Does Medicaid Coverage Modify the Relationship between Glycemic Status and Teeth Present in Older Adults?

Understanding the relationships among diabetes, teeth present, and dental insurance is essential to improving primary and oral health care. Participants were older adults who attended senior centers in northern Manhattan (New York, N.Y.). Sociodemographic, health, and health care information were obtained via intake interviews, number of teeth present via clinical dental examinations, and glycemic status via measurement of glycosylated hemoglobin (HbA1c). Complete data on dental insurance coverage status for 785 participants were available for analysis (1,015 after multiple imputation). For participants with no dental insurance and any private/other dental insurance, number of teeth present is less for participants with diabetes than for participants without diabetes; however, for participants with Medicaid coverage only, the relationship is reversed. Potential explanations include the limited range of dental services covered under the Medicaid program, inadequate diabetes screening and monitoring of Medicaid recipients, and the poor oral and general health of Medicaid recipients.

Third Places for Health Promotion with Older Adults: Using the Consolidated Framework for Implementation Research to Enhance Program Implementation and Evaluation.

This study extends the concept of third places to include community sites where older adults gather, often for meals or companionship. The Consolidated Framework for Implementation Research guided program implementation and evaluation. Depending upon health promotion program needs, the physical infrastructure of a site is important, but a supportive director (champion) can often overcome identified deficits. Senior centers may be locally classified into four types based upon eligibility requirements of residents in affiliated housing and services offered. Participants who attend these centers differ in important ways across types by most sociodemographic as well as certain health and health care characteristics.

The Impact of Medicaid Expansion on Oral Health Equity for Older Adults: A Systems Perspective.

This paper uses a collaborative, interdisciplinary systems science inquiry to explore implications of Medicaid expansion on achieving oral health equity for older adults. Through an iterative modeling process oriented toward the experiences of both patients and oral health care providers, complex feedback mechanisms for promoting oral health equity are articulated that acknowledge the potential for stigma as well as disparities in oral health care accessibility. Multiple factors mediate the impact of Medicaid expansion on oral health equity.

The ElderSmile TimeMap: Benefits of Connecting Statistics With Time and Place.

Community-based programs are critical for locally targeted public health education and accessible service delivery. Deriving useful information from such programs is important for their own evaluation and improvement and may facilitate research collaboration with partners and experts. Here we present an interactive Web-based application designed for a community-based oral health outreach program called ElderSmile to demonstrate how data can be summarized, filtered, compared, and visualized by time and place to inform program planning, evaluation, and research. The ElderSmile TimeMap ( http://www.acsu.buffalo.edu/∼smetcalf/resources/timemap.html ) is an emergent product of a US National Institutes of Health-funded collaboration of knowledge sharing among multidisciplinary team members at the University at Buffalo, Columbia University, and New York University.

A community-based oral public health approach to promote health equity.

OBJECTIVES: We explored the interrelationships among diabetes, hypertension, and missing teeth among underserved racial/ethnic minority elders. METHODS: Self-reported sociodemographic characteristics and information about health and health care were provided by community-dwelling ElderSmile participants, aged 50 years and older, who took part in community-based oral health education and completed a screening questionnaire at senior centers in Manhattan, New York, from 2010 to 2012. RESULTS: Multivariable models (both binary and ordinal logistic regression) were consistent, in that both older age and Medicaid coverage were important covariates when self-reported diabetes and self-reported hypertension were included, along with an interaction term between self-reported diabetes and self-reported hypertension. CONCLUSIONS: An oral public health approach conceptualized as the intersection of 3 domains-dentistry, medicine, and public health-might prove useful in place-based assessment and delivery of services to underserved older adults. Further, an ordinal logit model that considers levels of missing teeth might allow for more informative and interpretable results than a binary logit model.

Patterns of chronic conditions in older adults: exploratory spatial findings from the ElderSmile program.

