Transcript Strategic Planning Committee Charter

Oral Health and
Older Adults
W4A Advisory Councils and State
Council on Aging
October 16th, 2008
Seniors are at increased risk for oral disease
• Poor oral health throughout life – worsens with time
• New disease due to:
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Breakdown of previous restorations
New health condition which affects the mouth (including dry mouth)
Gum recession leaves tooth roots vulnerable to decay
Physical/mental conditions make home care challenging – must
rely upon caregiver
• Lack access to preventive care
• Expectation to need dentures (seems to be fading)
• Competing financial priorities – lower value on oral health
Magnitude of the Problem
• Nationwide, seniors’ oral health is improving:
• Untreated decay is down 30%
• Untreated root caries is down 36%
• Edentulism (toothlessness) is down 20%
• However, too many seniors still experience oral disease:
• 1 in 5 currently have decay
• 1 in 4 have severe periodontal disease (gum disease)
• Jumps to 1 in 3 among low-income
Gum Disease Increases with Age
Racial/Ethnic Disparities
Income Disparities
Difficulties Accessing Care
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Medicare doesn’t cover dental
75% of seniors in WA are dentally uninsured
Only ~20% on Medicaid access care
Seniors are age group most likely to have had no dental
visit in 5 years (BRFSS)
• Causes missed opportunities for prevention
• Many seniors put off paying for care until problem is
significant
Oral Health - Overall Health Connection
“You cannot be healthy without
oral health.”
Surgeon General’s Report on Oral Health
~May 2000
Periodontal Disease – Medical Link
• Diabetes:
• Diabetes increases risk for gum disease
• People with diabetes and severe gum disease are more likely to
have problems with glycemic control
• Treating gum disease may improve glycemic control and prevent
costly diabetic complications
• Heart Attack/Stroke
• Pnemonia
Gum Problems - Photos
4. Gingivitis
5. Periodontal Disease
Dry Mouth (xerostomia)
• Estimated that 25% of seniors have dry mouth
• Saliva is protective:
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cleanses the mouth;
neutralizes acid;
kills bacteria and other germs
remineralizes teeth (fluoride and calcium)
• Causes:
• Health conditions (diabetes, Sjögren’s Syndrome)
• Cancer treatments
• Medications
• 7 out of 10 most commonly prescribed medications
• Antidepressants, antipsychotics, antihistamines, decongestants,
antihypertensives, diruetics, antiparkinsonian drugs
Dry Mouth Incidence
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Risk increases with the number of medications taken.
Nederfors, et. al, 1997
Dry Mouth – Side Effects & Photos
11. Root Decay
Tongue
12. Cracks on Corners of Lips
13. Dry, Painful Tongue
14. Possible Fungal Infection
Dry Mouth Prevention and Remedies
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Saliva substitutes (Biotene, Orajel, etc…)
Increase water intake
Increase fluoride
Avoid alcohol (including in mouthwash), tobacco, sugary drinks
Xylitol:
• Plant-derived sugar alcohol.
• Sugar alcohols - reduce tooth decay interferes with the production of
acids.
• Xylitol the most effective sugar alcohol at reducing tooth decay.
Washington Dental Service Foundation
• Non-Profit Corporate Foundation
• Mission: to eliminate oral disease for all
• Values:
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All people should have an equal opportunity to be healthy.
We strive to end racial, ethnic and income disparities as barriers to oral health.
We make a positive impact on people’s lives by influencing environments that affect
oral health over the long-term.
We are creative, innovative, adaptive and take calculated risks.
We are outcomes-driven.
We value teamwork, integrity, trust, diversity and shared purpose in our work
internally and externally.
The Theory of Change for Eliminating Oral Disease
Conditions for Success
Policy/decision-makers buy-in to the importance of oral
health and establish policies that support:
• Prevention of oral disease
• Access to services
• Good oral health behaviors
Adequate pool of providers, which contains the appropriate
balance of disciplines (including medical professionals), offers
oral health services efficiently in easily–accessible and
geographically distributed settings.
Public values the importance of oral health; understands the
mechanics and link to overall health; demands services and is
motivated to conduct good oral health behaviors and nutrition
habits
Science-based best practices for prevention and treatment are
understood and implemented by health professionals. Science
continually advances in the understanding of the biology of
oral disease.
Determinants of Oral Health
Access to Quality Healthcare
People access oral health care including
preventive and restorative services
Physical Environment
The physical environment promotes good oral
health: WA residents drink fluoridated water,
healthy snacks are available in schools and work
places
Social Environment
Social norms define behaviors and policies that
promote oral health as an essential element of
overall health as the accepted and expected
standard
Personal Behavior
Financial system provides incentives for and eliminates
barriers to serving the underserved; all patients have coverage
for care.
Culturally competent and diverse workforce increases the
comfort and quality of care for all populations and participates
in efforts to improve oral health at the community level
Community systems and services facilitate access to care for
everyone in their local community
WDSF Mission
People regularly and effectively practice oral
self-care and avoid practices that increase their
risk for oral disease
Biology
People routinely assess and manage their risk for
oral disease based on their individual biology
Eliminating oral
disease in order to
improve overall
health
WDSF Role
Identify and drive strategic changes
in systems to improve oral health
WDSF Initiatives
• Seniors’ Dental Access Pilot Project
• Caregiver Curriculum
• Media Campaign
Seniors Dental Access Pilot
• Goal: Improve oral and overall health of seniors through
increased access to preventive and restorative dental care
in medical and dental settings.
