Informed consent in dental care and research for the older adult population: A systematic review.

BACKGROUND: Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. METHODS: The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the PubMed (MEDLINE), Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. RESULTS: The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 29 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical conditions, and only 3 involved consent related to dental care or research. CONCLUSIONS: Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. PRACTICAL IMPLICATIONS: This review is the first attempt, to the authors' knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.

Missing links in oral health care for frail elderly people.

A national interdisciplinary strategy is needed to address the comprehensive oral health care needs of frail elderly people residing in long-term care facilities. Reasonable care within the social and personal context of frailty encompasses active prevention of disease augmented by necessary restorative treatment, provided with sensitivity to a person"s propensity to seek care. Typically, dental emergencies are managed quite well in longterm care facilities, either by treating the resident on site or by transporting the resident to a local clinician. In addition, facility administrators are usually well aware of their legal responsibilities to provide diagnostic services to residents before disease or dysfunction causes irreparable damage. Consequently, many facilities have arrangements with dental hygienists, dentists or denturists for periodic clinical assessment of all residents, or they seek help at the first sign of trouble. On the other hand, effective, widely accepted strategies for assisting frail residents with daily oral hygiene are lacking, and in many regions across the country it is overly difficult for frail residents with severe oral impairment or dysfunction to receive appropriate care and treatment. A cooperative effort from many disciplines will be needed to provide these missing links in Canadian health services and to realize the principle of providing maximum benefit to the least advantaged in society.

Access to oral health care: Professional and societal considerations.

Access to health care is a complex subject with vast personal, economic, political, and societal ramifications. Issues concerning the rights and responsibilities of health care professionals-collectively and as individual members of a profession-comprise an important topic within ongoing debates concerning access to care, and constituted the overarching focus of the deliberations that form the basis of this publication. This article provides definitions of key terms; data concerning demography, oral health status, and use of dental services for children and seniors; and a contextual framework for examining broad underlying professional and societal considerations. It concludes with reflections on joint responsibilities and guiding principles that apply to dental professionals and government agencies charged with administering public benefits programs and the consequences likely to ensue if these vital stakeholders fail to respect fundamental principles of professionalism and economics.

A self-reported survey of Alzheimer's centers in Southwestern Pennsylvania.

Directors of nursing at 23 nursing homes with Alzheimer's units in Southwestern Pennsylvania completed a self-reported survey of 12 questions. Responses from the self-administered questionnaires (100% response rate) revealed a wide variation in the staff categories assessing the oral health status of newly admitted residents with AD. The respondents described oral examinations that were incomplete when compared to the oral indicators listed in the Minimum Data Set. All nursing homes reported that oral hygiene was provided each day. The number of residents in a facility had a significant effect on the frequency of oral hygiene provided. Only 52% of the facilities reported yearly oral examinations for this population. According to the respondents, dental treatment was typically performed on-site. The oral health care costs were paid by Medicare, Medicaid, the residents/family members, or by other undescribed resources. Insufficient time, staff, and training, as well as uncooperative behavior, were identified as barriers to optimum oral health care for residents with AD. Additional staff, specialized training, and increased government reimbursement were suggested to improve the oral health care for this group of older adults. For future studies, review of medical records and on-site evaluation of the oral health care at these facilities should be required to verify the reported practices.

Bioética y asignación de recursos para la atención odontológica del adulto mayor en Chile / Bioethics and dental health care resource allocation for elderly people in Chile

Una creciente preocupación entre quienes reconocen que los recursos sanitarios son finitos y que el deseo de beneficios en salud puede ser ilimitado, ha promovido una discusión sobre qué es una distribución justa y equitativa de los servicios en salud. En este escenario, la asignación de recursos para la atención sanitaria de adultos mayores es objeto de debate. La planificación de programas odontológicos para adultos mayores, necesita conocer la magnitud y distribución de las patologías en la población y costo-efectividad de las terapias. Sin embargo, una discusión que justifique la asignación de recursos debe ser planteada previamente, y más que datos demográficos y epidemiológicos, requiere incluir las consideraciones éticas que sostengan estas políticas. En esta revisión se expone brevemente las principales características de la salud oral de los adultos mayores en Chile. Posteriormente, se analizan algunas consideraciones bioéticas que pueden limitar o sustentar la asignación de recursos en este grupo de edad. Finalmente, se concluye que los fundamentos de Justicia en Salud y Bioética de la Protección deben aplicarse a la discusión sobre la asignación de recursos para programas de atención odontológica en los adultos mayores y otros grupos susceptibles que deberían ser el foco de la protección.

A growing concern among those who recognize that healthcare resources are finite and that desire for health benefits can be unlimited has promoted in recent years a policy of cost reduction, accountability, and an analysis of what is a fair and equitable health service. In this scenario, the resource allocation for health care for older adults has been debated. Planning for dental programs for older adults, like any other, needs to know the magnitude and distribution of diseases in the population and what are the cost-effective therapies. However, a discussion justifying the allocated resources should be raised previously. This requires ethical considerations that support these policies more than demographic and epidemiological data. This article outlines the oral health of older adults in Chile and subsequently, bioethical considerations that may limit or support health care resource allocation in this group. Finally, it can be concluded that Justice in Health and Protection Bioethics must be applied to the discussion about resources allocation in dental health care program for elderly people and other susceptible groups that should be the focus of protection.