Una Sonrisa SaludableNunca EnvejeceReporte sobre el estado de salud oral en población de adultos mayores en California

Conrado E. Barzaga, MDSahiti Bhaskara, MPH, BDS

2018 Conferencia AnualVisión y Compromiso

4-6 Octubre 2018

Definiciones y conceptos básicos

• Adulto mayor es un término reciente que se le da a las personas que tienen más de 65 años de edad• Baby boomer es un término usado para describir a las personas que

nacieron durante el ”baby boom”, que sucedió en Estados Unidos, en el período contemporáneo y posterior a la Segunda Guerra Mundial, entre los años 1946 y 1964

Los Adultos Mayores son el grupo de mayor crecimiento en California• Incremento de 143% entre 1990 al 2020

• Tasa de crecimiento aun mayor después del 2020

• Para el año 2030, uno de cada cinco californianos tendrá 65 o mas años de edad.

• Baby boomers: La influencia de personas mayores de 85 años en California será aun mayor entre el 2030 y el 2040

California Department of Aging, Data and Statistics – Facts about California’s Elderly; Accessed at https://www.aging.ca.gov/data_and_statistics/facts_about_elderly/#Percentage

Envejecimiento

Sistema Cambios morfológicos Cambios funcionales

Cardiovascular

•Aumento de matriz colágena en túnica media•Pérdida de fibras elastina•Hipertrofia cardiaca: Engrosamiento septum•Disminución cardiomiocitos

•Rigidez vascular y cardíaca•Mayor disfunción endotelial•Volumen expulsivo conservado•Mayor riesgo de arritmias

Renal•Adelgazamiento corteza renal•Esclerosis arterias glomerulares•Engrosamiento membrana basal glomerular

•Menor capacidad para concentrar orina•Menores niveles renina y aldosterona•Menor hidroxilación vitamina D

Nervioso Central

•Menor masa cerebral•Aumento líquido cefalorraquídeo•Mínima pérdida neuronal, focalizada•Cambios no generalizados de arborización neuronal

•Menor focalización actividad neuronal•Menor velocidad procesamiento•Disminución memoria de trabajo•Menor destreza motora

Muscular •Pérdida de masa muscular•Infiltración grasa

•Disminución fuerza•Caídas / Fragilidad

Metabolismo Glucosa

•Aumento de grasa visceral•Infiltración grasa de tejidos•Menor masa de células beta

•Mayor producción adipokinas y factores inflamatorios•Mayor resistencia insulínica y diabetes

Envejecimiento

Cambios morfológicos Cambios funcionales

Sistema Estomatognático (Buco-dental)

•Cambios degenerativos de las glándulas salivales mayores y menores•Trastornos en la unidad neuromuscular del aparato masticatorio•Escasez del epitelio oral•Disminución de la densidad ósea de los huesos maxilares (superior e inferior)•Retracción de la encía (exponiendo las raíces de los dientes)•Desgaste del esmalte

•Hipofunción de las glándulas salivares/Disminución en la producción de saliva (Xerostomía)•Declive en la producción de encimas digestivas•Alteración de la digestión •Disminución de capacidad masticatoria•Pérdida del gusto / pérdida del apetito

La saliva y sus funciones

Funciones Componentes Lubricación Mucina, glicoproteínas ricas en prolina, agua.

Antimicrobiana Lisocima, lactoferrina, lactoperoxidasas, mucinas, cis;nas, hista;nas, inmunoglobulinas, proteínas ricas en prolina, IgA.

Mantenimiento integridad de la mucosa Mucinas, electrolitos, agua.

Limpieza Agua.

Capacidad tampón y remineralización Bicarbonato, fosfato, calcio, staterina, proteínas aniónicas ricas en prolina, flúor.

Preparación de los alimentos para la deglución Agua mucinas.

Diges;ón Amilasa, lipasa, ribonucleasa, proteasas, agua, mucinas.

Sabor Agua, gustina.

Fonación Agua, mucina.

