mutations made at these locations were tested to block hydrolysis and validate PACMANS predictions. L253A and L253V cathepsin K mutants significantly reduced cathepsin S hydrolysis, validating PACMANS unbiased identification of these sites. Interfamilial protease interactions between cathepsin S and MMP‐2 or MMP‐9 were tested after predictions by PACMANS, confirming its utility for these systems as well. PACMANS is unique compared to other putative site cleavage programs by allowing users to define the proteases of interest and target, and can also be employed for non‐protease substrate proteins, as well as short peptide sequences.     

Oral health practices and beliefs among caregivers of the dependent elderly

doi: 10.1111/j.1741‐2358.2011.00553.x Oral health practices and beliefs among caregivers of the dependent elderly Background: Caregivers deal with oral health care of the dependent elderly; however, this has a low priority among them, and their education in daily oral care is deficient. Therefore, studying the oral care practices as well as their oral health beliefs is important as these affect the quality of the oral care they perform. Objective: To compare formal and informal caregivers’ oral care practices and oral health beliefs when taking care of severely dependent elderly. Material and methods: A cross‐sectional study was conducted on a convenience sample of 21 formal caregivers from a long‐term residence and 18 informal caregivers from a local primary health care domiciliary programme. Caregivers were surveyed using a questionnaire designed to elicit oral care practices and oral health beliefs. The nursing Dental Coping Beliefs Scale questionnaire was translated and validated in Chile. Results: Significant differences were observed between formal and informal caregivers’ performance of some oral health care practices. There were no significant differences between formal and informal caregivers’ oral health beliefs. Conclusions: Although there are some differences in formal and informal caregivers’ oral health care practices, we cannot state that one caregiver’s performance is better than the other, in fact, negative oral health beliefs were found in both groups.     

Medication error in mental health: implications for primary care

Medication errors are associated with significant morbidity and people with mental health problems may be particularly susceptible to medication errors due to various factors. Primary care has a key role in improving medication safety in this vulnerable population. The complexity of services, involving primary and secondary care and social services, and potential training issues may increase error rates, with physical medicines representing a particular risk. Service users may be cognitively impaired and fail to identify an error placing additional responsibilities on clinicians. The potential role of carers in error prevention and medication safety requires further elaboration. A potential lack of trust between service users and clinicians may impair honest communication about medication issues leading to errors. There is a need for detailed research within this field.     

Oral implants in dependent elderly persons: blessing or burden?

doi:10.1111/j.1741‐2358.2009.00314.x
Oral implants in dependent elderly persons: blessing or burden? Background: Implant‐supported (partial) dentures may raise problems in patients who have become dependent on others for daily oral health care. Dental hygienists and general dental practitioners, as well as care providers, volunteer aiders and even health care insurance companies, should anticipate the growing demand for specific oral health care for patients provided with implant‐supported (partial) dentures. Objective: To report three cases of dependent patients and to present recommendations to prevent or resolve implant‐related oral problems. Materials and methods: The three case reports are demonstrating that implant insertion in (dependent) elderly people needs careful consideration. Discussion: When considering implant treatment, some questions should be raised: (1) Is the treatment appropriate in contributing to the patient’s well‐being and quality of life? (2) Is the treatment the most suitable treatment? (3) Does the treatment integrate with the patient’s oral health care plan? (4) Is the patient sufficiently cooperative? (5) Is the patient supported by a well‐functioning oral (self) care assisting network? (6) Is it possible for the patient to regular see an oral health care professional and is oral health care easily accessible in cases of an emergency? Conclusion: Dependent elderly people can benefit from oral implants, providing that adequate oral health care and aftercare can be provided. When indicated, removal of the anchorage structure is easily performed by putting the implants to sleep. All implant patients should be provided with an ‘implant passport’. Regular information and instruction for care providers about the oral condition of the patient are essential.     

Ervaren belasting door mantelzorg; constructie van de EDIZ-plus

To measure the experienced burden by informal carers (N = 2.444), a 15-item Mokken scale has been developed. This concerns an extended version of the EDIZ ("Ervaren druk door Informele zorg"); several items refer to the pressure of time brought by the combination of labour and care and the consequences for the health of the informal carers are added to the EDIZ. We call this new scale the EDIZ-plus; it concerns a reliable one-dimensional and hierarchical scale which extends from o (no burden) to maximum 15 (severe burden). First, the burden manifests itself in feelings of responsibility of the carer, followed by having difficulty with combining work and family tasks and ultimately exceeding all limits due to too many obligations. In most cases this last group does not only deal with conflicts at home or at work and a decline in their own health, they also experience all other problems in the scale. The presumed limit for overburdening is enclosed by the proposition 'caring put too much pressure on me'. This is a score on the EDIZ-plus of nine or higher. Furthermore, the scale has proved to be usable for several population groups, such as carers of partners and children, parents/parents-in-law and carers of different patient populations (people with dementia, mental disability or a chronic disease). The EDIZ-plus is not only suitable because of its reasonable psychometric qualities, but also because of the usability in different populations.     

Call type signals caller goal: a new take on ultimate and proximate influences in vocal production

After 40 years of debate it remains unclear whether signallers produce vocalizations in order to provide receivers with information about call context or external stimuli. This has led some researchers to propose that call production is arousal‐ or affect‐based. Although arousal influences certain acoustic parameters within a call type, we argue that it cannot explain why individuals across vertebrates produce different call types. Given emerging evidence that calls are goal‐based, we argue that call type is a signal of a caller's goal to elicit a change in receiver behaviour. Using chimpanzees (Pan troglodytes) and vervet monkeys (Cercopithecus aethiops) as case studies, we demonstrate the two benefits of viewing call production as signalling both caller goal (which determines call type) and caller arousal (which affects within‐call‐type variation). Such a framework can explain first, why a single class of calls is apparently given in multiple contexts, and, second, why some species have larger call repertoires than others. Previous studies have noted links between sociality and repertoire size, but have not specified exactly why animals living in societies that are more complex might require a greater number of differentiated signals. The caller‐goal framework potentially clarifies how social complexity might favour call diversification. As social complexity increases, callers may need to elicit a larger number of distinct behaviours from a wider range of distinct audiences.     

