The role of biobehavioral, environmental, and social forces on oral health disparities in frail and functionally dependent nursing home elders
The role of biobehavioral, environmental, and social forces on oral health disparities in frail and functionally dependent nursing home elders
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DOI：
10.1177/1099800405275726
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发表时间：
2005-07-01
影响因子：
2.5
通讯作者：
Elswick, RK
中科院分区：
文献类型：
--
作者：
Jablonski, RA;Munro, CL;Elswick, RK
本文的目的是回顾文献，并讨论如何生物行为老化，疗养院环境，社会力量塑造当前的医疗保健政策之间的相互作用，导致口腔健康的差距体弱和功能依赖的老人谁住在疗养院。新出现的经验证据表明，口腔健康不良与牙菌斑沉积和全身性疾病（如疗养院获得性肺炎）之间存在联系。大多数疗养院居民缺乏功能能力或心理能力来执行自己的口腔护理，因此必须依赖他人为他们执行口腔护理。提供大部分护理活动的注册护理助理（CNA）不确定如何为从事护理抵抗行为的居民提供护理。监督CNA的护士对提供口腔护理的总体知识有限，尤其是缺乏为表现出护理抗拒行为的老年人提供口腔护理的知识。养老院的老人在支付牙科护理费用时选择有限;医疗保险通常不包括常规牙科护理。医疗补助覆盖范围在各州之间差异很大;即使存在覆盖范围，低医疗补助报销也会阻止牙医接受医疗补助患者。减少这些口腔健康差异所需的策略是复杂的，但并非不切实际。愿意接受这一原因的研究人员将有很多机会来测试改善口腔护理的方法，以及监测和重新评估这些方法。
The purpose of this article is to review the literature on and discuss how interactions between bio-behavioral aging, nursing home environments, and social forces shaping current health care policies have contributed to oral health disparities in frail and functionally dependent elders who reside in nursing homes. Emerging empirical evidence suggests links between poor oral health with dental plaque deposition and systemic disease, such as nursing home acquired pneumonia. The majority of nursing home residents lack either the functional ability or the mental capacity to perform their own,mouth care and therefore must rely on others to perform mouth care for them. Certified nursing assistants (CNAs), who provide the majority of care activities, were unsure how to provide care to residents who engaged in care-resistive behaviors. The nurses who supervise the CNAs have limited knowledge regarding the provision of mouth care in general, and they specifically lack knowledge regarding the provision of mouth care to elders exhibiting care-resistant behavior. Elders in nursing homes have limited options when paying for dental care; Medicare does not generally cover routine dental care. Medicaid coverage varies widely between individual states; even when coverage exists, low Medicaid reimbursements discourage dentists from accepting Medicaid patients. The strategies needed to reduce these oral health disparities are complicated but not unrealistic. Investigators willing to embrace this cause will have no shortage of opportunities to test methods to improve the delivery of oral care as well as to monitor and reassess these methods.