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

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 (in 2005) <$15K $15-24.9 $25-34.9 $35-49.9 $50-74.9 $75-99.9 $100K+ Health, United States 2007 1

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 2

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 • of Dental Medicine of 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 1000 68% 800 Females 38% Males 600 32% White 30% Black 400 17% 10% Hispanic Asian 200 5% Other 0 2003-2007 3

OHEP: Insurance OHEP: Insurance 1400 88% 1200 76% 76% 78% 1000 +medical 800 +dental 36% 38% -dental 600 had MA/lost it 400 19% 20% DK 200 3% 6% 0 overall 2003-2006 OHEP: Insurance OHEP: Insurance 120 100% 100 +medical 80 50% +dental 60 35% -dental had MA/lost it 40 DK 20 3% 4% 0 2006-2007 After Medicaid was reinstated for adults in MA 4

OHEP: Oral Health Status OHEP: Oral Health Status 1000 63% dentate untreated caries 800 46% F varnish root tips 600 51% dentures 28% 60% 58% 41% 400 -stability 29% needs reline/repair 200 labelled 22% 15% needs dentures 0 abnormal soft tissue 2003-2007 More OHEP elders were edentulous More OHEP elders were edentulous • NHIS data from 2005 NHIS data from 2005 • 60 show that 21% of 65- -74 74 show that 21% of 65 year olds and 32% of 75 50 year olds and 32% of 75 + are edentulous + are edentulous 65-74 40 • Elders from public Elders from public • 30 75+ housing are more likely housing are more likely to have lost all their to have lost all their 20 OHEP teeth: 54% of 60+ year teeth: 54% of 60+ year 60+ 10 olds have lost all their olds have lost all their teeth teeth 0 NHIS 2005 5

OHEP: Untreated caries 3* greater OHEP: Untreated caries 3* greater than national studies than national studies • NHANES 1999 NHANES 1999- -2004 2004 • 75 showed that 17.1% of showed that 17.1% of 70 65 65- 65 -74 year olds and 74 year olds and 60 65-74 19.5% of 75+ year olds 19.5% of 75+ year olds 55 NHANES 50 had untreated caries had untreated caries 45 1999-2004 40 • 60% of 60+ year olds in 60% of 60+ year olds in 75+ • 35 NHANES 30 Boston’ ’s elders housing s elders housing Boston 25 1999-2004 had untreated decay had untreated decay 20 OHEP 15 • Source: Dye, Tan et al., Source: Dye, Tan et al., • 60+ 10 5 NCHS Series 11, #248, NCHS Series 11, #248, 0 2007 2007 % with untreated decay 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% • 6

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 < <2 yrs 2 yrs Most elders use dental care in • 65 65- -74 year olds: 60% 74 year olds: 60% • 75 65-74 70 use care every year and use care every year and 65 another 10% every 2 another 10% every 2 60 55 years years 50 75+ • 75+ year olds: 55 use 75+ year olds: 55 use • 45 40 care every year and care every year and 35 7.5% every other year 7.5% every other year 30 25 Goal: • Goal: At least half of • Goal: At least half of 20 elders in 15 elders in public housing elders in public housing public 10 will use care within 2 will use care within 2 housing 5 years 0 years NHIS 2005 7

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 and and Medicare Medicare primary insurance carriers – At least for basic services – At least for basic services- -primary care, primary care, tx tx of pain of pain and infection and prevention and infection and prevention • Partner with Elders Partner with Elders’ ’ organizations to keep oral organizations to keep oral • health care a part of health care health care a part of health care CDC’ ’s Advisory Committee to s Advisory Committee to CDC 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 older adults work, reside, and congregate… … older 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. MMWR 2/14/03 8

It takes a village to improve oral health for our elders Diego Rivera, Detroit Institute of Arts 9