Transcript Association between Dental Status and Time-to

Association between Dental Status
and Time-to-Death among Nursing
Home Residents in Eastern Iowa
Chaitra Anil Kumar
Health Informatics
Objective
• To examine the relationship between dental
status and time-to-death among nursing home
residents
Introduction
• Health 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):410-7
• Dental 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 02/12/2010
• Oral 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
• 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): 89-99
• Oral 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 667–671
• In 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
• 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+ teeth
•
Paganini-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 pages
• Dental 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
Methods
Participants: 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’
Colonial
Manor
n = 54
Crest View
n = 59
IC Care &
Rehabilitation
Greenwood
Manor
n=44
n = 72
Living
Center
East
n =60
n=586
Lantern
n
= 67
Park
n = 67
Living
Center West
n = 85
Oaknoll
n = 36
Park View
n = 44
Pleasantview
n = 65
• Design: retrospective cohort study
• Procedure: data collected during dental screenings are
used to match individuals with entries in the death
certificate database
• Residents were screened from 2006 through 2008
• Screening 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
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
Results
• Of the 586 residents screened, death records
were matched to 372 individuals.
• Mean age at screening was 83.8 (10.7) years
Screened
n = 586
Mean age at Screening
(83.8)
Residents who died
n = 372
Mean age at Screening
(85.4)
Residents who did not die
n = 214
Mean age at Screening
(81.0)
Frequency Distribution (Dental)
Frequency Distribution of Variables (Denture and Denture Use)
Characteristic
Maxillary Denture
Mandibular Denture
Maxillary Denture Usage
Mandibular Denture Usage
N
Level
517
Complete
199 (39)
Partial
32 (6)
None
180 (35)
NA
32 (6)
Complete
120 (24)
Partial
42 (8)
None
147 (30)
NA
189 (38)
498
327
301
N(%)
Day & Night
51 (16)
All Day
114 (35)
Never + Occasionally
28 (9)
NA
134 (41)
Day & Night
35 (12)
All Day
78 (26)
Never + Occasionally
29 (10)
NA
159 (53)
Frequency Distribution of Variables (Oral Cavity)
Characteristic
Dentate
Xerostomia
Oral Hygiene
N
Level
521
Max/Man
303 (58)
Edentulous
151 (29)
Lower Arch Only
58 (11)
Upper Arch Only
6 (1)
Root Frag Only
3 (1)
502
201
N(%)
None
194 (39)
Slight
178 (36)
Moderate
103 (21)
Severe
27 (5)
Self
127 (63)
Other
74 (47)
Frequency Distribution of Variables (Teeth and Associated Structure)
Characteristic
Soft Deposits on Teeth
Hard Deposits on Teeth
Periodontitis
Gingivitis
N
Level
333
Heavy
115 (35)
Moderate
122 (37)
Slight
96 (29)
Heavy
72 (22)
Moderate
150 (45)
Slight
111 (33)
Advanced
32 (13)
Moderate
113 (45)
Slight
108 (43)
Severe
52 (18)
Moderate
144 (49)
Slight
100 (34)
333
253
296
N(%)
Frequency Distribution (Other)
Frequency Distribution of Variables (Mental Status)
Characteristic
Gender
Mental Status
Cooperative (Extraoral exam)
Cooperative (Intraoral exam)
N
Level
586
Male
181 (31)
Female
405 (69)
Alert
418 (83)
507
508
497
N(%)
SemiAlert
69 (14)
NonCommunicative
20 (4)
Very
221 (44)
Somewhat
192 (38)
Slightly
61 (12)
Uncooperative
34 (7)
Very
362 (73)
Somewhat
73 (15)
Slightly
30 (6)
Uncooperative
32 (6)
Frequency Distribution of Variables (Physical Status)
Characteristic
Auditory
Sight
Speech
Physical Status
N
Level
505
Normal
373 (74)
Other
132 (26)
Normal
236 (47)
Corrected
219 (44)
Other
48 (10)
Normal
367 (73)
Speaks W/Difficulty
97 (20)
Unintelligible Speech
36 (7)
Ambulatory
89 20)
Walks W/Difficulty
94 (21)
Easy/Transport
177 (39)
Difficulty/Transport
88 (20)
503
500
449
Bedfast
N(%)
1 (0)
Frequency Distribution
(Death Records)
Frequency Distribution of Variables
Characteristic
Education
Marital Status
Place of Death
N
Level
372
<12 grade
116 (31)
12 grade
154 (41)
>12 grade
102 (27)
371
372
Single + Divorced
76 (21)
Married
76 (21)
Widowed
219 (59)
Inpatient
72 (19)
Nursing Home
Race
Funds
372
351
N(%)
283 (76)
Other
17 (5)
White
365 (98)
Other
7 (2)
Title19
271 (77)
Private
80 (23)
Mean age at death was 86.7 (5.2) years and n=371
Time-to-death was 1.26 (0.8) years and n=371
Dental Status
N (%)
Mean (SD) Age at
Screening (Years)
% Male
Time to Death
(Years) of
% Deaths % Deaths
No Denture, No Teeth
26
(5)
80.2 (14.2)
35
73
0.88
Denture, No Teeth
136 (27)
84.7 (8.9)
27
69
1.08
No Denture, 1-16 Teeth
47
(9)
82.7 (11.7)
38
47
1.39
Denture, 1-16 Teeth
63 (12)
85.0 (10.3)
27
63
1.41
17-24 Teeth
131 (26)
85.1 (9.6)
34
69
1.26
25-32 Teeth
105 (21)
81.8 (12.7)
32
53
1.21
Total
508 (100)
83.8 (10.7)
31
63
1.26
Highest 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
population
Discussion
• Findings support literature review that
edentulous individuals had a higher risk of death
compared to those individuals who had teeth
Limitations
• Socio-economic factors of individuals as well as
the nursing homes were not considered for
analysis
• Time-to-Death does not reflect quality of life
• Some potentially important variables were not
available for analysis (e.g., utilization of health
services)
Strengths
• Some 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)
Acknowledgements
• Dr. Daniel J Caplan – Dept. of Preventive and
Community Dentistry
• Dr. Michael W Finkelstein – Dept. of Oral
Pathology, Radiology and Medicine
• Dr. Der Fa Lu – College of Nursing