Dental Care Among Adults Aged 65 Years and Over, 2017

May 29, 2019

Questions for Lead Author Ellen Kramarow, Health Statistician, of “Dental Care Among Adults Aged 65 Years and Over, 2017.”

Q: Why focus on dental care among adults aged 65 years or older in the United States?

EK: Dental care is often overlooked as people age, but it is an important component of overall health care. Chronic diseases such as diabetes and osteoporosis, which are common among older persons, can affect oral health; in addition, having poor oral health may contribute to some chronic conditions and impact nutrition. Routine dental care is not covered under fee-for-service Medicare, so older adults may have trouble accessing appropriate dental care.


Q: What are the main findings on dental insurance, dental visits, and unmet dental care due to cost?

EK: In 2017, among adults aged 65 and over, 29.2% had dental insurance; 65.6% had a dental visit in the past 12 months; and 7.7% had an unmet need for dental care due to cost.

No statistically significant differences by sex were observed in any of these dental care indicators. Adults aged 65–74 were more likely to have dental insurance, to have visited the dentist in the past 12 months, and to have unmet need for dental care due to cost compared with adults over age 75.

Poor older adults were less likely to have dental insurance and to have visited the dentist, and more likely to have an unmet need for dental care due to cost compared with not-poor older adults.


Q: Are there any reasons why more U.S. adults aged 65 years or older don’t have dental insurance?

EK: Most older adults have access to health insurance through Medicare, which does not cover routine dental care.  Older adults who do have dental insurance may have obtained it through purchase of a separate dental plan, through retiree health benefits, through a Medicare Advantage plan, or through Medicaid.


Q: Was there a specific finding in your report that surprised you?

EK: Only 30.3% of older adults who were edentate (had no natural teeth) had a dental visit in the past 12 months, compared with 73.6% who had at least some natural teeth.  Even edentate adults need dental care to help maintain good oral health.


Q: What is the take home message for this report?

EK: Many older adults do not receive dental care, and access to dental care varies by age, poverty status, and race and Hispanic origin.

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Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers

April 30, 2019

Questions for Lead Author Christine Caffrey, Health Statistician, of “Service Provision, Hospitalizations, and Chronic Conditions in Adult Day Services Centers: Findings From the 2016 National Study of Long-Term Care Providers.”

Q: Why did you decide to do a report on hospitalizations and chronic conditions by service provision in adult day services centers?

CF: A primary goal of adult day services centers is to help individuals remain living in the community and preventing or delaying institutionalization.  As part of this goal, adult day services centers offer a variety of services, including mental health, social work, therapeutic, dietary and nutritional, and skilled nursing services.

Hospitalizations among older adults are a strong predictor of future institutionalization or nursing home admission, and are associated with health and disability declines, lower quality of life, and greater health care costs. The increased risks associated with hospitalizations are of particular concern to adult day services centers, and reducing hospitalizations and readmissions is a main goal for them.  Often adult day services centers have participants with diverse health needs, including common chronic conditions, such as Alzheimer disease and other dementias, depression, diabetes, and heart disease.  These chronic conditions have been found to be associated with hospitalizations and readmissions in long-term care settings.

Having a participant case mix with hospitalizations and several different chronic conditions may increase the need to provide a wider variety of services. Despite adult day services centers main goals of reducing hospitalizations and readmissions and managing chronic conditions among participants through service provision, national estimates on the relationship between service provision and hospitalizations and chronic conditions are limited. This report fills this gap by presenting 2016 national estimates of the percentages of hospitalizations in the past 90 days and the number of chronic conditions among ADSCs, by service provision.


Q: How did the data vary by service provision?

CF: Overall, more than one-half of adult day services centers (52.6%) provided all five services, about 37.0% of centers provided one to four of the five services, and approximately one-tenth of centers (10.2%) provided none of the five services.  Nearly one-tenth (8.4%) of adult day services centers provided all of the five services with employees and 10.3% provided all of the five services by arrangement or referral.  The prevalence of hospitalizations varied by service provision.

Almost three-fourths of adult day services centers that provided all five services (74.3%) reported at least one hospitalization in the past 90 days compared to almost one-third (31.5%) of adult day services centers that provided none of the five services.  Among adult day services centers that provided all five services with employees, 81.7% had hospitalizations compared with 59.4% of centers that provided all five services by arrangement or referral.  The number of chronic conditions in an adult day services center also varied by service provision.  Across adult day services centers that provided all five services, 17.5% had zero to three of the four chronic conditions in their center and 82.5% had all four conditions.  In adult day services centers that provided none of the five services, 70.6% had zero to three of the four chronic conditions in their center and 29.4% had all four conditions.

Among adult day services centers that provided all five services with employees, 3.8% had zero to three of the four chronic conditions in their center and 96.2% had all four conditions.  In adult day services centers that provided all five services by arrangement or referral, 36.3% had zero to three of the four chronic conditions in their center and 63.7% had all four conditions.


