The relationship of age and gender to fear and anxiety in response to dental care.

The apparent association in the published literature of gender and age with dental fear and anxiety is far from consistent or universal. A random, age-stratified telephone survey of 398 adults was performed in a US metropolitan area: Denver, Colorado. Information collected included Kleinknecht's Dental Fear Survey (DFS). In addition to total DFS scores, values were also calculated for the sums of the five DFS physiologic response items (PATRESP) and 12 DFS fear-producing stimulus items (DENTSTIM). Tests for reliability of these three scales were performed (alpha = 0.804 to 0.936). In this sample population, significant age and gender differences were noted. In general, fear and anxiety decreased in importance with increased respondent age, with the largest difference noted between the 40-50 and 60-69 age groups. Increased fear and anxiety were most apparent among younger females (20-30 and 40-50) as compared with older females (60 and older). However, among males, the summary variable for physiologic response to fear and anxiety did not appear to be age-related. Among the oldest respondents (ages 70+), 12.2% did report a "major" response to muscle tension when in the dental chair. Females reported more fear of some stimuli associated with dental care (e.g., "feeling the drill in the mouth") than did males.

A comparative study of the attitude of dental students towards the elderly.

The aim of this study was to assess the attitudes of dental students towards the elderly in the two dental schools in Israel. The study population comprised 180 dental students currently enrolled in the two dental schools in Israel. The response rate was 59% and 92% for the students in Tel Aviv and Hebrew University respectively. The self-administered questionnaire measured attitudes using the Rosencranz and McNevin Aging Semantic Differential Scales. Students' attitudes were observed to be more or less neutral. No differences of significance were observed between the students of the two schools. Social contact with and experience in treating the elderly did not seem to change students' attitudes and their desire to work with elderly patients in the future. Further development of the curriculum should be implemented in order to try to change students' attitudes towards the elderly from neutral to positive for the benefit of the provider and society.

A national survey of dentists' awareness of elder abuse and neglect.

This paper reports the results of a national survey of 1,321 general practitioners regarding their level of awareness of and experiences with the treatment of older victims of abuse and neglect. Greater than 90% were aware of elder abuse and neglect as a social and medical problem. Greater than 10% had personal knowledge or had treated a victim of abuse or neglect. Data suggest that dentists will increasingly come in contact with victims and must be trained to recognize, treat, and report such incidents.

Appropriate responses by elders to oral symptoms: dentists' recommendations.

This paper reports the results of a study of dentists' recommendations regarding the appropriate health action of elders in response to certain oral common symptoms and problems. Previous studies have found that elders most commonly respond to oral symptoms by using nonprofessional means. This study found that, without exception, the recommendation to consult a dentist was the primary mode of response favored by dentists, even in response to symptoms and problems that are most often trivial and rarely indicative of serious health problems. The results of this pilot study suggest that the need exists for dentists to reach a more realistic consensus regarding alternatives to professional consultation in response to some symptoms and problems.

Predicting utilization of dental services by the aged.

This article reports the results of a study of factors that differentiate among utilizers and nonutilizers of dental services in old age. Two hundred community-dwelling subjects aged 60-89 were surveyed regarding utilization of dental services, dentate status, current treatment needs, recent symptom experiences, and dental fear and anxiety. Discriminant analysis was used to differentiate among utilizers and nonutilizers. Dentate status, perceived need, and recent symptom experiences were the best predictors of utilization. The contribution to accurate classification made by two measures of dental fear and anxiety was marginal at best. When dentate status was removed as a predictor, the role of fear and anxiety became somewhat more important.

Training dental and nondental professionals together: the oral health gerontology fellows program.

This project demonstrated the feasibility of training dental and nondental professionals to develop and implement programs in oral health care of older adults. Eight self-guided study modules were developed and tested. Trainees drawn from dentistry, dental hygiene, nursing, and planning/administration completed a 6-month individualized training program under the guidance of faculty mentors. Program structure, content, and implications are discussed.

Current status of Geriatric Dentistry Educational Activities in U.S. dental schools.

The current status of Geriatric Dentistry Educational Activities (GDEA) in U.S. dental schools is reported in this survey. Data were collected regarding faculty involvement in geriatric programs, didactic and clinical academic curricula, and other aspects of the ongoing activities in schools. Data were reported by 50 (88 percent) of the nation's 57 dental schools in continuing operation. Forty-two schools reported discrete GDEA at the time of the study. Seven of these schools had a formal division or department of geriatric dentistry. The survey indicated that educational qualification of GDEA coordinators had risen significantly in recent years. The mean number of didactic hours (29) of instruction in geriatric education available to students has also risen. Curriculum time and financial considerations were the primary obstacles to expansion of clinical geriatric activities. With the current economic constraints in dental education, present GDEA levels are unlikely to expand in the foreseeable future, unless governmental or private agencies recognize the importance of developing GDEA and increase their support.

Health and early retirement decisions.

Health and economic considerations have consistently played important roles in retirement decisions. Increases in early retirement benefits by some employers have increased the incentive to retire early, thus inducing a change in the health and economic relationships. During the three months following implementation by a large manufacturing firm of a labor contract which included substantial improvement in early retirement benefits, structured interviews were conducted with 45 employees who had chosen early retirement and 35 eligible employees who had chosen to continue working. Data are presented on the relationship between health and retirement decisions, and on the differences between early retirees and non-retirees in regard to perceived health status, job satisfaction, potential for continued employment, leisure involvement, and morale. Implications for the primary care physician's interactions with workers who face early retirement are discussed.

Specialty preference and attitudes toward the aged.

The relationship between the attitudes and knowledge regarding the aged and specialty preference of undergraduate medical students at three medical schools was studied. No significant differences in attitudes were found when students were classified by class (freshman, sophomore, junior, or senior) or by sex. A significant though weak relationship between class and level of cognitive knowledge was found. Students indicating a preference for family practice as a specialty demonstrated levels of cognitive knowledge which did not differ significantly from all other students. Similarly, attitudes of family practice students did not differ significantly from attitudes expressed by other students. However, when all students expressing a preference for a primary care specialty were compared to students expressing preferences for non-primary care specialties, primary care students had significantly more positive attitudes toward the aged than their peers. Levels of cognitive knowledge did not differ significantly. The data appeared to suggest that students selecting primary care specialties are somewhat more humanistic and empathetically oriented, at least in regard to the aged, than their peers while exhibiting essentially identical levels of cognitive knowledge. The implications of these findings for family practice education are discussed.

Geriatrics program for medical students. II. Impact of two educational experiences on student attitudes.

In an innovative program in geriatrics for undergraduate medical students, the preliminary report concerned attitudes toward the aged among health care personnel. This follow-up report concerns the stability of, and changes in medical students' attitudes toward the aged after participation in one of the following types of geriatric educational experience: 1) a Family Practice clerkship, or 2) a selective course in Medical Humanities. Although both experiences resulted in positive changes in general attitudes, the one that emphasized empathy toward the elderly along with observation of healthy aged persons produced more positive feelings about rehabilitation potential. Implications for the geriatric training of physicians are discussed in the light of these findings.