• Medicaid-insured adults age 55 and up
• 3-Year Pilot project
• July 09 – June 2010: systems, training, provider recruitment
• July 2010 – June 2012: Medicaid payments
Pilot Sites
San Juan
Whatcom
Okanogan
Ferry
Skagit
Stevens
Island
Clallam
Snohomish
Chelan
Jefferson
Douglas
Kitsap
King
Grays Mason
Harbor
Kittitas
Thurston
Pacific
Grant
Spokane
Lincoln
Adams
Whitman
Pierce
Lewis
Wahkiakum
Cowlitz
Pend
Oreille
Franklin
Skamania
Yakima
Benton
Walla
Walla
Garfield
Columbia
Klickitat
Clark
Clark County- Clark County Health Department
Southeast Region- Southeast WA Aging and LTC
Asotin
Partners
University of Washington
School of Dentistry
ELDERCARE
ALLIANCE
WASHINGTON SENIOR CITIZENS’
LOBBY
How it will work
• Based on Access to Baby and Child Dentistry model
• Links with other chronic disease management programs
• WDSF funds local coordinating agencies to conduct
patient outreach and provider recruitment
• UW School of Dentistry offers training events for dental
and medical providers
• Medicaid provides enhanced rates to dentists and
payments to physicians for oral health services
• Track utilization rates and study improvements in health
for patients with diabetes
Key Metrics
• Dental utilization rates - are more seniors accessing care
in dental setting?
• Preventive oral health services - does improved network
lead to more preventive screening and services in medical
and dental settings?
• Attracting participating providers - are more dental and
medical providers serving Medicaid-insured seniors?
• Medical and dental costs – will increased dental care for
this population that is at risk for chronic diseases reduce
medical costs associated with those diseases?
Caregiver Training
• Curriculum developed in 2004,pilot-tested by PRN,
certified by DSHS to qualify for 10 hour c.e. rolled-out to
caregiver training agencies
• Goal is to engage caregivers in oral health and teach skills
for improving oral health of clients/family members
• 6 modules: tooth decay, gum disease, oral cancer,
dentures, nutrition, dry mouth
Caregivers Can Improve Oral Health!
Prompt, assist, or perform the oral health care.
Monitor client’s mouth for changes.
Educate client about oral health information.
Refer problems to supervisor or case manager.
Tooth Decay - Process
Germs
+
Acid Attacks
Refined Carbohydrates
+ Tooth
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Acid
Decay
Untreated Decay  Infection, Abscess, Loss of Tooth
Activity: Check Your Mouth
Look at your gums, teeth, and tongue
What do you see?
Normal?
Not normal?
Evaluation
• Conducted in 2007 – 96 participants
• Key Question: Does training impact how caregivers
provide oral health care to clients/loved ones?
• Qualitative design:
• 14 focus groups –
• 6 trained, 6 untrained, 2 mixed
• 11 IPs, 3 agency
• 2 Russian
• 17 phone interviews
• Survey
• King, Pierce, Lewis, Yakima Counties
Partners
• Professional Registry of Nursing
• AAAs:
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LMT AAA
Pierce County AAA
King County Aging and Disability Services
Southeast Washington Aging and LTC
• ResCare HomeCare (formerly Armstrong)
• Elite International
Key Findings
• Trained caregivers are more active participants in their
clients’ oral health care (60% vs. 20%)
• Trained caregivers are more likely to:
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Look in the mouth – screen for problems
Help clients access dental care
Prompt or assist with brushing
Prompt or assist with cleaning dentures
Encourage wearing dentures
Recommend dry mouth remedies
Key Findings continued
• Trained caregivers are more confident in ability to care for
client’s teeth and mouth
• Trained caregivers mentioned improvements to their own
oral health care following the training:
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Eating healthier
Brushing right after meals
Flossing more regularly
Making a dentist appointment
Using gum with xylitol
Challenges
• Caregivers experience the following challenges in
providing oral health care for their clients:
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Client resistance
Conflict of roles with family members
Client dementia
Access to dental care for clients
Implications/Recommendations
• Need tips and support for overcoming client resistance
• Need additional content on providing oral health care for
clients with dementia
• Oral health needs a greater role in care plans – currently
falls in personal hygiene section, not health
• Develop programs to improve access to dental care for
this population
• Engage medical community
Media Campaign
• Television and radio spots
• Summer 2007: greater Puget Sound area
• Fall/Winter2007 and early 2008: Major WA markets
• Op-Ed pieces
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Tacoma News Tribune
Spokane Spokesman Review
Seattle PI
Tacoma News Tribune
Resources
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Geriatric Dental Group – Federal Way (253-839-1300)
Community Clinics
Local Health Jurisdictions/Oral Health Coalitions
WSDA Senior Discount Program – through I and R
Preventive services by hygienists in senior centers
Dental societies – community access programs
Vision…
• Public and leaders understand the link between oral health
and overall health
• Medical providers screen and provide preventive services
• Pharmacists counsel on dry mouth
• Oral health services available in community-based
settings
• Medicare includes dental benefit
Anything else????????