Focus on the Different Projects of Telemedicine Centered on the Elderly In France

Telemedicine is now in vogue, allowing computer and communication tools to be deployed in different fields of health, such as Cardiology, Dermatology, areas in which it has received interest, and in international studies. As the population ages, older people are increasingly concerned about this innovative practice. This is a narrative review of both the literature and Internet pertaining to telemedicine projects within the field of geriatric subjects in France. Since the beginning of the 2000's, several telemedicine projects and trials focused on chronic heart failure have been developed in the elderly, and also in the field of dermatology. The potential contribution of second-generation telemedicine projects in terms of mortality, morbidity, and the number of hospitalizations avoided is currently under study. Their impact in terms of health economics is likewise being investigated, taking into account that the economic and social benefits brought up by telemedicine solutions were previously validated by the original telemedicine projects. We take a look at telemedicine projects in France concerning the elderly.

Emerging Models of Dental Practice Aim at Addressing Needs of the Aged

Currently, about 46 million seniors, citizens over the age of 65, live in the United States. That number is expected to roughly double to more than 98 million by 2060, an increase from the current 15% of the population to 24%. Seniors are living longer and, due to advances in dental care and access to fluoridated water, keeping more of their teeth. As a result, many will be seeking to access services through a dental care delivery system that is already struggling to meet existing need. This article will describe emerging oral health workforce models, as well as interprofessional team approaches, that may help improve access to the growing population of senior citizens. The article will include discussions on dental therapists, dental hygienists, physicians, nurses, and physician assistants.

Geriatric Dentistry in the 21st Century: Environment and Opportunity

The aging of the baby boomers in the 21st century is creating unprecedented numbers of vulnerable older adults. The increase in people keeping their teeth and their increasingly complex conditions all point to more people with more complex needs. Although these demographic shifts are providing unparalleled challenges for our health care system, they also bring new opportunities to develop and implement innovative systems for reaching and maintaining the oral health of older Americans.

[The attitude of elderly people living in Samara to organizational forms in gerontostomatology (based on materials of medical and sociological research)]

This article presents the results of medical and sociological research devoted to the study of elderly patients' opinion about different organizational forms providing gerontostomatological assistance. We came to the conclusion that the citizens of the old age groups have different preferences. The introduction of new organizational forms into dentistry for the elderly should be based on the results of sociological research.

[Dental treatment strategies for elderly patients]

The elderly are influenced from a various and complex combination of factors, such us individual genetic predispositions, lifestyle, society and environment, the sum of all the individual life experiences concerning the dental care, the caries, the periodontal and iatrogenic diseases.

AIM

This paper evaluates the dental treatment in the elderly.

MATERIAL AND METHODS

The study was performed on 112 patients, aged over 65, at the Clinical Department of Dental Semiology und Geriatric Dentistry, Iaşi, Romania.

RESULTS

The treatment interventions were dental hygiene procedures (in 97 patients), restaurations (in 29 patients), removable partial and total denture preocedures (in 50 patients), fixed prosthetic procedures (in 18 patients), rebasing of dentures (in 25 patients) and teeth extractions (in 26 patients). There were 36 endodontic emergencies and 15 periodontal emergencies and 8 emergencies that resulted from other causes.

CONCLUSIONS

The periodical dental examinations and the proper daily oral hygiene routine are still important in the old age and they should not be neglected, because the prosthetical components request also treatment interventions.

[Quality of life in gerodontology]

In clinical decision-making on whether or not to treat an oral disease and on making a choice from the spectrum of treatment options, the influence of the treatment on the physical and psycho-social well-being of the patient should play a crucial role. This awareness originates from gerodontology. To assess the value of a potential treatment, the concept quality of life has been advanced and various related questionnaires have been developed and employed. In the meantime, doubts have arisen about the value of these questionnaires. The present-day trend is to return to so-called qualitative research, which consists of systematic interviews of groups of older people using open-ended questions without making use of structured response options.

Gerodontology--how big is the challenge in Ireland?

Population trends suggest that the Irish population is ageing, and that this population will have substantial treatment needs. These patients will be better informed than previous generations, and will demand treatment aimed at preserving a natural dentition. This will impact upon delivery of oral healthcare and manpower planning needs to consider how to address the increased demand for dental care. Poor oral health is associated with systemic health problems, including cardiovascular disease, respiratory disease and diabetes mellitus. It also has a negative impact upon quality of life, and the World Health Organisation has encouraged public healthcare administrators and decision makers to design effective and affordable strategies for better oral health and quality of life of older adults, which, in turn, are integrated into general health management programmes. Treatment concepts such as minimally invasive dentistry and the shortened dental arch concept are discussed in the context of these demographic changes and recommendations.

Principles of geriatric dentistry and their application to the older adult with a physical disability

The older adult living with a physical disability faces many daily challenges. Limited hand function or impaired cognition often has profound effects on activities of daily life including oral hygiene. This article explores age-related changed in dentition and common causes of pathology of the oral cavity with special emphasis in populations with impaired hand function or cognition. This article will also assist the treating physician as it relates to oral diagnosis and patient management.

Access to dental care among older adults in the United States

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.

