WA State Seniors Oral Health Status

1. WA State Seniors Oral Health Status

2. 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 state’s 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%.

3. Findings

4. 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? (n=4400) Q8. How would you describe the condition of your teeth? (n=4400) Q9. How would you describe the condition of your gums? (n=4400)

5. 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 don’t 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? (n=4031) – 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? (n=4031) – Asked of those who still have their original teeth

6. 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? (n=4400) Q10A. What dental care do you need in the next month? (n=860)

7. 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? (n=4400) Q18. Do you sip liquids to aid in swallowing any foods? (n=4400)

8. 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? (n=4400)

9. 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 didn’t 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? (n=4400) Q4. What is the main reason you have not visited a dentist in the last year? (n=1119)

10. 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? (n=4400)

11. 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? (n=4400) * US source: Manski, Richard, et. al. Dental Care Coverage & Retirement. Journal of Public Health Dentistry, 2009; 70(1); US figure for ages 51-64.

12. 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? (n=4400) Q21A. Is this person paid? (n=247)

13. 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).

14. 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

15. Discussion and Questions • Next steps in Washington • Other areas of interest to explore in further depth?