Toward a better understanding of the elder abuse forensic center model: comparing and contrasting four programs in California.

Resolving elder abuse, neglect, and self-neglect often requires the authority and expertise of multiple providers. Prior research of the elder abuse forensic center (FC) model, although limited, has indicated strong member support, increases in prosecution of abusers, and increases in conservatorship for those lacking capacity. This study expands on previous single-site research by conducting a cross-site multimethod evaluation of four established FCs to better describe the model and inform its replication with fidelity.

The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment.

Ten percent of older adults experience elder mistreatment, and it is much more common in older adults with dementia. It is associated with higher rates of psychological distress, hospitalization, and death and, in the United States, costs billions of dollars each year. Although elder mistreatment is relatively common and costly, it is estimated that fewer than 10% of instances of elder mistreatment are reported.

Is This Broken Bone Because of Abuse? Characteristics and Comorbid Diagnoses in Older Adults with Fractures.

Objectives: To examine the relationship between individual characteristics and potential correlates of elder abuse in older adults who present with fractures.

Design: Cross-sectional analysis of deidentified data extracted from medical records.

Setting: Academic medical center.

Variability in Findings From Adult Protective Services Investigations of Elder Abuse in California.

Adult Protective Services (APS) workers in California investigate complaints of elder abuse and must determine the validity of a complaint with minimal guidelines. It is unclear whether APS workers reach similar conclusions given cases with similar circumstances. To assess variation in case findings and reasons for them, we used data from monthly reports of completed investigations, and investigation outcomes from all 58 California counties from September 2004 to August 2005, telephone interviews with 54 of 58 counties, and site visits to 17 counties.

The association between oral health literacy and failed appointments in adults attending a university-based general dental clinic.

Objectives: The purpose of this study is to determine the association between personal characteristics, a person's oral health literacy, and failing to show for dental appointments at a university dental clinic.

Methods: A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January 2005 and December 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior was gathered, and electronic records were reviewed.

A program to recruit and mentor future academic dentists: successes and challenges.

There is a continuing shortage of academic dentists due to myriad factors. However, each graduating class of dental students includes a select group who choose to explore academic positions. It is this group of potential academic dentists that a four-year R25 initiative, funded by the National Institute of Dental and Craniofacial Research, has targeted with the intent of increasing their numbers and mentoring them for success in a future faculty position.

Social support and dental visits.

Background: The authors conducted a study to examine the influence of social support on dental visits among an adult population.

Methods: Using 2003-2004 National Health and Nutrition Examination Survey data, the authors analyzed information pertaining to adults 40 years and older (N = 2,598) (with the exclusion of edentulous people), who represent about 108 million people in the United States. They weighted logistic regression models for dental visits, while controlling for demographic characteristics (age, race/ethnicity, sex, education, insurance, income), socioenvironmental characteristics (marital status, emotional and financial support, number of close family members and friends, years lived in the neighborhood) and physical and mental health status.

A brief 20-item dental/medical health literacy screen (REALMD-20).

Objectives: Few health literacy instruments are available to clinicians to help understand the implications of patient difficulty understanding health information. Those that do exist are lengthy and would not be conducive to use in a busy clinical setting. Long-term dental and medical outcomes may improve if health care providers can identify individuals with low health literacy levels who may benefit from tailored communication, yet few instruments are available for clinical use.

Education and training of mandated reporters: innovative models, overcoming challenges, and lessons learned.

Several Archstone Foundation funded projects developed and implemented training curricula on elder abuse for mandated reporters such as dentists, adult protective services workers, paramedics, and coroner investigators. Common education and training issues emerged, including the need to provide basic content on normal aging and the need for creating standardized trainings. Strategies include integrating elder abuse and neglect content into existing courses, building relationships with stakeholders, and customizing content and delivery to student needs and preferences.

Dental students' knowledge about elder abuse and neglect and the reporting responsibilities of dentists.

Dentists are in a unique position to detect elder abuse and neglect. Approximately 75 percent of all physical domestic violence results in injuries to the head, neck, and/or mouth area, clearly visible to the dental team during examinations and treatment. The goal of this project was to gather a comprehensive understanding of predoctoral dental students' perceptions of the culture of abuse and neglect and their level of fluency regarding their rights and responsibilities as mandated reporters.

Predictors of risk tolerance among oral surgery patients.

Purpose: This study attempts to provide insight on how the treatment preference for a mandible fracture and treatment received and its consequences are related to the patient's risk tolerance, as measured by the Standard Gamble (SG).

Patients And Methods: Data from a prospective cohort study of 203 subjects receiving treatment at the former King/Drew Medical Center in Los Angeles, CA, for either a mandible fracture (n = 98) or third molar removal (n = 105) were examined. Subjects were interviewed at 4 time points: on admission to the medical center and at 3 monthly follow-up visits.

