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Strive-The Student View Elder Abuse: The Opportunities and Obligations of the Dental Profession
The aging U.S. population will have a tremendous impact on health care in the next 10 to 20 years as the “baby boomer” generation—the fastest growing health care expenditures age group—enters their golden years of 65 and older.[1] Those who care for the elderly will feel this impact the most. The stress caused by the increased need for elder care due to the baby boomers will occur at a time when reports of elder abuse have been surfacing at shocking levels. According to the Massachusetts Department of Elder Affairs, over 11,500 reports of elder abuse were made in 2005. More than one million elders are victims of abuse every year.[1] Dental care professionals are uniquely qualified and positioned to help address this problem. With proper planning and preparation, they can help focus on the situation now, as well as be ready to deal with the future burdens of a larger senior population. This paper will explore why dental professionals should prepare themselves to recognize and address elder abuse.[1-2] How can dental professionals address the social and moral issue of elder abuse? What should they do about it in response to legal, moral and social obligations? To understand how dental professionals can play a role, their basic professional mission must be considered. Dental hygienists and dentists have a unique position in recognizing elder abuse because of the head and neck assessments they routinely perform. Many times, the patient visits the dentist because of a complaint or ailment that is injury-related.[1] There are various signs the dental professional can look for to detect elder abuse. For instance, indications of physical abuse include injuries to the face or the mouth, such as trauma to the lip, broken teeth or bruises around the eye. Dental hygienists or dentists should be aware of ill-fitting dentures or lack of dental hygiene, which can be indicators of neglect or abuse. Nursing home residents often have limited dexterity and are unable to brush or floss their own teeth. Many times, people who work in nursing homes do not feel that assisting residents with daily dental hygiene is a part of their job. As a result, residents may go without having their teeth brushed or flossed for days or even weeks.[1-2] In addition to physical cruelty, elder abuse can also include mental, financial, emotional and sexual exploitation. Emotional mistreatment is frequently overlooked because the patient seems to be in good health and shows no physical signs of any wrongdoing. During their patient visits, dental professionals should ask if their clients have been left alone or are in confinement. The senior may suddenly seem reserved or unhappy when they were usually more sociable and outgoing during previous visits.[1-2] Financial exploitation is another form of elder abuse. A big indication of financial “foul play” is when the patient is unaware of large withdrawals from their bank accounts. Other warning signs include changes in their wills or unpaid dental bills that have previously been paid on time.[1-2] Dental hygienists or dentists should tactfully ask the patient or the patient’s family members questions regarding these issues during their patient visits, and in the very least, take note of any comments that may suggest any wrongdoing. It is the dental professional’s responsibility as a health care provider to notice these physical, emotional or financial changes in their patients. The best way for a dental professional to find out what is happening in the nursing home is to talk with his or her patient. The patients remember their dental hygienist and may confide or trust in him or her if good rapport has been established. It is best to discuss any concerns with patients without family members or caregivers present. The dental professional should convey concern for his or her patient’s well-being and offer assistance if they are in a detrimental situation. Given these examples, how should the dental professional proceed and why? Health care providers including dental professionals, licensed physicians, nurses, police officers, psychologists, physical therapists and nursing home employees are expected to identify and report any findings of abuse or neglect while working.[3] These mandated reporters suspecting foul play, neglect, exploitation or abandonment of anyone over the age of 60 are obligated to file a report to the Department of Social Services (DSS) within five days of the offense. If they choose not to report, they could be fined up to $500. The statement must include the patient’s name, address and description of the wrongdoing or anything else that would be helpful in the investigation. This account can be written or spoken; if it is written, some states require that it be filed within 24 hours of the occurrence or the reporter could be fined. He or she will be granted both civil and criminal protection in proceedings unless they had bad intentions.[3] The dental professional’s responsibility with regard to noticing and addressing elder abuse is a daunting duty and one which is made even more burdensome when you consider the increased case load from the enlarging elderly segment caused by the aging baby boomers. This generation, defined in the United States as Americans born between 1946 and 1964, is moving into their retirement years. There are approximately 76 million baby boomers representing 28 percent of the United States population. Kathleen Casey-Kirschling is generally recognized as the first baby boomer. She was born in Philadelphia on Jan. 1, 1946 at 12:01 a.m. Casey-Kirschling, a former teacher from New Jersey, applied for retirement benefits on Oct. 15, 2007 at an event attended by Social Security Commissioner Michael Astrue.[4] This segment represents a large portion of the economy and wealth in the United States. They purchase 80 percent of high-end cars and specialty products, take 80 percent of cruises and purchase 50 percent of all skin care products.[5] More than any other generation, it is said that the boomers have greater concern about how they look and feel. They want to live forever and do not wish to discuss their demise.[6] The boomers, while large in numbers and wielding substantial economic influence, are joining the ranks of elders who will eventually need care. They represent both an obligation and an opportunity for the dental profession. The obligation is a professional one that addresses the elder’s oral health. The opportunity is partly business related around providing services to help elders maintain a pleasant, attractive and healthy smile. Dental professionals should concentrate on elder care because of this unique opportunity. The higher quality of health care services overall demanded in a competitive marketplace would tend to eliminate low-quality service providers and help to reduce or eliminate elder abuse, because one of the factors identifying a low-quality provider would be services that tend to result in unhappy, disgruntled and potentially abused patients. Higher-quality providers will be sought after to meet demand, while lower-quality abusers will be shunned.[7] Additionally, because of the obligation for dental professionals to be aware of any signs of elder abuse during routine oral exams, identifying, properly addressing and reporting possible abuse is an important responsibility for dental professionals to have while serving a lucrative market.[8] The dramatic increase in the number of elder Americans will place a strain on the health care system because of the increased demand for services. Specifically impacted will be nursing home and hospice care facilities. According to the Department of Health and Human Services, recent trends in nursing home deficiencies and complaints have increased from 2005 to 2007.[9] If free market forces do not fully address the issue, regulatory and professional responsibility will need to be relied upon. The current health care demographics of elder care and the dental professional’s basic mission of offering quality dental care while being vigilant for signs of elder abuse in the growing elderly population provide the dental professional with many opportunities and obligations. Dental professionals should take the time to get to know their elder patients’ surroundings and conditions while building strong relationships with them based on trust and respect. By doing this, they will be in a strong and unique position not only to address their dental health care needs but also to identify any potential elder abuse. They can then execute their professional, legal, moral and social obligations to report on and address elder abuse. In the end, this truly provides a rewarding service to their patients while assisting in supporting and alleviating the pressure on the elder care system. The elders of America, our parents and grandparents, aunts and uncles, brothers and sisters, neighbors and friends, have earned and deserve this basic, decent treatment. Dental professionals can take great pride and personal satisfaction in playing a vital role in addressing and eliminating elder abuse. They can do this while building their practices, keeping health care costs low and helping to address the strain on the health care system due to the influx of elders. Dental professionals have an opportunity and an obligation to help eliminate elder abuse.
References
Jenna Schnell is a fourth-year dental hygiene student at Southern Illinois University, Carbondale, Il. The faculty mentor for this edition of Strive was Faith Y. Miller, CDA, RDH, MSEd.
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