Contemporary evaluation of oral health in US nursing homes

About This Grant

PROJECT SUMMARY This proposal responds to PA-25-304. The proposed R21 directly responds to the National Institute of Dental and Craniofacial Research (NIDCR) Strategic Goal 3. The US Oral Health Workgroup monitors trends in 12 oral health indicators aimed at reducing the prevalence of tooth decay, untreated tooth decay, tooth loss, and periodontitis. However, a more granular evaluation of progress by older age groups (e.g., 75-84, ≥85 years) is not possible. Furthermore, nursing home residents are excluded from the data used to track oral health progress. This is so despite: 1) the dramatic aging of the US population; 2) the increasing importance of nursing homes as a health care setting, and 3) explicit calls to action to improve nursing home resident oral health care in the 2000 Surgeon General and 2021 NIDCR Oral Health Reports. In the 25 years since the first Surgeon General Oral Health report highlighted the unmet oral health needs of nursing home residents, there has been no monitoring of oral health indicators or contemporary, national estimates of oral health in nursing homes. The proposed R21 seeks to evaluate the extent to which the federally mandated Minimum Data Set 3.0 (MDS), collected on virtually all US nursing home residents, can be leveraged to monitor the advancement of these goals, predict those in greatest need of oral health services, and identify successful regulatory and policy strategies to improve oral health in a population with a high burden of unmet need. To begin addressing the Oral Health Strategic Framework’s call for essential data needed for program planning and evaluation on “the frail elderly,” this R21 will merge in-house MDS 3.0 (2011-2023) to Medicare 2011-2022 (e.g., Medicare Advantage plans with dental benefits), nursing home files (e.g., nursing home staff), and area-level information (e.g., dental workforce shortages). Natural variations in time and place, combined with advanced statistical analyses and research- ready data, will yield actionable insights into regulatory, insurance, and workforce factors that influence oral health patterns among older nursing home residents. The specific aims are to: 1) Provide a comprehensive epidemiological analysis profiling resident oral health at nursing home admission, separately for skilled nursing facility patients and long-stay nursing home residents; 2) Identify resident-level and area-level factors associated with poor oral health at nursing home admission; 3) Estimate the extent to which residents experience decline in oral health status over time and identify the resident-, nursing home-, and area-level factors associated with oral disease progression; and 4) Identify nursing home- and area-level factors associated with oral health deficiency citations in nursing homes. The R21 provides much-needed contemporary, national information to understand the oral health needs of nursing home residents, facilitating the identification of intervention targets. The development of a practical oral health decline risk tool may help identify residents in need of early dental care intervention at admission.