Longitudinal analysis of cost and dental utilization patterns for older adults in outpatient and long-term care settings in Minnesota

Abstract

Background Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. Methods Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. Results Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.

Barriers and Opportunities to Support the Oral Health of Older Adults: A Rapid Review of Health Policy and Systems

“…Poor oral health has been hypothesized to increase risk of hypertension and stroke, while gum disease has been correlated to heart disease, stroke, pulmonary conditions, and type 2 diabetes (Calvo et al, 2016; Northridge et al, 2015; Yellowitz, 2016). There is moderate evidence to indicate that low oral health not only increases risk for other health issues and exacerbates current comorbidities, but it also lowers quality of life by negatively impacting one's ability to chew, smile, and talk (Chávez et al, 2016; Smith et al, 2020).…”

“…One systematic review, one longitudinal control study, two cohort studies, and three case reports all shared community program models and outcomes aimed to address the oral health needs of older adults (Becerra & Nguyen, 2016; Chávez & Lederman, 2016; Crete et al, 2018; Lee, 2012; Mao et al, 2015; Orozco et al, 2019; Smith et al, 2020). These programs bring care to patients such as in long-term care facilities and patient homes to lessen barriers to access and utilization.…”

“…Within the review, eight articles mentioned the connection between low oral health and other health conditions that negatively impact one another (Calvo et al, 2016;Crete et al, 2018;Davis & Plaspohl, 2017;Manski & Moeller, 2017;Northridge et al, 2015;Smith et al, 2020;Yellowitz, 2016). Poor oral health has been hypothesized to increase risk of hypertension and stroke, while gum disease has been correlated to heart disease, stroke, pulmonary conditions, and type 2 diabetes (Calvo et al, 2016;Northridge et al, 2015;Yellowitz, 2016).…”

Evaluation of an Oral Care Program to Improve the Oral Health of Home-Dwelling Older People

“…The data of this study were collected just before the COVID−19 pandemic. The COVID-19 pandemic reinforced the difficulties and barriers for older people to access dental care and researchers suggest that the COVID-19 pandemic will increase dental problems in frail older people [ 45 , 46 ]. This highlights the importance to implement oral care programs such as the OCP in home care nursing in the near future.…”

Costs for Statutorily Insured Dental Services in Older Germans 2012–2017

“…In the United States, for example, per capita costs for dental care have grown faster over the last decade than costs for other healthcare services in the elderly [ 10 ], possibly as dental health improvements in children and adults, indicated by fewer restored or missing teeth [ 11 , 12 ], have so far not been fully translated into higher age: While the very old retain a higher number of teeth than ever, they concomitantly suffer from a higher number of coronal and root caries lesions as well as periodontal disease, requiring complex restorative and periodontal interventions as well as different kind of prosthetic management (replacing fewer teeth; for example, edentulism is an increasing rare phenomenon) [ 13 ]. Dental costs have been found to be affected by a range of factors, namely age (decreasing in high age) [ 9 , 14 ], sex (mainly via life expectancy differences and the different “chance” to utilize services in higher age) [ 9 ], but also insurance type or SES [ 14 , 15 ].…”