Oral diagnostics for the geriatric populations: current status and future prospects

Because it is a noninvasive technique, there is growing interest in replacing blood with oral-based methods of diagnostics. Oral diagnostics may be used for diagnosis and therapeutic drug monitoring of both oral diseases (eg, caries, periodontal disease,oral lesions, oral cancer) and systemic diseases (eg, infectious diseases, including HIV and AIDS, autoimmune diseases, cancer,and endocrine disorders). The authors address both existing techniques and oral-based diagnostics that will be applicable to the aging population in the future. They also highlight those techniques that are uniquely suited to point-of-care applications.

The evolving impact of aging America on dental practice

American dentistry has recognized for a quarter century that the growth in the proportion of elderly in the population is impacting on the profession. Multiple articles in the professional literature have speculated on the ways in which this change will be manifested. Data and projections from earlier articles are revisited and five trends are offered to guide professionals as they position their practices for the coming years. The increase in number and proportion of elderly in dental practices stems from successes in preventing and controlling infectious diseases during the last century. The trend has not peaked but will continue for at least two more decades. Retention of teeth into advanced age has resulted from emerging and improved preventive and restorative dental advances directed at children and adults beginning mid-century, and dental utilization studies confirm the elderly are seeking dental care at an unprecedented and growing rate. Chronic disease and infirmity that accompany advanced age make dental care more challenging for this group. Dentists and their staff will need to continuously undertake educational opportunities that will foster and maintain their facility in providing care to the elderly. They will need to do this because Americans of advanced age are becoming the dominant age group seeking, and able to pay for, sophisticated dental services. The blend of those services is shifting away from removable prostheses to a rising demand for restorative, periodontic, and endodontic care. Root caries, in particular, will be a growing challenge to both providers and patients. There is mounting evidence oral disease impacts endocrine, cardiovascular, and pulmonary health, particularly in frail elders, and will likely provide many elderly additional stimuli to seek dental care. Providers who seek an alternative approach for delivering their services will find growing demand for and satisfaction with traveling to patients, rather than the other way around.

30 Years of Preventive Dentistry – and 30 Years into the Future

Preventive dentistry has had a major impact on the prevalence of dental caries and, to a lesser extent, periodontal disease since the 1970s. It should continue to have a positive effect on the oral health of the community in the future. The factors behind improvements seen in oral health are many and varied but include changes in public health policy, technology and commercial decisions made in the industrial sector. As oral health has improved, and tooth retention increased, the focus of preventive dentistry has widened to include all population groups, increasingly including older adults, and to include a wider range of disorders. The major issues relevant to preventive dentistry which have occurred over the last 30 years are discussed. The authors will speculate on the impact that the prevention of oral disease might have over the next 30 years.

Dental needs of the elderly in the 21st century

The average age of the world's population is increasing rapidly. The "graying of America" presents new opportunities and new challenges for improving the oral health of the elderly, particularly those afflicted with neurocognitive impairments. The dental problems associated with these conditions include but are not limited to a decrease in oral hygiene; difficulty in controlling and retaining dentures; xerostomia, which often is drug-associated, and consequential root caries, recurrent decay, and purposeless chewing. Parkinson's disease and Alzheimer's disease are the most prevalent type of progressive neurocognitive impairing illnesses, affecting millions of elderly Americans. As the adult population increases, a greater number of patients with these diagnoses will require dental care. Dental providers need to be aware of the special problems associated with the treatment of the older healthy subject and the neurocognitively impaired patient.

Geriatric dentistry. A review for the general dentist

In the 20th century, the oral health of Americans, along with their life expectancy, improved dramatically. The 21st century offers dental professionals the opportunity to help patients maintain their oral health for a lifetime.

Clinical practice of the future. The future of dentistry

The last 20 years have brought enormous change to the dental profession. The American Dental Association Future of Dentistry Report examines some of these advancements and discusses what changes to anticipate in the future. Among the most significant changes are those that will occur in the scope of clinical dental practice. This is largely due to anticipated shifts in patient demographics, provider availability, advancements in science and technology, and a changing role for the dentist in the health care community. Future dentists will maintain their role as experts on diseases of the oral cavity. However, their responsibilities will change and increase as they observe the interaction between oral and systemic health. Dental education, therefore, must reflect the changing role of the dentist.

The future of dental care for the elderly population

The U.S. population is aging, and the elderly are maintaining many of their natural teeth. Studies have shown that if older people have teeth, they tend to utilize dental services to a similar extent as younger cohorts. Geriatric dental care is the diagnosis, treatment, and prevention of dental and oral diseases for all older adults. A functional categorization of the aging population is more useful in dentistry than a chronological one, and 70 percent of this population, or 23.2 million people, is able to visit a dentist in his or her office. The oral health care of older adults has become more challenging because they will no longer accept extraction and dentures as a solution to complex restorative needs. This paper discusses these issues and looks at the future of geriatric dental care.

