Oral Health and Malnutrition: Opportunities for Oral and Public Health Professionals to Partner with an Elder Nutrition Program to Make an Impact

Transcription

1 Oral Health and Malnutrition: Opportunities for Oral and Public Health Professionals to Partner with an Elder Nutrition Program to Make an Impact Wisconsin Institute for Healthy Conference Sara Koenig, Elder Nutrition Program Manager Anne Hvizdak, Statewide Coordinator Evidence-Based Health Promotion Programs Wisconsin Department of Health Services Bureau of Aging and Disability Resources June 7, 2018 Wisconsin Department of Health Services Division of

2 Objectives Learn about: How public health professionals can work in partnership with the Elder Nutrition Program. Tools and resources available to oral health professionals. Tools and resources available to Elder Nutrition Managers.

3 Quick Facts from The Oral Health of Wisconsin Adults Survey (2015) Used Basic Screening Survey (BSS) and self reports. 13% of Wisconsin adults surveyed 65 years and older had no natural teeth. Adults with income below $25,000 had significantly higher unmet dental need. Adults with chronic conditions were 1.5 times more likely to report pain. Adults with an intellectual disability reported two times more pain when eating. DHS P (01/2016)

4 Oral Health By the Numbers National Academy for State Health Policy Americans without dental insurance are two times more likely than those without medical insurance Low income adults are two times as likely to go without an annual dental checkup. Between , Emergency Department (ED) visits for preventable dental conditions increased 16%. ED visits cost healthcare system $2.1 billion in

5 The Aging Network US Department of Health and Human Services Administration for Community Living (ACL), Administration on Aging State Unit on Aging (Wisconsin Bureau of Aging and Disability Resources) Area Agencies on Aging (AAAs) (Greater Wisconsin Agency on Aging Resources, AAA of Dane County, Milwaukee County Department on Aging) County and Tribal Aging Units

6 Older Americans Act (OAA) Signed into law July 14, 1965, part of Johnson s Great Society. Medicare and Medicaid also enacted in Serves adults 60 and older. Provides nutrition and community support to millions. Protects the rights of older adults and has been the key to independence. Serves as a foundation for economic, health, and social support for millions of older adults and adults with disabilities.

7 Older Americans Act (OAA) Title II: Administration on Aging (AoA) Title III: Grants for State and Community Programs on Aging Part A General Provisions Part B Supportive Services and Senior Centers Part C Congregate and Home-Delivered Nutrition Services Part D Disease Prevention and Health Promotion Services Part E National Family Caregiver Support Program Title IV: Training, Research, and Discretionary Projects and Programs Title V: Community Service Employment for Older Americans Title VI: Grants for Native Americans Title VII: Allotments for Vulnerable Elder Rights Protection Activities

8 OAA Title III Target populations older adults who are: Low-income From minority or Limited English Proficiency populations Living in rural areas Socially and economically needy No income or asset test Eligible participants must have the opportunity to contribute but cannot be charged a fee

9 OAA Title III Part C Congregate (C-1) and Home-Delivered Nutrition Services (C-2) Purpose: Reduce hunger and food insecurity Promote socialization of older individuals Promote the health and well-being of older adults through access to nutrition and other disease prevention and health promotion services to delay the onset of adverse health conditions

10 OAA Title III Part C Congregate (C-1) and Home-Delivered Nutrition Services (C-2) Objectives: Prevent malnutrition Promote good health behaviors through nutrition education, nutrition screening, and nutrition counseling of participants. Serve wholesome, delicious meals that are safe and of good quality. Coordination with nutrition-related and other supportive services for older individuals.

11 Nutrition Programs Must: Have both a congregate (senior dining) and home-delivered meal (Meals on Wheels) program Have at least one dining center that serves meals five or more days per week Deliver home-delivered meals five days per week in most of the service area Provide nutrition education and counseling services

12 Community Dining Centers Approximately 505 dining center locations in Wisconsin. Most meals provided Monday through Friday around the noon hour, but days and times open can vary. Dining centers also sponsor programs on health, nutrition education, and other consumer issues.