Avian biodiversity monitoring in Australian rangelands

Abstract Birds have been widely regarded as a key element in monitoring biodiversity both in Australia and elsewhere. We believe that, although birds are unlikely to be an umbrella or indicator taxon for other biota (other vertebrates, invertebrates, plants, microorganisms), they do represent a taxon that can be monitored more easily and with less effort per datum than other biotic components. It has been shown by the great participation rate of lay observers (whom we call monitors) in several schemes (notably the Birds Australia Atlas programs) that there is a capacity to mobilize the public to undertake bird surveying. Although there are many limitations to acquiring high‐quality information (scale, dynamism, mobility, irruptiveness, paucity of monitors over much of the rangelands), we think that these can be dealt with to allow the use of birds as a key component of biodiversity monitoring. We outline some of the possible options for statistically characterizing monitoring data for rangeland birds.     

Recruitment calling: a novel form of extended parental care in an altricial species

In many altricial birds, fledglings disperse when they are no longer fed, and this dispersal marks the end of parental care. In some species, however, young remain in close association with their parents after nutritional independence. Because juveniles are still inferior foragers at this stage, they might benefit from parental assistance in locating good feeding sites, but this possibility remains largely unexplored. Here, we show that parents and helpers in pied babbler (Turdoides bicolor) societies use a recruitment call to direct nutritionally independent, but inexperienced, foragers to particular food patches. Observations and a playback experiment indicated that adult babblers use a "purr" call to recruit group members to a foraging patch. Creation of experimental foraging patches supported observations that individuals tend to give the call when they are foraging on abundant, divisible food sources and when their group contains independent fledglings (youngsters who are no longer fed directly). Fledglings responded to calls more often than adults, who frequently encountered aggression from the caller if they did, and the fledglings gained significant foraging benefits. This is the first study to demonstrate that altricial birds may use recruitment calls to extend parental care past the period of direct provisioning.     

Calling at the highway: The spatiotemporal constraint of road noise on Pacific chorus frog communication

Loss of acoustic habitat due to anthropogenic noise is a key environmental stressor for vocal amphibian species, a taxonomic group that is experiencing global population declines. The Pacific chorus frog (Pseudacris regilla) is the most common vocal species of the Pacific Northwest and can occupy human‐dominated habitat types, including agricultural and urban wetlands. This species is exposed to anthropogenic noise, which can interfere with vocalizations during the breeding season. We hypothesized that Pacific chorus frogs would alter the spatial and temporal structure of their breeding vocalizations in response to road noise, a widespread anthropogenic stressor. We compared Pacific chorus frog call structure and ambient road noise levels along a gradient of road noise exposures in the Willamette Valley, Oregon, USA. We used both passive acoustic monitoring and directional recordings to determine source level (i.e., amplitude or volume), dominant frequency (i.e., pitch), call duration, and call rate of individual frogs and to quantify ambient road noise levels. Pacific chorus frogs were unable to change their vocalizations to compensate for road noise. A model of the active space and time (“spatiotemporal communication”) over which a Pacific chorus frog vocalization could be heard revealed that in high‐noise habitats, spatiotemporal communication was drastically reduced for an individual. This may have implications for the reproductive success of this species, which relies on specific call repertoires to portray relative fitness and attract mates. Using the acoustic call parameters defined by this study (frequency, source level, call rate, and call duration), we developed a simplified model of acoustic communication space–time for this species. This model can be used in combination with models that determine the insertion loss for various acoustic barriers to define the impact of anthropogenic noise on the radius of communication in threatened species. Additionally, this model can be applied to other vocal taxonomic groups provided the necessary acoustic parameters are determined, including the frequency parameters and perception thresholds. Reduction in acoustic habitat by anthropogenic noise may emerge as a compounding environmental stressor for an already sensitive taxonomic group.     

The evolution of non-maternal care in anthropoid primates: a test of the hypotheses

The amount of non-maternal care (allocare) found in primates varies greatly from species to species. Our paper examines this variation and focuses on possible reasons why mothers in some anthropoid primate species are prepared to relinquish their infants to other carers whereas others are not. We use data collected from the literature to test a number of hypotheses that attempt to explain the observed variation in non-maternal care. Analyses were carried out using comparative methods that control for the influence of both body size and phylogeny on life-history and ecological variation. The results support previous studies of both primates and other mammals in finding a clear link between the amount of allocare provided and female reproductive rates. Species with high allocare levels grow rapidly post-natally and wean their infants at a younger age (but at the same relative size) than species of the same body size with lower allocare levels. This early weaning allows high allocare species to support higher birth rates than low allocare species but does not result in earlier maturation. Our results, therefore, suggest that mothers allow non-maternal care of their infants in order to increase their own reproductive output. It is not clear whether such a strategy also benefits the infant, as we could find no link between the presence of allocare and early maturation (which would increase the infant's reproductive output) or between allocare levels and infant survival (as measured by vulnerability to infanticide). This suggests that mothers and infants might come into conflict over transfer to other carers, as the benefits to the mother may not be accompanied by benefits to the infant. However, although mothers may benefit from allocare in some circumstances, they will not be expected to allow allocare if the costs are high (e.g. if there is a high risk to the infant).