Oral Health Status of Low- Income Seniors Living in Sedgwick County

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1 Oral Health Status of Low- Income Seniors Living in Sedgwick County Judy Johnston 1, Milan Bimali 1,2, Susan Parsons 3, 1: Department of Preventive Medicine and Public Health, KUSM-W 2: Office of Research, KUSM-W 3: School of Nursing, Wichita State University

2 What we will discuss: Project history and pilot data 2017 project description & data Additional research questions that might be of interest discussion with participants

3 Project History Pilot project funded in 2015 by Frontiers: The Heartland Institute for Clinical and Translational Research (NIH funds) and Kansas Bioscience Authority Exploring mechanisms for improved oral health outcomes among older adults living in assisted living communities Low-cost intervention in assisted living communities coordinated with WSU Nursing, Physician Assistant, and Dental Hygiene Departments Inclusion criteria: > 60 yrs. of age; living in assisted living community in Wichita area; with some or all natural teeth; currently using manual toothbrush Designed with 3 cohorts of seniors Control Brushing reminder & manual toothbrush Brushing reminder & power toothbrush

4 Data: Access & Oral Hygiene 18-months of recruitment yielded one cohort of 25 participants Median age: 84.4 yrs. (71-91) Education: 20% completed high school or less 75% experience in college or technical school

5 Insurance Status Time Since Last Cleaning < 6 months 12 months Yes No 2-3 years > 3 years Never Don't remember

6 Oral Health Status Mouth Pain Untreated Decay Seldom or Never Yes No Some of the Time Don't Know/Don't Remember Refused 1 person 1 decayed tooth

7 Oral Health Status Untreated Root Decay Health of Gums Yes No 1 person 3 teeth Normal Mild Periodontal Disease Moderate Periodontal Disease Severe Periodontal Disease

8 Oral Health Status Other Indicators Tooth Mobility None Urgent Care Needs None Early Care Needs 4 people Untreated decay (2) Broken tooth (1) Broken filling (1) Periodontal Disease (1)

9 Oral Health Habits Floss Brush at least Once Daily Some or Most of the Time Seldom Never Yes No Refused Refused

10 Oral Health Quality of Life Trouble pronouncing words due to tooth/mouth/denture problems Never Hardly Ever Sense of taste worsened due to problems with teeth, mouth, or dentures Never Hardly Ever Occasionally Occasionally

11 Oral Health Quality of Life Painful aching in your mouth Difficult to relax due to problems with teeth, mouth or dentures Never Hardly Ever Occasionally Fairly Often Never Hardly Ever Occasionally Fairly Often Very Often

12 Oral Health Quality of Life Self-conscious due to problems with teeth, mouth, or dentures Felt tense due to problems with teeth, mouth or dentures Never Hardly Ever Occasionally Fairly Often Very Often Never Hardly Ever Occasionally Fairly Often Very Often

13 Oral Health Quality of Life Diet unsatisfactory due to problems with teeth, mouth or dentures Have had to interrupt meals due to problems with teeth, mouth or dentures Never Hardly Ever Occasionally Fairly Often Very Often Never Hardly Ever Occasionally Fairly Often Very Often

14 Oral Health Quality of Life Have been a bit embarassed because of problems with teeth, mouth or dentures Never Hardly Ever Occassionally Fairly Often Very Often Have felt that life was less satisfying because of problems with your teeth, mouth or dentures Never Hardly Ever Occasionally Fairly Often Very Often

15 Oral Health Quality of Life Have been irritable with other people due to problems with teeth, mouth or dentures Have had difficulty doing your usual jobs due to problems with your teeth, mouth or dentures. Have been totally unable to function due to problems Never Hardly Ever Occasionally Fairly Often Very Often

16 2017 Healthy Smiles Project Description Observational study of: oral health access, oral health self-care practices, oral health status, and oral health quality of life Inclusion criteria: Live in HUD-subsidized senior housing community in or around Wichita. Three data collection tools: Oral health access, OH self-care practices, and demographic information Oral Health Assessment Oral Health Impact Profile 14 (QOL assessment)

17 Low-Income Housing Criteria HUD-subsidized Housing SG County Median Income - $66,400 Income Limit Category Very Low (50%) Income Limits Extremely Low Income Limits Person(s) In Family 1 $23,250 $13,930 2 $26,600 $15,920 3 $29,900 $17,910 4 $33,200 $19,900 5 $35,900 $21,492 HUD-subsidized Senior Housing is for those aged 55 years and older

18 Specific Aims Assess oral health status of low-income seniors living in or near Sedgwick County, KS Assess oral health quality of life of lowincome seniors living in Sedgwick County, KS Assess oral health self-care behaviors of low-income seniors living in Sedgwick County, KS Explore correlations of oral health status and/or behaviors and health outcomes and/or quality of life outcomes

19 Participants Ten HUD-subsidized senior residences in Wichita, Derby & El Dorado participated Recruiting presentations by PI 174 signed consent forms Required a minimum of 10 participants to schedule data collection on-site from 6-9 PM on scheduled weekday evenings Participants 163 participants kept appointments and completed assessments (93%) Incentives (oral self-care supplies) were provided

20 Data Collection Data collected March 9 - April 24, 2017 ECP Hygienists Oral Health Assessment Doreen Eyler, GraceMed Davette McCoy, E.C. Tyree health and Dental Clinic Kathy Trilli, WSU WSU accelerated nursing students were taught to administer: Oral health access, OH self-care practices, and demographic information & Oral Health Impact Profile 14 (QOL assessment) All tools were read to all participants and oral responses recorded by nursing students

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25 Oral Health Assessment Tool Removable lower denture: 38% Removable upper denture: 47% Wear lower denture to eat: 33% Wear upper denture to eat: 44% Substantial oral debris: 8% Untreated decay: 39% Untreated root decay: 25% Root fragments: 22% Loe and Silness Gingival Index: Normal - 54% Mild/Moderate inflammation 37% Severe inflammation 9%

26 Oral Health Assessment Tool Miller Mobility: Normal 88% Mobility greater than physiologic 7% Tooth movement 1 mm or more 5% Urgency of dental care (urgent): 9% Urgency of dental care (within few weeks): 40% Dry cracked lips: 35% Dry cracked tongue: 37% Lack of saliva: 41%

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28 Words Taste Aching Eating SelfConscious Oral Health Impact Profile 14 Never Occasionally Often Top to bottom: Self-conscious, Eating, Aching, Taste, Words

29 Tensed Diet InterruptedMeal Relaxation Embarrased Oral Health Impact Profile 14 Never Occasionally Often Top to bottom: Embarrassed, Relaxation, Interrupted Meal, Diet, Tense

30 Irritable Usual.Activity Life.Satisfaction Functionality Oral Health Impact Profile 14 Never Occasionally Often Top to bottom: Functionality, Life Satisfaction, Usual Activity, Irritable

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32 Additional Findings Risk of pneumonia among Normal Miller Mobility is 7% lower than Mobile Miller mobility Risk of dry mouth (lack of saliva) is 4% higher among participants with untreated root decay compared to those without untreated root decay Risk of diabetes among Normal Miller Mobility is 28% higher than Mobile Miller mobility.

33 Questions for Discussion Should we try to replicate this study in other areas of KS? Why or why not? What additional research questions are of interest?