13 Home-Delivered Meals (HDMs) Available to older adults who are: Homebound due to health reasons. Physically or emotionally unable to travel for a meal with others. Home visit to determine eligibility. Meals delivered in-person by volunteer and paid staff drivers who are concerned with the well-being of the individual.

14 Title III Dining Center Locations and County-level % of Population Ages 60 and Older with Income Under 150% of the Federal Poverty Level Legend Geocoding Re County Bounda LessThan150Per 10% - 16% 17% - 20% 21% - 29% Source: American Community Survey, Special Tabulation on Aging for ACL/AGiD, prepared by U.S Census

15 Wisconsin s Nutrition Program FY ,517,474 senior dining meals 2,278,468 home-delivered meals 67,308 older adults (60 and older) served 46,260 senior dining participants 21,048 Meals on Wheels participants 141,155 nutrition education sessions provided 470 older adults provided with 1,764 nutrition counseling sessions

16 What is Malnutrition? Mal (without, poor, bad) nutrition Nutrition imbalance that affects both overweight and underweight individuals Presence of two or more of the following characteristics: insufficient energy intake weight loss loss of muscle mass loss of subcutaneous fat localized or generalized fluid accumulation diminished functional status White JV, et al. J Acad Nutr Diet. 2012;112(5):

17 Physical Signs of Malnutrition Skin rash, wounds Puffy feet Sunken cheeks Poor-fitting dentures Cracks at the corners of the mouth Appearance of loss of muscle mass, particularly in the upper arms Appearance of weight loss, such as clothing that is too large or drooping, sagging skin Dry mouth or chapped lips

18 Risk Factors Associated with Poor Nutritional Status of Older Adults Difficulties preparing or eating food Decreased intake below recommended levels Eating less than one or two meals per day Lack of: consumption from all the food groups appetite or hunger facilities social support to provide food Recent loss of a spouse or caretaker who provided food Special or therapeutic diet Food avoidances

19 Oral Tissues Oral soft tissues among first tissues in body to develop clinical manifestations of nutrient deficiencies Rapid turnover of oral mucosal cells Examples: B vitamins, Vitamin C, protein, iron Nutrient excesses also impact oral soft and hard tissues Example: Vitamin A toxicity

20 Oral Health Problems Can Lead to Malnutrition Decayed (caries), painful or broken teeth Bleeding or swollen gums (periodontal disease) Painful or swollen tongue Mouth sores that will not heal Jaw pain or clicking Frequent dry mouth Difficulty swallowing

21 Chronic Conditions that Can Impact Oral Health and Nutrition Eating disorders (bulimia, anorexia) Oropharyngeal cancer Chemotherapy Diabetes Autoimmune disorders Cardiovascular disease Osteoporosis Swallowing Disorders

22 Nutrition Screening Manual of Policies, Procedures, and Technical Assistance for the Wisconsin Aging Network Nutrition screening checklist helps identify participants who are at nutritional risk. Required screening tool nationwide is the "DETERMINE Your Nutritional Health" checklist. All participants receiving services with Title III-C funds receive a nutrition screen at least once per year.

23 DETERMINE Your Nutritional Health Checklist nutritionandaging.org/toolkit-the-nutrition-screening-initiatives/ 25

24 Persons Served at High Nutritional Risk in Wisconsin 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% Senior Dining Home-Delivered Meals 0.00%

25 Home-Delivered Meal Assessment Includes: DETERMINE Your Nutritional Risk Activities of Daily Living (ADL) Instruments of Daily Living (IADL) 25% of Meals on Wheels participants have three or more ADLs. Older adults with impaired ability to perform ADLs are at greater risk of declining nutritional status. 74% of Meals on Wheels participants have three or more IADLs. 27

26 Nutrition Education Manual of Policies, Procedures, and Technical Assistance for the Wisconsin Aging Network Nutrition, physical fitness, or health (as it relates to nutrition) information. Suitable to participant needs and interests: personal, cultural, socioeconomic. Provided a minimum of four times per year (one time per quarter). Examples include cooking demonstrations, educational tastetesting, presentations, lecture or small-group discussions, and printed materials. Reviewed and approved by program nutritionist.

