Henry R G
Geriatric Dental Program, Lexington VA Medical Center, KY 40511, USA.
Med Care. 1995 Nov;33(11 Suppl):NS143-63.
This article discusses issues related to the quality and effectiveness of new, emerging, and existing oral health delivery mechanisms and models for the functionally dependent veteran. It describes the particular needs and unique qualities of functionally dependent veterans and enumerates the clinical dental interventions and delivery systems available to this group. Barriers specific to The Department of Veterans Affairs (VA) regarding this population and suggestions for improved access to care are summarized. Suggestions for further research are proposed with the intent that limited resources be utilized so that maximum benefits are provided to the functionally dependent veterans who need care most. What we know: Among the veteran population and the general population, the oldest cohort of elderly (those age 85 and older) are growing faster than any other age group. The rate of functional dependency increases dramatically with age, from about 10% at age 65 to 69 to about 57% after age 85. Functionally dependent elderly are the most likely group to be home-bound or in nursing homes. Compared with independent elderly, the oral status of functionally dependent elderly tends to be poorer. Functionally dependent elderly have higher rates of tooth loss, greater prevalence of denture-related problems, greater prevalence and severity of dental caries, higher prevalence of gingival and periodontal disease, and typically not seen a dentist in at least 5 years. The Department of Veterans Affairs has several advantages over non-VA settings in delivering dental care to the functionally dependent including the presence and availability of dental clinics at VA medical centers and outpatient facilities, the fact that they are free to eligible VA patients, and the greater knowledge base of the dentists. Although VA is effective in delivering oral care to a small percentage of the total population, it is likely that demand will increase and resources exhausted if certain anticipated changes occur (eg, greater demand for dental care and/or changing dental status, such as more elderly with teeth). Questions that need to be answered: What quality of oral care is VA providing to the functionally dependent veteran? What delivery systems are the most effective in providing care to the functionally dependent elderly? Is there a difference in oral health outcomes when dental personnel serve on patient care teams? What barriers exist for delivering quality oral care for the functionally dependent elderly? How can we eliminate or minimize these barriers?
本文讨论了与新出现的、现有的以及针对功能依赖型退伍军人的口腔健康服务机制和模式的质量与有效性相关的问题。它描述了功能依赖型退伍军人的特殊需求和独特特质，并列举了可供该群体使用的临床牙科干预措施和服务系统。总结了退伍军人事务部（VA）针对这一人群的特定障碍以及改善就医途径的建议。提出了进一步研究的建议，目的是合理利用有限资源，以便为最需要护理的功能依赖型退伍军人提供最大益处。我们所了解的情况：在退伍军人和普通人群中，年龄最大的老年人群体（85岁及以上）的增长速度比其他任何年龄组都快。功能依赖率随年龄急剧上升，从65至69岁时的约10%增至85岁以后的约57%。功能依赖型老年人是最有可能居家或住在养老院的群体。与独立生活的老年人相比，功能依赖型老年人的口腔状况往往较差。功能依赖型老年人的牙齿脱落率更高，假牙相关问题的患病率更高，龋齿的患病率和严重程度更高，牙龈和牙周疾病的患病率更高，而且通常至少5年没有看过牙医。退伍军人事务部在为功能依赖型人群提供牙科护理方面比非退伍军人事务部的机构有几个优势，包括退伍军人事务部医疗中心和门诊设施中有牙科诊所且可提供服务，这些服务对符合条件的退伍军人患者免费，以及牙医拥有更丰富的知识储备。尽管退伍军人事务部在为总人口中的一小部分提供口腔护理方面很有效，但如果发生某些预期变化（例如，对牙科护理的需求增加和/或牙齿状况改变，如牙齿较多的老年人增多），需求可能会增加，资源可能会耗尽。需要回答的问题：退伍军人事务部为功能依赖型退伍军人提供的口腔护理质量如何？哪些服务系统在为功能依赖型老年人提供护理方面最有效？牙科人员加入患者护理团队时口腔健康结果是否存在差异？为功能依赖型老年人提供高质量口腔护理存在哪些障碍？我们如何消除或最小化这些障碍？
