Contemporary evaluation of oral health in US nursing homes
openNIA - National Institute on Aging
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.
Up to $461K
health research