Anatomía dental

La saliva y sus funciones

3 Alteraciones patológicas mas comunes del adulto mayor:

- Xerostomía- Periodontitis- Caries (especialmente del

cuello)

Una Sonrisa SaludableNunca Envejece

Reporte sobre el estado de salud oral en población de adultos mayores en California

Sahiti Bhaskara, MPH, BDS Conrado E. Barzaga, MD

AgradecimientosAgradecimientos

Archstone Foundation The California Wellness Foundation Delta Dental Health Education and Research Fund Liberty Dental Plan Foundation

Autores: Sahiti Bhaskara, MPH, BDS, Conrado E. Barzaga, MD. Center for Oral Health

Consultores y Consejeros: Kathy Phipps, DrPH

Coordinadora de Tamizaje: Vanessa Montano, RDH

Especialistas de Tamizaje: RDHs and RDHAPs

Background(Antecedentes)

California has the second highest senior poverty rate in the Country• Poverty and social inequities

significantly impact oral health, well-being and quality of life of older adults

• Nationally, many older adults live on limited incomes and have modest savings, especially Medicare beneficiaries. (50% have incomes <$26,200 and 25% have incomes <$15,200)

Nearly one in two older Californians

lives in poverty

How Many Seniors Are Living in Poverty? National and State Estimates Under the Official and Supplemental Poverty Measures in 2016; Kaiser Family Foundation; Accessed at https://www.kff.org/medicare/issue-brief/how-many-seniors-are-living-in-poverty-national-and-state-estimates-under-the-official-and-supplemental-poverty-measures-in-2016/

Older Adults have high unmet oral health care needsNationally, • 1 in 5 older adults have lost all their natural teetha

• 70% older adults have periodontal (gum) diseaseb

Older adults also have unique oral health care needs –• Natural process of aging• Frail older adults and inability to perform ‘Activities of Daily Living’• Chronic health conditions

a. QuickStats: Prevalence of Edentualism in Adults Aged ≥65 Years, by Age Group and Race/Hispanic Origin — National Health and Nutrition Examination Survey, 2011–2014. MMWR MorbMortal Wkly Rep 2017;66:94.

b. Eke, P. I., Dye, B. A., Wei, L., Slade, G. D., Thornton-Evans, G. O., Borgnakke, W. S., ... & Genco, R. J. (2015). Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. Journal of periodontology, 86(5), 611-622

Poor oral health undermines overall health, well-being and quality of life

• Diabetes and glycemic control; other chronic conditions

• Malnutrition, hunger

• Acute exacerbation of conditions like aspiration pneumonia

Several barriers and gaps in care contribute to poor oral health• Insurance and ability to pay – Medicare, Dual-eligible, Uninsured

• Disability and frailty – physical barriers

• Social inequities and determinant of health

• Poor integration of care and services – Medical, Dental and Social Services

• Provider capacity and specialty training

• Health literacy and knowledge of coverage options

Oral Health Status of Older Californians

Methods• Basic Screening Survey – Association of State and Territorial Dental

Directors (ASTDD)

• Non-invasive open-mouth survey (screening)

• Public health surveillance, not research

• Study sample –- Skilled Nursing Facilities (n = 36, probabilistic sample)- Community sites (n = 51, convenience sample)

Key Findings

19

KEY FINDING # 1

Many of older adults suffer from untreated tooth decay

20

Key Finding # 1: Skilled Nursing Residents

• Nearly half the older adults residing in skilled nursing facilities have untreated tooth decay

• The rate of untreated tooth decay was highest among adults aged 85 years and older

48% 46% 48% 50%

0%

20%

40%

60%

80%

CA SKILLED NURSING HOME RESIDENTS (65 YEARS AND OLDER) WITH UNTREATED TOOTH DECAY BY AGE

65 years and older 65 to 74 years 75 to 84 years 85 years and older

21

Key Finding # 1: Community-Dwelling Seniors

• More than one in three older adults suffer from untreated tooth decay

• Nearly 20% of the older adults screened, had one or more decayed root fragments in their mouth

81.6%

15.9%

1.40% 1.20%

PREVALENCE AND NUMBER OF ROOT FRAGMENTS

CA community-Dwelling Seniors (65 years and older)

None 1 to 3 teeth 4 to 6 teeth <7 teeth

22

KEY FINDING # 2

Untreated dental disease is leading to a high prevalence of tooth loss in older adults in California

23

More than one in three older adults in California’s skilled nursing facilities have lost all their teeth

Key Finding # 2: Skilled Nursing Residents

34.6%

5.6%

59.8%

0%

10%

20%

30%

40%

50%

60%

70%

TOOTH LOSS AS MEASURED BY THE NUMBER OF REMAINING NATURAL

TEETH

CA Skilled Nursing Home Residents (65 years and older)

No natural teeth 1 to 6 natural teeth More than 6 natural teeth

24

Key Finding # 2: Community-Dwelling Seniors

Eighteen percent (18%) of the community dwelling older adults screened, have lost all their natural teeth,

most of them due to tooth decay.

