Addressing oral health and healthcare in meals-on-wheels recipients in NYC

Background: A number of community-based services such as Home Delivered Meals (HDM) are designed to help community-dwelling older adults maintain independence. HDM provides food for homebound older adults, but oral disease and dysfunction which are associated with ability to eat are not addressed. This work, designed to assess difficulty eating and oral health needs among HDM recipients in New York City (NYC), is a first step towards developing oral health interventions for this population. Since HDMs are provided across the nation, these data can inform interventions in other states and settings. Methods: A cross-sectional telephone survey was used to assess difficulty eating and oral health related quality of life in a random sample of HDM recipients with a telephone in NYC, using a 54-item instrument which included items from the Oral Health Impact Profile-14. A second in-depth interview which will provide context to the data is on-going with respondents who reported problems in the survey. Focus groups with HDM stakeholders were conducted to assess the feasibility of integrating interventions in the HDM system. Results: Thirty-eight percent of participants reported difficulty chewing and avoiding foods due to problems with their mouth/teeth/dentures. Average time since last dental visit was over three years, and 40% of visits were symptomatic; the most frequent reason for not using dental services was cost. Implications: Oral disease and dysfunction may result in difficulty eating in this population and access to and utilization of dental services is difficult. Interventions targeting caseworkers/careproviders, policy makers and HDM recipients are feasible.