Future treatment needs in children, adults and the elderly

Future treatment needs for dental services are discussed in the perspective of the objective which the services are meant to fulfill. These are, broadly speaking, equal distribution of services and economic efficiency. Within the Nordic countries, the emphasis has been on equity, perhaps less on efficiency. Equity of utilization is best understood as being a situation where patients with equal needs for oral health care receive equal treatment, in terms of both the volume and the quality of the services. The justification for arguing that equality of utilization is the appropriate measure is mainly based on the externality argument: health-care consumption by one person may be the source of utility to another person. According to that view there are two beneficiaries of dental care: the patient who is sick, and the rest of society who care for the sick patient and who derive utility from seeing the patient become healthy. The public dental services for children in the Nordic countries are organized according to the principle of equity of utilization. Equity of access is best understood as being a situation where people with equal needs have equal opportunity to use dental services. It is a supply-side phenomenon; equal access is achieved when patients with the same needs face the same costs of dental-care consumption in terms of both time and money. The oral health situation among children, adults and the elderly is exemplified by national service data and recent studies.

The changing face of geriatric dental care

Just because a patient has reached a certain age does not necessarily mean he or she requires specific treatments. This will vary depending upon the patient's general history, his or her oral hygiene, general health and diet. It is important to avoid stereotyping seniors: they all have different medical backgrounds, different lifestyles and different needs.

Alberta's universal dental plan for the elderly: differences in use over 6 years by two cohorts

OBJECTIVES

Dental services use by two cohorts under the universal dental plan for the elderly in Alberta, Canada, was examined.

METHODS

Two birth cohorts 65 to 69 years old at entry who used the plan from 1978 to 1979 (n = 17,816) or from 1985 to 1986 (n = 27,474) were analyzed over 6 successive years for differences in dental services use and costs.

RESULTS

The 1985/86 cohort received 24% more visits per patient than the 1978/79 cohort. Their inflation-adjusted expenditures increased by 19% mainly as a result of increases in denturists' expenditures (33%) (dentists' expenditures increased just 4% because of lower plan fee increases). The 1985/86 cohort received relatively many more periodontal and fewer denture services. Annual attendance over 6 consecutive years was high, especially for the 1985/86 cohort and dentists' patients; 55% of the 1985/86 cohort who used dentists did so in 5 or all 6 years.

CONCLUSIONS

Differences in plan expenditures per patient between the birth cohorts and dentists and denturists, along with the high continuity of care for dentists' patients, have important implications for planning and administering dental plans for the elderly. The large expenditure decreases for removable dentures and the large increases for periodontal services to the 1985/86 cohort are noteworthy.

Preparing for the "silver age of dentistry"

Providing oral health care to older adults will be a challenging and rewarding part of dental practice in the years ahead. It will include understanding normal aging, appreciation of the pathophysiology of chronic diseases experienced by many elderly, and application of key principles of pharmacology in care of patients receiving medications for treatment of these diseases. It will involve an understanding of the interaction of systemic conditions with oral health status, adequate diagnosis of oral disease, and appropriate rational treatment planning with a strong emphasis on preventive dentistry. It will include care provided in nursing homes or during housecalls for the homebound. Dentist-geriatricians will be working with teams of healthcare professionals that include physicians, dentists, podiatrists, ophthalmologists, nurses, social workers, nutritionists, pharmacists, and occupational and physical therapists. Above all, the team will provide skilled compassionate care, which is always good business!

Factors influencing the future need for treatment of root surfaces

This paper discusses the current status of root surface caries in the elderly population and the need for treatment of this condition in the future. Although root surface exposure and root caries have been reported for adults at all ages, the people at greatest risk for these conditions are the elderly. In the United States, life expectancy and the population aged 65 years and older has increased substantially, and the proportion of the elderly population who are dentate has increased and is projected to increase further. Utilization of dental services by the elderly is similar to that of employed adults. Interpretation of studies of the prevalence and incidence of root surface caries are difficult due to differences in sampling, definition of lesions, and reporting conventions. Root surface caries prevalence is related to age and continues to be a significant problem for this population as they age. Factors that may affect the future need for treatment are explored.

Report on seniors' dental care. Past experience and future challenges

After attending the CDHA North American Research Conference held in Niagara Falls last October, Ms. Bowes says she found a significant amount of interest in the area of geriatric care being expressed by those in attendance. Consequently, when she returned home, she decided to offer CDHA members an opportunity to gain some insight on this topic from her own experiences. Although no 'formal' report summarizing the findings noted here was ever forwarded to the facilities involved, Ms. Bowes says that "some of the information gathered has been used in documents and reports that were forwarded to the Ministry of Health and the local Board of Health for Simcoe County." The purpose of this report is to alert dental professionals to the future dental needs of our rapidly aging population and to perhaps assist those who are considering the provision of the elderly by outlining my personal experience.

Cohort differences among aging populations: a challenge for the dental profession

The pattern of utilization of oral health services by older adults is changing as more older people maintain their natural teeth. Heterogenicity among persons aged 65 and older is probably greater than in any other period in the life cycle; however, all too often, all age groups over age 65 have been grouped together for program planning or data analysis. The socio-dental and historical influences on five specific age cohorts born between 1905 and 1945 are presented so that dentists may better understand the differences in attitudes and expectations of these individuals when they seek treatment.