18.4%

6.8%

74.8%

0%

20%

40%

60%

80%

TOOTH LOSS AS MEASURED BY THE NUMBER OF REMAINING NATURAL TEETH

CA Community-Dwelling Older Adults (65 years and older)

No natural teeth 1 to 6 natural teeth More than 6 natural teeth

25

KEY FINDING # 3

Many older adults in California suffer from inability to chew due to poor contact between teeth

26

Key Finding # 3: Skilled Nursing Residents

• Nearly 40% of SNF residents cannot chew due to lack of a functional contact between their upper and lower back teeth on either side of their mouth.

• Thirty-six percent (36%) of the older adults with total tooth loss did not have any dentures

35.9%

4.8%

59.4%

DENTURE STATUS OF OLDER ADULTS WITH TOTAL TOOTH LOSS

CA Skilled Nursing Home Residents (65 years and older)

Has no dentures

Has only one denture (upper or lower)

Has both dentures (upper and lower)

27

Key Finding # 3: Community-Dwelling Seniors

• Nearly 18% of the community-dwelling older adults cannot chew due to lack of a functional contact between their upper and lower back teeth

• Eighteen percent (18%) of the older adults with total tooth loss did not have any dentures

18%

12%

70%

DENTURE STATUS OF OLDER ADULTS WITH TOTAL TOOTH LOSS

CA Community-Dwelling Older Adults (65 years and older)

Has no dentures

Has only one denture (upper or lower)Has both dentures (upper and lower)

28

KEY FINDING # 4

Majority of older adults need treatment for tooth decay and/ or gum diseases

29

Key Finding # 4: Skilled Nursing Residents

More than one in three older adults need gum (gingival or periodontal) treatment immediately

37.8%

27.2%

21.3%

13.7%

OLDER ADULTS WHO NEED EARLY OR IMMEDIATE DENTAL TREATMENT AND PERIODONTAL CARE

CA Skilled Nursing Home Residents (65 years and older)

No obvious problem Only periodontal care needed

Only early or urgent care needed Both periodontal and early/urgent care needed

30

Key Finding # 4: Skilled Nursing Residents

Nearly one out of three (27%) older adult needs treatment for a decayed tooth immediately or within 2 to 4 weeks

69.8%

20.9%

7.1%

NEED FOR EARLY OR IMMEDIATE DENTAL TREATMENT FOR TOOTH DECAY (EXCLUDING NEED

FOR PERIODONTAL OR GUM CARE) CA Skilled Nursing Home Residents (65 years and older)

No obvious problem Early care needed Urgent care needed

31

Key Finding # 4: Community-Dwelling Seniors

One out of three (32.7%) older adult needs treatment for a decayed tooth immediately or within 2 to 4 weeks

67.4%

28.0%

4.7%

NEED FOR EARLY OR IMMEDIATE DENTAL TREATMENT FOR TOOTH DECAY (EXCLUDING NEED FOR PERIODONTAL OR GUM CARE)

CA Community-Dwelling Older Adults (65 years and older)

No obvious problem Early care needed Urgent care needed

32

KEY FINDING # 5

Older adults residing in rural areas have higher unmet needs than their urban counterparts

33

• Older adults residing in nursing homes located in rural counties were significantly more likely to have untreated tooth decay than their urban counterparts

• Rural residents are twice as likely as urban counterparts to lack any dentures

42.9%

51.9%

0%

10%

20%

30%

40%

50%

60%

PERCENT OF OLDER ADULTS IN CALIFORNIA WITH UNTREATED

CARIES BY RURALITY OF COUNTY OF RESIDENCE

Urban Rural

Recommendations

• Include dental benefits in Medicare

• Ensure responsive public programs and better monitoring of services in care settings

• Breakdown healthcare silos to adopt integrated approaches

• Adopt and expand innovative approaches/ practices to address needs

• Eliminate barriers to care and address social determinants

• Address workforce shortage

A multi-pronged approach is imperative

Conclusion

Questions?

Thank you!

Sahiti Bhaskara, MPH, BDSDirector of Public Policy Research

Center for Oral Health Sbhaskara@tc4oh.org

909-469-8302

Full report available at: www.centerfororalhealth.org