Medical Emergencies · patient case question
The daughter mentions that many of her father's friends are also housebound. Which statement about homebound patients is correct?
Patient case: The tremor that came before the toothache
demo: 74-year-old male, brought by his daughter
chief: Broken lower molar and difficulty maintaining oral hygiene.
history: Parkinson disease diagnosed six years ago. He now lives with his daughter and rarely leaves the house; she manages his transport and his brushing. Two weeks ago he had his annual influenza vaccination, and since then she reports he has become noticeably weaker in both legs, though he has no fever.
meds: Carbidopa-levodopa. No anticoagulants.
findings: Masked facies with reduced blink rate. Pill-rolling tremor of the right hand at rest that settles when he reaches for an object. Generalised plaque accumulation and drooling. Symmetrical ascending weakness of the lower limbs with absent ankle reflexes.
Show answer and explanation
Correct answer: B. They represent an underserved population that is growing in number
- A. The reverse is true. Reduced access, dependence on carers for daily hygiene, polypharmacy causing xerostomia and high-frequency soft diets all combine to increase disease.
- B. Correct. Homebound and long-term care residents are a recognised underserved group, and their numbers are rising as the population ages and more people live longer with chronic disease. Access is limited by transport, mobility, cognition and cost, and their rates of untreated disease exceed the general population.
- C. No federal statute requires an individual dentist to make domiciliary visits. Portable and mobile dentistry is voluntary, and the resulting access gap is exactly the problem.
- D. Traditional Medicare Part A and B exclude routine dental care. Some Medicare Advantage plans add limited dental benefits, but coverage is far from comprehensive.
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