Chaitra Anil Kumar Health Informatics Objective To examine the relationship between dental status and timetodeath among nursing home residents Introduction Health status of elderly findings support prevalence of cognitive impairment Functional deficits such as bladder incontinence were al ID: 1046770
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1. Association between Dental Status and Time-to-Death among Nursing Home Residents in Eastern IowaChaitra Anil KumarHealth Informatics
2. ObjectiveTo examine the relationship between dental status and time-to-death among nursing home residents
3. IntroductionHealth status of elderly: findings support prevalence of cognitive impairment. Functional deficits such as bladder incontinence were also noticed. Residents needed help most with ADLs like bathing, personal hygiene and dressing. Quinn ME, Johnson MA, Andress EL, McGinnis P, Ramesh M. Health characteristics of elderly personal care home residents. J Adv Nurs. 1999 Aug; 30(2):410-7Dental health status of elderly: about 45% of the nursing home residents required assistance with eating. Oral care not mentioned specifically but it was conservatively estimated that residents who required assistance with eating also required assistance with mouth care. Jablonski RA. Examining Oral Health in Nursing Home Residents and Overcoming Mouth Care–Resistive Behaviors. Annals of Long-Term Care 02/12/2010Oral health problems: greatest need among dentate elderly was for routine oral hygiene (72%) Kiyak HA, Grayston MN, Crinean CL. Oral health problems and needs of nursing home residents. Community Dent Oral Epidemiol. 1993 Feb; 21(1):49-52
4. Barriers to good oral health: ability to pay, extended periods of time without direct access to dental care delivery system and serious chronic medical conditions Gift HC, Cherry-Peppers G, Oldakowski RJ. Oral health status and related behaviours of U.S. nursing home residents, 1995. Gerodontology. 1997; 14(2): 89-99Oral health and systemic health: poor oral hygiene is associated with an increased risk of aspiration pneumonia and ventilator-associated pneumonia (VAP) Haumschild MS, Haumschild RJ. The Importance of OralHealth in Long-TermCare. Jamda. Volume 10, Issue 9, November 2009, Pages 667–671In gerontological population studies of four 70-year-old cohorts, it was found that each remaining tooth at age 70 decreased the 7-year mortality risk of the individual by 4%. The number of teeth was a significant predictor of mortality independent of health factors, socio-economic status and lifestyle Osterberg T, Carlsson GE, Sundh V, Mellstrom D. Number of teeth--a predictor of mortality in 70-year-old subjects. Community Dent Oral Epidemiol. 2008 Jun; 36(3):258-68
5. Dental health behaviors: tooth brushing at night, using dental floss every day and visiting the dentist were significant factors for longevity. Edentulous individuals (even with dentures) had a 30% higher risk of death compared to those with 20+ teethPaganini-Hill A. Lifestyle Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study. Cardiology Research and Practice Volume 2011 (2011), Article ID 983764, 7 pagesDental health and 10-year mortality: more teeth or filled teeth a subject had, the smaller was their risk of death. Hamalainen P, Meurman JH, Keskinen M, Heikkinen E. Relationship between dental health and 10-year mortality in a cohort of community-dwelling elderly people. Eur J Oral Sci. 2003 Aug; 111(4): 291-6
6. MethodsColonial Manorn = 54Crest ViewLiving Center Westn = 85Pleasantviewn = 65Park Viewn = 44n=586n = 59 n = 67Living Center East n =60Oaknoll n = 36Lantern ParkGreenwood Manor n=44n = 67 n = 72Participants: 586 residents of 10 nursing homes in Eastern Iowa examined (screening exams of 1-3 minutes’ duration) by the faculty of the College of Dentistry at the University of Iowa through the ‘Geriatric Mobile Dental Unit’IC Care &Rehabilitation
7. Design: retrospective cohort studyProcedure: data collected during dental screenings are used to match individuals with entries in the death certificate databaseResidents were screened from 2006 through 2008Screening data were maintained as patient records at the University of Iowa Death certificates were matched on 06/06/2010 through IDPH death certificates in cooperation with Dr. Chuck Lynch, University of Iowa College of Public Health, Dept. of Epidemiology.Time-to-death is defined as the time period from Date of Screening to Date of Death
