WA State Seniors Oral Health Status

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WA State Seniors Oral Health Status
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Methodology

• A total of 4,400 surveys were completed by phone
  with Washington State residents age 55 and older.
• Geographic quotas targeting equal representation
  of the 11 Area Agencies on Aging.

• Telephone interviews using Random Digit Dialing
  between July 24th and October 1st.
• Weights were created based on Census estimates
  for Washington State age and gender ratios were
  applied to reflect the states demographics.

• Statistical power
• Statistically significant differences are
  reported at the 95 confidence level all
  differences noted among subgroups are significant
  differences.
• With a confidence level of 99, the maximum
  margin of error for a sample of 4,400 is 1.5.
  The maximum margin of error in each AAA region,
  sample 400, is 4.8.

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Findings
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Oral Health Status

• Nearly six out of ten seniors have had at least
  one permanent tooth removed due to tooth decay,
  gum disease, or infection (59). This compares
  with roughly seven out of ten (69.3) nationally
  source 2010 BRFSS.
• Seniors who visit the dentist at least once a
  year are more likely to still have all their
  teeth (46) compared to those who visit the
  dentist less frequently (20).
• Insured seniors are less likely to have had a
  tooth removed (43 still have all their teeth)
  than those without dental insurance (31 have all
  their original teeth).
• One in five seniors rated the condition of their
  teeth as Fair or Poor.
• Roughly one in six rated their gums as Fair or
  Poor.

Those insured and those who visit the dentist at
least once a year are also more likely to have
their teeth and gums in very good or excellent
condition.
Q7. How many of your permanent teeth have been
removed because of tooth decay, gum disease or
infection? (n4400) Q8. How would you describe
the condition of your teeth? (n4400) Q9. How
would you describe the condition of your gums?
(n4400)
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Prevalence of Gum Disease and Tooth Decay

• Those seniors who still have at least some of
  their original teeth were described the symptoms
  of both gum disease and tooth decay and then
  asked if they think they might have either.
  question adapted from 2009-2010 NHANES
• 13 think they might have gum disease.
• 16 feel they might have tooth decay.

Those insured are less likely to think they have
gum disease (12 vs. 14) or tooth decay (11 vs.
21) than those who are not insured.
Those who visit the dentist at least once a year
are less likely to think they have gum disease
(11 vs. 20) or tooth decay (9 vs. 35) than
those who dont visit the dentist on an annual
basis.
Q11. People with gum disease might have bleeding
or swollen gums, receding gums, sore or infected
gums or loose teeth. Do you think you might have
gum disease? (n4031) Asked of those who still
have their original teeth Q12. People with tooth
decay might have holes in their teeth, a broken
filling or pain. Do you think you might have
tooth decay? (n4031) Asked of those who still
have their original teeth
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Needed Dental Work

• One out of five seniors currently have a dental
  issue that will need to be addressed within the
  next month (20).
• Over half of the needed work is for filling or
  replacing teeth (54) and other work is routine
  cleanings (33) or check-ups (21).
• Seniors who have not visited the dentist on at
  least an annual basis are more likely to need
  dental work in the next month (28) than those
  who see the dentist at least once a year (16).

Q10. Do you have any dental problems that need to
be addressed in the next month? (n4400) Q10A.
What dental care do you need in the next month?
(n860)
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Dry Mouth

• One out of ten (10) seniors indicated they have
  too little saliva in their mouths.
• One out of six (16) seniors sip liquids to help
  aid them in swallowing.
• Prevalence of dry mouth nationally is roughly 30
  for ages 65 and over.

Q17. Does the amount of saliva in your mouth seem
to be too little, too much, or do you not notice
it? (n4400) Q18. Do you sip liquids to aid in
swallowing any foods? (n4400)
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Frequency of Dental Visits

• More than two out of three seniors typically
  visit their dentist or hygienist at least once a
  year (69).
• WA seniors in the 25K to 75K income range were
  nearly twice as likely to see a dentist annually
  than seniors with incomes of 25K or less (70.9
  vs. 36.9).

Those who are insured are significantly more
likely to visit the dentist at least once a year
(84) than those without dental insurance (54
visit once a year or more).

• Income plays a role in frequency of visit as
  those with a high income (75K or more) are most
  likely to visit the dentist more than once per
  year
• 89 with high income (75,000 or more)
• 71 with middle income (25,000 to 75,000)
• 37 with low income (Less than 25,000)

Q2. How often do you usually go to the dentist
of dental hygienist? (n4400)
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Most Recent Dental Visit

• One in four (25) WA seniors have not had a
  dental visit within the past year.
• The main reason cited for not going is cost of
  the appointment.
• Nearly one in four (24.3) seniors with incomes
  under 25K had not seen a dentist in five years
  or more.

Those who are insured are significantly more
likely to have visited the dentist in the last
year (87) than those without dental insurance
(61).
Insured respondents are most likely to say they
didnt visit because there was no reason in
particular to go (38) while those not insured
were more likely to mention cost as a barrier to
a dental visit (55).
Q3. How long has it been since you last visited a
dentist or dental clinic for any reason?
(n4400) Q4. What is the main reason you have not
visited a dentist in the last year? (n1119)
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Dental Insurance Coverage

• Age and income both appear to be a factor of
  whether or not seniors have dental insurance
  coverage.
• As age increases, the chance of having dental
  insurance decreases.
• As income increases, the proportion of seniors
  with insurance increases.

Q6. Do you have any kind of insurance coverage
that pays for some or all of your routine dental
care? (n4400)
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Dental Insurance Washington State vs. National

• More older seniors in Washington have dental
  insurance compared to seniors nationally

Q6. Do you have any kind of insurance coverage
that pays for some or all of your routine dental
care? (n4400) US source Manski, Richard,
et. al. Dental Care Coverage Retirement.
Journal of Public Health Dentistry, 2009 70(1)
US figure for ages 51-64.
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Seniors with Caregivers

• Only 6 of seniors have a caregiver who comes to
  their home on a regular basis to help them with
  daily activities.
• Overall, seniors with caregivers are less healthy
  than seniors without caregivers. Seniors with
  caregivers were more likely to
• have at least one tooth removed due to disease or
  infection (74.4 with caregivers compared to
  58.4 without caregivers)
• rate the condition of their teeth and gums as
  fair or poor (30.2 compared to 19.1 for
  seniors without caregivers)
• indicate they had a dental problem that needed to
  be addressed with a month (28.9 compared to
  18.9 of seniors without caregivers).

78 of caregivers are paid for their help.
Q21. Does someone come to your home on a regular
basis, for example daily or weekly, to help you
with activities such as bathing, eating, house
chores, or shopping? (n4400) Q21A. Is this
person paid? (n247)
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Geographic

• Overall oral health differs by region as defined
  by the Area Agencies on Aging, but there may be
  more factors involved than merely the location.

• Cost of care is a primary barrier to care in
  Southeast, Olympic, Eastern and Snohomish regions
  (see map).

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Next Level of Analysis

• Deeper analysis of results to identify
  differences between regions and opportunities to
  design regional strategies
• Frequency of visits and barriers to care
• Prevalence of disease, especially dry mouth
• Income and insurance status within AAA regions
• Caregiver status within AAA regions
• Mapping locations of current seniors low-cost
  clinics with areas of need
• Identifying specific issues by age cohort to help
  design targeted strategies
• Severity and urgency of oral health problems
• Barriers associated with each age category
• Survey will be repeated every five years

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Discussion and Questions

• Next steps in Washington
• Other areas of interest to explore in further
  depth?