Oral Health Status of Low-Income Seniors Living in Sedgwick County Judy Johnston1, Milan Bimali1,2, Susan Parsons3, 1: Department of Preventive Medicine and Public Health, KUSM-W 2: Office of Research, KUSM-W 3: School of Nursing, Wichita State University

What we will discuss: Project history and pilot data 2017 project description & data Discussion

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 Study approved by University of Kansas School of Medicine – Wichita and Via Christi Health Systems Institutional Review Boards

Project History 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

2015-2016 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

Dental Insurance Status

Oral Health Status Mouth Pain

Oral Health Status

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)

Oral Health Habits

Oral Health Quality of Life

Oral Health Quality of Life

Oral Health Quality of Life

Oral Health Quality of Life

Oral Health Quality of Life

Oral Health Quality of Life

2017 Healthy Smiles Project Description Study approved by University of Kansas School of Medicine – Wichita Institutional Review Board Observational study of: oral health access, oral health self-care practices, oral health status, and oral health quality of life

2017 Healthy Smiles Project Description 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 for Seniors Oral Health Impact Profile 14 (QOL assessment)

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

Specific Aims Assess oral health status of low-income seniors living in or near Sedgwick County, KS Assess oral health quality of life of low-income 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

Participants Participants Ten HUD-subsidized senior residences in Wichita, Derby & El Dorado 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 (~ $10 in oral self-care supplies) were provided

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 Dental Hygiene Program WSU accelerated nursing students were taught to administer: Oral health access survey questions OH self-care practices, and demographic information survey questions, Oral Health Impact Profile 14 (QOL assessment) All tools were read to all participants and oral responses recorded by nursing students Either Ms. Johnston or Dr. Parsons supervised students at each data collection event

Oral health access, oral health self-care practices, and demographic information

Oral Health Assessment Tool for Seniors Indicators from Basic Screening Surveys: An Approach to Monitoring Community Oral Health of Older Adults, Association of State and Territorial Dental Directors (ASTDD), October 2010, with the addition of specific quantitative measures of gingival health and tooth mobility

ASTDD Recommended Indicators Seven recommended and five optional oral health status indicators for older adults Recommended Indicators Dentures and denture use Number of natural teeth Untreated decay Root fragments Need for periodontal care - Loe and Silness Gingival Index 0 = Normal gingival 1 = Mild inflammation – slight change in color, slight edema 2 = Moderate inflammation – redness, edema, and glazing. 3 = Severe inflammation – marked redness and edema, ulceration, tendency to spontaneous bleeding Suspicious soft tissue lesions Urgency of need for dental care

ASTDD Recommended Indicators Optional Indicators Functional posterior occlusal contacts Substantial oral debris Severe gingival inflammation Obvious tooth mobility (Miller Classification of Tooth Mobility) 0 = Normal (physiologic) movement when force is applied 1= Mobility greater than physiologic 2= Tooth can be moved up to 1mm or more in a lateral direction (buccolingual or mesiodistal); Inability to depress the tooth in a vertical direction (apicocoronal) 3= Tooth can be moved 1mm or more in a lateral direction (buccolingual or mesiodistal; Ability to depress the tooth in a vertical direction (apicocoronal) Severe dry mouth

Oral Health Assessment Data 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% Dry cracked lips: 35% Dry cracked tongue: 37% Lack of saliva: 41%

Oral Health Impact Profile 14: Oral Health Quality of Life Assessment

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

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

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

Correlations

Eating Discomfort correlated with untreated root decay, root fragments & mouth pain; Feeling of embarrassment correlated with denture use

Additional Findings Risk of pneumonia among participants with “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

Questions for Discussion Should we try to replicate this study in other areas of KS? Why or why not? What additional research questions about oral health among seniors are of interest? What ideas for low-cost interventions might you have?