BACKGROUND: The increasing prevalence of primary care-sensitive conditions, notably diabetes and hypertension, among older adults presents a challenge to the public health community. Systems science conceptualizations of health, along with considerations of the social and environmental context in which older adults live, are needed before effective interventions can be designed and implemented. PURPOSE: To examine whether spatial patterns exist in hemoglobin A1c and blood pressure measurements among participants in ElderSmile, a community-based oral health and primary care screening program. METHODS: Two spatial statistical methods, global Moran's I and Cuzick-Edwards tests, were used to determine if there were significant spatial patterns among ElderSmile participants residing in northern Manhattan during 2010-2012. The analyses were conducted in 2013. RESULTS: Significant spatial patterns of hemoglobin A1c values and potential diabetes cases, and possibly blood pressure measurements, were found among ElderSmile participants residing in northern Manhattan. CONCLUSIONS: The presence of spatial patterns allows for the identification of subpopulations in need of additional resources, and can assist in informing advanced spatial and statistical analyses. Screening data collected from an ongoing community-based program can be used to understand broader patterns of urban health.

Modeling social dimensions of oral health among older adults in urban environments.

In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by older adults in urban environments, this article presents a portfolio of systems science models that have been developed on the basis of observations from the ElderSmile preventive screening program operated in northern Manhattan, New York City, by the Columbia University College of Dental Medicine. Using the methodology of system dynamics, models are developed to explore how interpersonal relationships influence older adults' participation in oral health promotion. Feedback mechanisms involving word of mouth about preventive screening opportunities are represented in relation to stocks that change continuously via flows, as well as agents whose states of health care utilization change discretely using stochastic transitions. Agent-based implementations illustrate how social networks and geographic information systems are integrated into dynamic models to reflect heterogeneous and proximity-based patterns of communication and participation in the ElderSmile program. The systems science approach builds shared knowledge among an interdisciplinary research team about the dynamics of access to opportunities for oral health promotion. Using "what if" scenarios to model the effects of program enhancements and policy changes, resources may be effectively leveraged to improve access to preventive and treatment services. Furthermore, since oral health and general health are inextricably linked, the integration of services may improve outcomes and lower costs.

Integrating oral and general health screening at senior centers for minority elders.

Racial/ethnic and socioeconomic disparities regarding untreated oral disease exist for older adults, and poor oral health diminishes quality of life. The ElderSmile program integrated screening for diabetes and hypertension into its community-based oral health activities at senior centers in northern Manhattan. The program found a willingness among minority seniors (aged ≥ 50 years) to be screened for primary care sensitive conditions by dental professionals and a high level of unrecognized disease (7.8% and 24.6% of ElderSmile participants had positive screening results for previously undiagnosed diabetes and hypertension, respectively). Dental professionals may screen for primary care-sensitive conditions and refer patients to health care providers for definitive diagnosis and treatment. The ElderSmile program is a replicable model for community-based oral and general health screening.

Dental caries experience in northern Manhattan adolescents.

OBJECTIVE: The study sought to document dental caries among adolescents residing in northern Manhattan, New York, by race, sex, and community. METHODS: Clinical and demographic data were collected from children aged 12-17 years at five school-based dental clinics in northern Manhattan. Data on dental caries were collected by calibrated examiners using the National Institute of Dental and Craniofacial Research criteria for oral examinations. RESULTS: A total of 566 children participated in the study. They were predominantly Hispanic (64%) or African American (28%). Compared to data from the National Health and Nutrition Examination Survey III, mean DMFT (3.36 vs 2.53; P<.01) and the prevalence of untreated disease (36% vs 16%; P<.01) were significantly higher for northern Manhattan adolescents. Of the adolescents evaluated, 13 percent had at least one severely carious tooth with pulpal involvement that required either extraction or endodontic therapy. CONCLUSIONS: Adolescents in northern Manhattan have higher caries prevalence and higher levels of untreated caries than their national counterparts. Carious lesions progress to pulpal involvement in a high percentage of northern Manhattan children and require extraction or root canal therapy as treatment. There is an urgent need for affordable and available dental primary care services targeted to economically disadvantaged communities.