8. Statistical Analysis Univariate and Bivariate frequency distributions generated using SAS (Statistical Analysis Software, Version 9.2 for Windows) Multiple regression analysis will be done at a later date
9. ResultsOf the 586 residents screened, death records were matched to 372 individuals.Mean age at screening was 83.8 (10.7) yearsScreenedn = 586Mean age at Screening (83.8)Residents who diedn = 372Mean age at Screening (85.4)Residents who did not dien = 214Mean age at Screening (81.0)
10. Frequency Distribution (Dental)Frequency Distribution of Variables (Denture and Denture Use)CharacteristicNLevelN(%)Maxillary Denture517Complete199 (39) Partial32 (6) None180 (35) NA32 (6)Mandibular Denture498Complete120 (24) Partial42 (8) None147 (30) NA189 (38)Maxillary Denture Usage327Day & Night51 (16) All Day114 (35) Never + Occasionally28 (9) NA134 (41)Mandibular Denture Usage301Day & Night35 (12) All Day78 (26) Never + Occasionally29 (10) NA159 (53)
11. Frequency Distribution of Variables (Oral Cavity)CharacteristicNLevelN(%)Dentate521Max/Man303 (58) Edentulous151 (29) Lower Arch Only58 (11) Upper Arch Only6 (1) Root Frag Only3 (1)Xerostomia502None194 (39) Slight178 (36) Moderate103 (21) Severe27 (5)Oral Hygiene201Self127 (63) Other74 (47)
12. Frequency Distribution of Variables (Teeth and Associated Structure)CharacteristicNLevelN(%)Soft Deposits on Teeth333Heavy115 (35) Moderate122 (37) Slight96 (29)Hard Deposits on Teeth333Heavy72 (22) Moderate150 (45) Slight111 (33)Periodontitis253Advanced32 (13) Moderate113 (45) Slight108 (43)Gingivitis296Severe52 (18) Moderate144 (49) Slight100 (34)
13. Frequency Distribution (Other) Frequency Distribution of Variables (Mental Status)CharacteristicNLevelN(%)Gender586Male181 (31) Female405 (69)Mental Status507Alert418 (83) SemiAlert69 (14) NonCommunicative20 (4)Cooperative (Extraoral exam)508Very221 (44) Somewhat192 (38) Slightly61 (12) Uncooperative34 (7)Cooperative (Intraoral exam)497Very362 (73) Somewhat73 (15) Slightly30 (6) Uncooperative32 (6)
14. Frequency Distribution of Variables (Physical Status)CharacteristicNLevelN(%)Auditory505Normal373 (74) Other132 (26)Sight503Normal236 (47) Corrected219 (44) Other48 (10)Speech500Normal367 (73) Speaks W/Difficulty97 (20) Unintelligible Speech36 (7)Physical Status449Ambulatory89 20) Walks W/Difficulty94 (21) Easy/Transport177 (39) Difficulty/Transport88 (20) Bedfast1 (0)
15. Frequency Distribution (Death Records)Frequency Distribution of VariablesCharacteristicNLevelN(%)Education372<12 grade116 (31)12 grade154 (41)>12 grade102 (27)Marital Status371Single + Divorced76 (21)Married76 (21)Widowed219 (59)Place of Death372Inpatient72 (19)Nursing Home283 (76)Other17 (5)Race372White 365 (98)Other7 (2)Funds351Title19271 (77)Private80 (23)
16. Mean age at death was 86.7 (5.2) years and n=371Time-to-death was 1.26 (0.8) years and n=371Highest percentage of deaths occurred in residents classified as ‘having no dentures and no teeth’This group also had the lowest mean age at screening among the entire resident populationDental StatusN (%)Mean (SD) Age at Screening (Years)% Male % DeathsTime to Death (Years) of % DeathsNo Denture, No Teeth26 (5)80.2 (14.2)35730.88Denture, No Teeth136 (27)84.7 (8.9) 27691.08No Denture, 1-16 Teeth 47 (9)82.7 (11.7)38471.39Denture, 1-16 Teeth 63 (12)85.0 (10.3) 27631.4117-24 Teeth131 (26)85.1 (9.6)34691.2625-32 Teeth105 (21)81.8 (12.7)32531.21Total 508 (100)83.8 (10.7)31631.26
17. DiscussionFindings support literature review that edentulous individuals had a higher risk of death compared to those individuals who had teeth
18. LimitationsSocio-economic factors of individuals as well as the nursing homes were not considered for analysisTime-to-Death does not reflect quality of lifeSome potentially important variables were not available for analysis (e.g., utilization of health services)
19. StrengthsSome variables were collected that could be analyzed later (e.g., medical conditions)Some variables were available that have not yet been collected (e.g., medications)
20. AcknowledgementsDr. Daniel J Caplan – Dept. of Preventive and Community DentistryDr. Michael W Finkelstein – Dept. of Oral Pathology, Radiology and MedicineDr. Der Fa Lu – College of Nursing
21. Questions?