Improving Community Capacity to Address Older Adults' Oral Health Disparities

Objectives: 1. Assess the utility and feasibility of integrating oral health services within the homecare delivery system which provides medical/social/mental health services to community-dwelling older adults; 2. Use a systems level approach to improve potential for sustainability; and 3. Build community capacity to provide services and improve research readiness. Methods: A partnership between Columbia University College of Dental Medicine (CDM) and Isabella Homecare (Isabella) used a systematic sequential approach to integrating and sustaining services within the homecare structure and service-delivery systems. Key-informant interviews were used to determine points of intervention, assess provider scopes of practice, policies, challenges and available resources. Focus groups were used to assess homecare workers' knowledge, practices and training needs; data were used to develop provider-specific interventions. Data capture systems were modified to include oral care services. Process measures were used to assess feasibility and sustainability; quasi-experimental design was used to evaluate program effectiveness. Results: 143 home health aides and 23 nurses were trained to determine oral care needs, provide daily oral care, tobacco cessation services and referrals to dental providers. At six-month follow up, 96% of clients had documentation of receipt of services. Within and between group analyses indicated significant improvements in denture fit, cleanliness, structure, Filled Teeth and time since last dental visit; 10% of clients were identified as smokers and 20% of smokers were referred to the NYS Quitline. Nurses' oral health related knowledge was significantly improved post-intervention (p=0.00), but there were no significant differences in oral health related opinions. 65% of trainees thought the training was appropriate, and Isabella successfully leveraged additional funding to ensure service continuity and expansion. Conclusion: Using the homecare system is an important mechanism for addressing oral health disparities among hard-to-reach and vulnerable older adults across the nation.