Screening for oral health literacy in an urban dental clinic.

Objective: Studies show that the average person fails to understand and use health care related materials to their full potential. The goal of this study was to evaluate a health literacy instrument based on the Rapid Estimate of Adult Literacy in Medicine (REALM) that incorporates dental and medical terms into one 84-item Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D) measure and determine its association with patient characteristics of a culturally diverse dental clinic population.

Methods: An 84-item dental/medical health literacy word list and a 48-item health beliefs and attitudes survey was provided to a sample of 200 adult patients seeking treatment for the first time at an oral diagnosis clinic located in a large urban medical center in Los Angeles, California.

Social support and resource needs as mediators of recovery after facial injury.

Although many trauma centers provide excellent surgical care, little attention is paid to psychosocial needs and problems of posttrauma adaptation. Social support and resource needs have been identified as significant mediators of recovery after injuries. This article presents an overview of various social and material resources instrumental to psychological adjustment and recovery.

Predictors of treatment preference for mandibular fracture.

Background: Patient treatment preferences do not necessarily remain stable over time.

Objective: This study focuses on predictors of patient treatment choice and on the extent to which patients are willing to take risks by choosing surgical versus nonsurgical treatment for mandibular fracture.

Methods: Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either a mandibular fracture (n = 98) or third-molar removal (n = 105) were used to investigate patterns of patient preference over the course of a 4-month study period using generalized estimating equations controlling for age, gender, income, and fracture versus third-molar patient.

Predictors of depressive symptoms following mandibular fracture repair.

Purpose: This study sought to identify sociodemographic, psychosocial, and clinical factors associated with increased postsurgery depressive symptoms among inner-city minority patients recovering from a mandibular fracture.

Patients And Methods: Surveys of African American and Hispanic adults receiving treatment at King/Drew Medical Center for a mandible fracture (n=98) are used to identify factors associated with increased postsurgery depressive symptoms. Using correlation coefficients and t tests, bivariate relationships between patient characteristics and depressive symptoms at first follow-up were examined.

Baseline characteristics and treatment preferences of oral surgery patients.

Purpose: Patient preferences for treatment choices may depend on patient characteristics. Using standard gamble (SG) and willingness to pay (WTP), this study compares preferences for treatment of mandibular fracture among patients in a low-income urban area.

Patients And Methods: Surveys of African-American and Hispanic adults receiving treatment at King/Drew Medical Center for either mandibular fracture (n = 98) or third molar removal (n = 105) were used to investigate differences in patient characteristics across treatment groups (third molar vs fracture) and treatment preference (wiring vs surgery).

Evaluating psychosocial function in elderly dental patients.

Comprehensive dental care for older adults includes an understanding of, and sensitivity to, the psychosocial changes with age that can influence oral health care, including emotional functioning, anxiety, depression, cognitive functioning, alcohol and substance use, social support, and elder abuse and neglect. A case vignette highlights the contribution of an interdisciplinary psychosocial assessment to the oral health care of elderly patients.

A qualitative study of hardiness and social support among underserved, inner-city minority adults recovering from oral surgery.

Using qualitative data, this study examines hardiness and social support among twenty-two African American and Hispanic subjects, at least 18 years of age, who received treatment for a jaw fracture and participated in an hour-long focus group to discuss the treatment they received at King/Drew Medical Center, an inner-city hospital in Los Angeles, California. Treatment was either a non-surgical wiring of the teeth closed for six to eight weeks or surgical placement of a metal bone plate in the lower jaw with a short period of jaw fixation following surgery. A mandibular fracture is one of the most common orofacial traumas for minority individuals, and the majority of these fractures among patients at urban trauma centers are a result of interpersonal violence.

Decision-making process for treatment of mandibular fractures among minority groups.

Objectives: While patients' preferences for medical care are widely studied, only a small number of studies have looked at the decision-making process for dental treatment of mandibular fracture. This study examines the decision-making process for treatment of mandibular fractures among minority groups. Study participants were asked to consider Maxillomandibular Fixation (MMF--a non-surgical approach of wiring the teeth for 4-8 weeks) or Rigid Internal Fixation (RIF--surgical placement of bone plate).

A qualitative report of patient problems and postoperative instructions.

Purpose: While surgery related stress may interfere with the patient's ability to concentrate on instructions, language difficulty or low health literacy may also impede appropriate doctor/patient communication. The purpose of this study is to understand from a sample of minority patients the types of problems encountered during healing and the level of information regarding elements of postoperative instructions they recalled receiving at an inner-city safety net hospital. We initiated a qualitative study to understand the care sequence process and provision of informed consent and postoperative instruction.