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29 Nutrition Counseling Manual of Policies, Procedures, and Technical Assistance for the Wisconsin Aging Network Individualized advice and guidance for improving nutritional status. Provided to individuals with nutritional risk due to health or nutritional history, dietary intake, medication usage or chronic illnesses. Suitable to participant needs and interests: personal, cultural, socioeconomic. Includes home and caregiver resources. Performed by a qualified nutritionist.

30 Opportunities for Collaboration Oral Health and Nutrition Address oral health as part of nutrition screening, assessment, intervention, and monitoring (nutrition program nutritionists and community dietitians). Diet interventions that target individual needs. Oral health screening and referral for individuals identified with unmet needs. Daily oral health care plans including appropriate dental aids, etc.

31 OAA Title III Part D Part D Disease Prevention and Health Promotion Services Purpose: Provide opportunities to improve health through selfmanagement and behavior change programs known as evidence-based health promotion programs: Living Well, Healthy Living with Diabetes, Stepping On Prevent disease through screening and health promotion activities

32 Administration for Community Living Administration on Aging Oral Health Guide: Community Guide to Adult Oral Health Program Implementation Program development process Community needs assessments (Basic Screening Survey) Evaluation of program effectiveness Templates and worksheets Tools to target population selection Development of vision, mission, and goals Program design and implementation Partnership-building Funding

33 Association of State and Territorial Dental Directors ASTDD Basic Screening Survey (BSS) for Older Adults Planning and Implementation Tool Kit Tool kit targeted at older adults can be purchased for $10.00 BSS survey for older adults focuses on: Dentures and denture use Number of natural teeth Untreated decay Root fragments Need for periodontal care Suspicious soft tissue lesions Urgency of need for dental care

34 Oral Health America Wisdom Tooth Project: State of Decay series Legislative priorities to implement OAA oral health screening provisions Campaign for Oral Health Equity, Alliance for Aging Research and National Association for Nutrition and Aging

35 National Association of States United for Aging and Disabilities Convened an Oral Health Learning Collaborative focused on Older Adults and People with Disabilities. Presented at Home and Community Based Services Conference. Focused on poor oral health and overall health and wellbeing for since

36 Gerontological Society of America Collection of resources including links to: oral health-related organizations and initiatives, publications and presentations, research opportunities and funding. White paper, "Interprofessional Solutions for Improving Oral Health in Older Adults: Addressing Access Barriers, Creating Oral Health Champions."

37 Wisconsin Oral Health Program Wisconsin Oral Health Roadmap Reports and publications that can be used for oral health education Free and reduced clinics

38 Wisconsin Oral Health Coalition (WOHC) Oral Health and Systemic Health Connection cuments/oh3infographic.pdf

39 American Dental Hygienists Association October is National Dental Hygiene Month

40 Smiles for Life Curriculum Eight 60-minute modules covering core areas of oral health relevant to health professionals. Graphics and brochures that target adults are available. User competencies are measured through assessments at course completion. Users must score an 80% or higher to receive credit for each course.

41 Healthy Smiles for Seniors Oral health educational project sponsored by Northern Area Health Education Centers and Wisconsin Public Health Association (WPHA). Training and materials available to Wisconsin Oral Health Coalition (WOHC) members upon request. Created by members of the WPHA Dental Hygiene Section. Presented at personal care worker, caregiving, assisted living and Leading Age Conferences.

42 ACL s Oral Health Website Additional Links Washington Dental Service Foundation, Senior Oral Health CDC, Oral Health Healthy People 2020, Oral Health HRSA, Oral Health HRSA, Rural Oral Health Toolkit National Cancer Institute, Oral Cancer NIDCR Information for Older Adults NIH Senior Health: Gum (Periodontal) Disease Senate Hearing on the Dental Crisis in America, Health Education Labor and Pensio Senate Subcommittee Report Dental Crisis in America: the Need to Expand Access

43 Thank you TOGETHER WE CAN HAVE AN IMPACT! Sara Koenig Anne Hvizdak Wisconsin Department of Health Services Division of