Elders in Public Housing: Elders in Public Housing: An opportunity - - PDF document

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Elders in Public Housing: Elders in Public Housing: An opportunity for prevention An opportunity for prevention

Judith A. Jones, DDS, MPH, DScD Judith A. Jones, DDS, MPH, DScD Professor and Chair Professor and Chair Department of General Dentistry Department of General Dentistry Boston University Boston University Goldman School of Dental Medicine Goldman School of Dental Medicine 75% of elders: Household income < $50k 75% of elders: Household income < $50k

<$15K $15-24.9 $25-34.9 $35-49.9 $50-74.9 $75-99.9 $100K+

Health, United States 2007

(in 2005)

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Oral Health Equity Project Oral Health Equity Project

• “

“Serving Boston Serving Boston’ ’s Elders s Elders” ” at the request of at the request of Boston City Councilman Michael Ross Boston City Councilman Michael Ross

• 1.2 Million households in public housing*

1.2 Million households in public housing*

• Multiyear partnership 2002

Multiyear partnership 2002-

• 2007

2007

• Focused on surveillance, access to care,

Focused on surveillance, access to care, education and prevention education and prevention

• Free oral screenings, fluoride varnish, denture

Free oral screenings, fluoride varnish, denture labeling, education and referral for elders labeling, education and referral for elders

– – 81 sites; 1443 elders ages 60+ screened 81 sites; 1443 elders ages 60+ screened

*HUD, 2008; http://www.bphc.org/programs/initiative.asp?i=278&p=87&b=2&d=

OHEP Community Partners OHEP Community Partners

• Councilman Michael Ross and his office

Councilman Michael Ross and his office

• Boston Housing Authority

Boston Housing Authority

• Commission on the Affairs of the Elderly

Commission on the Affairs of the Elderly

• Mayor

Mayor’ ’s Health Line at BPHC s Health Line at BPHC

• Mayor

Mayor’ ’s Health Van of BPHC s Health Van of BPHC

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Oral Health Equity Project Oral Health Equity Project (OHEP) Partnership (OHEP) Partnership

• Boston Public Health Commission

Boston Public Health Commission

• Boston University Henry M. Goldman School

Boston University Henry M. Goldman School

• f Dental Medicine
• f Dental Medicine
• Forsyth School of Dental Hygiene at the

Forsyth School of Dental Hygiene at the Massachusetts College of Pharmacy and Health Massachusetts College of Pharmacy and Health Sciences Sciences

• Harvard School of Dental Medicine

Harvard School of Dental Medicine

• Tufts School of Dental Medicine

Tufts School of Dental Medicine

• Funded by the Oral Health Foundation

Funded by the Oral Health Foundation

OHEP: Demographics OHEP: Demographics

200 400 600 800 1000 2003-2007 Females Males White Black Hispanic Asian Other

68% 32% 38% 30% 10% 17% 5%

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OHEP: Insurance OHEP: Insurance

200 400 600 800 1000 1200 1400

• verall

2003-2006 +medical +dental

• dental

had MA/lost it DK

88% 6% 76% 36% 19% 76% 20% 78% 3% 38%

OHEP: Insurance OHEP: Insurance

20 40 60 80 100 120 2006-2007 +medical +dental

• dental

had MA/lost it DK

100% 35% 50% 3% 4%

After Medicaid was reinstated for adults in MA

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OHEP: Oral Health Status OHEP: Oral Health Status

200 400 600 800 1000 2003-2007 dentate untreated caries F varnish root tips dentures

• stability

needs reline/repair labelled needs dentures abnormal soft tissue

46% 60% 58% 22% 63% 15% 28% 51% 29% 41%

More OHEP elders were edentulous More OHEP elders were edentulous

10 20 30 40 50 60 NHIS 2005 65-74 75+ OHEP 60+

• NHIS data from 2005

NHIS data from 2005 show that 21% of 65 show that 21% of 65-

• 74

74 year olds and 32% of 75 year olds and 32% of 75 + are edentulous + are edentulous

• Elders from public

Elders from public housing are more likely housing are more likely to have lost all their to have lost all their teeth: 54% of 60+ year teeth: 54% of 60+ year

• lds have lost all their
• lds have lost all their

teeth teeth

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OHEP: Untreated caries 3* greater OHEP: Untreated caries 3* greater than national studies than national studies

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 % with untreated decay 65-74 NHANES 1999-2004 75+ NHANES 1999-2004 OHEP 60+

• NHANES 1999

NHANES 1999-

• 2004

2004 showed that 17.1% of showed that 17.1% of 65 65-

• 74 year olds and

74 year olds and 19.5% of 75+ year olds 19.5% of 75+ year olds had untreated caries had untreated caries

• 60% of 60+ year olds in

60% of 60+ year olds in Boston Boston’ ’s elders housing s elders housing had untreated decay had untreated decay

• Source: Dye, Tan et al.,

Source: Dye, Tan et al., NCHS Series 11, #248, NCHS Series 11, #248, 2007 2007

Summary of OHEP Needs Summary of OHEP Needs

• Access: half

Access: half-

• no insurance

no insurance

• Prevention: 60%

Prevention: 60%

• Restoration: 60%

Restoration: 60%

• Dentures: 56%

Dentures: 56%

• Diagnosis: 28%

Diagnosis: 28%

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Barriers Barriers

• Insurance

Insurance

• Location: 1443 elders in 81 sites

Location: 1443 elders in 81 sites

• Multiple cultures and languages

Multiple cultures and languages

• Similar to schools: identify those at high risk and

Similar to schools: identify those at high risk and provide preventive services provide preventive services

• Legal issues: who can and cannot provide care

Legal issues: who can and cannot provide care

• needs for diagnostic, restorative and denture care

needs for diagnostic, restorative and denture care

• Must have these services at least by referral

Must have these services at least by referral

OUR GOAL: OUR GOAL: Most elders use dental care in Most elders use dental care in < <2 yrs 2 yrs

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 NHIS 2005 65-74 75+ Goal: elders in public housing

• 65

65-

• 74 year olds: 60%

74 year olds: 60% use care every year and use care every year and another 10% every 2 another 10% every 2 years years

• 75+ year olds: 55 use

75+ year olds: 55 use care every year and care every year and 7.5% every other year 7.5% every other year

• Goal: At least half of

Goal: At least half of elders in public housing elders in public housing will use care within 2 will use care within 2 years years

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Advocacy Advocacy

• Keep oral health care in Medicaid

Keep oral health care in Medicaid

• Include oral health care for elders in publicly

Include oral health care for elders in publicly financed plans financed plans

• Advocate for elder coverage among private

Advocate for elder coverage among private primary insurance carriers primary insurance carriers and and Medicare Medicare

– – At least for basic services At least for basic services-

• primary care,

primary care, tx tx of pain

• f pain

and infection and prevention and infection and prevention

• Partner with Elders

Partner with Elders’ ’ organizations to keep oral

• rganizations to keep oral

health care a part of health care health care a part of health care

MMWR 2/14/03

CDC CDC’ ’s Advisory Committee to s Advisory Committee to Director suggests: Director suggests:

• “

“Require new efforts to address the special Require new efforts to address the special needs of older adults needs of older adults… …

• Deliver programs in communities in which

Deliver programs in communities in which

• lder adults work, reside, and congregate
• lder adults work, reside, and congregate…

…

• Existing public health programs required to

Existing public health programs required to examine whether they meet the needs of an examine whether they meet the needs of an aging population. aging population.” ”

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Diego Rivera, Detroit Institute of Arts

It takes a village to improve oral health for our elders