When an 87-year-old dental patient showed up at a clinic without an appointment one spring day in 2007, she appeared confused and unkempt. Previously, she had phoned her student dentist because she was perplexed about her upcoming appointments. Suspecting something deeper was at play than a presumed memory lapse that might be attributed to aging, the University of California, Los Angeles (UCLA) dental student discussed the incident with her group-practice director as a possible sign of elder abuse and neglect (EAN). Taking the director's advice, the dental student contacted a hospital social worker and escorted the patient to the social worker's office.
AS A HEALTH AND AGING AWARD WINNER
This incident marked the first instance in which a student at the UCLA School of Dentistry Clinic made a formal referral to hospital social services for suspected elder abuse or neglect, according to Melanie W. Gironda, who helped create a new training program to educate dental students in recognizing signs of potential abuse. The program, which the school is developing for replication nationally, won an American Society on Aging (ASA) 2008 Healthcare and Aging Award, presented by ASA's Healthcare and Aging Network in collaboration with Pfizer Medical Humanities Initiative.
Gironda, an adjunct assistant professor of public health and community dentistry at the UCLA School of Dentistry, explained mat dental professionals often are the first people outside the elder's home with the opportunity to recognize signs and symptoms of abuse. In addition, she said, changes in medical practice and insurance have interrupted the continuity of care between older adults and primary physicians, especially in some managed care settings. Furthermore, dentists frequently are the healthcare provider for multigenerational families.
She continued, "Dentists have me opportunity to see patients and caregivers over the course of many months and years, enabling the detection of self-neglect and other, less obvious forms of elder abuse."
To date, she said, about 350 dental students have signed up for the EAN curriculum, almost 90 a year. The first of the four classes taking EAN courses completed each of the training modules earlier this year. The UCLA Dental Clinic admits more man 3,000 new patients each year, of which about 45% are age 60 or older. Total patient visits exceed 43,000 annually, with dental students providing direct care to patients in a variety of community settings throughout the Los Angeles area, she said.
However, Gironda added, even though dentists are mandated reporters of elder abuse in California and other states, "Dental professionals often do not see themselves as responsible for dealing with forms of abuse and neglect, and neither preprofessional training nor guidelines provided by dental groups emphasize the detection and reporting of EAN. …