Q: Was there a specific finding in your report that surprised you?

CF: That adult day services center with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general, and these services are more often provided by employees and not solely by arrangement or referral.


Q: What is the take home message for this report?

CF: This report demonstrates that adult day services centers with greater levels of participant needs, as indicated by increased hospitalizations and the number of chronic conditions, are more likely to provide a greater number of services in general and these services are more often provided by employees and not solely by arrangement or referral. The level of participant needs, as indicated by hospitalizations, and chronic conditions among participants, were lower in adult day services centers that provided select services by arrangement or referrals and in adult day services centers that did not provide select services.


Dementia Mortality in the United States, 2000–2017

March 14, 2019

A new NCHS report presents data on mortality attributable to dementia. Data for dementia as an underlying cause of death from 2000 through 2017 are shown by selected characteristics such as age, sex, race and Hispanic origin, and state of residence.

Trends in dementia deaths overall and by specific cause are presented. The reporting of dementia as a contributing cause of death is also described.

Key Findings:

  • In 2017, a total of 261,914 deaths attributable to dementia as an underlying cause of death were reported in the United States. Forty-six percent of these deaths were due to Alzheimer disease.
  • In 2017, the age-adjusted death rate for dementia as an underlying cause of death was 66.7 deaths per 100,000 U.S. standard population. Age-adjusted death rates were higher for females (72.7) than for males (56.4).
  • Death rates increased with age from 56.9 deaths per 100,000 among people aged 65–74 to 2,707.3 deaths per 100,000 among people aged 85 and over.
  • Age-adjusted death rates were higher among the non-Hispanic white population (70.8) compared with the non-Hispanic black population (65.0) and the Hispanic population (46.0).
  • Overall, age-adjusted death rates for dementia increased from 2000 to 2017.
  • Rates were steady from 2013 through 2016, and increased from 2016 to 2017. Patterns of reporting the individual dementia causes varied across states and across time.

Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

September 12, 2018

Jessica Lendon, Health Statistician

Questions for Jessica Lendon, Health Statistician and Lead Author of “Advance Directive Documentation Among Adult Day Services Centers and Use Among Participants, by Region and Center Characteristics -The National Study of Long-Term Care Providers, 2016

Q: Can you describe what an advance directive is?

JL: An advance directive is any written statement that expresses a person’s health care preferences in the event that she or he are unable to make decisions. The types of advance directives include documents that designate a health care decision maker, proxy, or surrogate, do-not-resuscitate orders, physician or medical orders for life-sustaining treatments, and living wills.  Advance directives can be completed by adults at any age and any health status.


Q: Why did you decide to focus on advance directives in the United States?

JL: Advance directives are an important component of care planning for individuals with serious illnesses who require long-term care services and supports or need end-of-life care, which may improve quality and satisfaction with end-of-life care. Advance directives has been examined in many healthcare settings in the United States, but has not yet been studied in adult day services centers (ADSCs).

ADSCs are not federally mandated to provide information about advance directives to users or to maintain documentation, like other long-term care settings. ADSCs are licensed by a variety of requirements at the state level.


Q: How many adult day service centers maintain documentation of advance directives?

JL: An estimated 3,300 (78%) adult day services centers reported that they maintain documentation of advance directives in their participants’ files.


Q: How did the findings vary by region?

JL: A larger percentage of adult day services centers in the Northeast reported that they maintained documentation and had participants with an advance directive, compared to the other regions. The West had the lowest percentage of centers that maintained documentation and prevalence among participants.


Q: Is this the most recent data that you have on this topic and will you be continuing to examine in future data?

JL: Yes. This is the most recent data on advance directives in adult day services centers. My co-authors and I are preparing another report, which will be a more in-depth examination of the relationship between policy, practices, and prevalence of advance directives in adult day services centers in 2016. The 2018 National Study of Long-Term Care Provider’s survey of adult day services centers also includes questions about advance directives, which will be analyzed in the future.


Q: What is the take home message in this report?

JL: The majority of adult day services centers document advance directives, which may be an important part of ensuring individuals’ end-of-life wishes are fulfilled, and only 38% of participants have a documented advance directive.

This report shows policy-relevant differences regarding advance directives, for example, adult day services centers that are Medicaid licensed are more likely to maintain documentation and have a larger percentage of participants with advance directives.


QuickStats: Percentage Distribution of Long-Term Care Staffing Hours by Staff Member Type and Sector — United States, 2016

May 4, 2018

In 2016, aides provided more hours of care in the major sectors of long-term care than the other staffing types shown. Aides accounted for 59% of all staffing hours in nursing homes, compared with licensed practical or vocational nurses (21%), registered nurses (13%), activities staff members (5%), and social workers (2%).

Aides accounted for 76% of all staffing hours in residential care communities, in contrast to activities staff members (10%), registered nurses (7%), licensed practical or vocational nurses (6%), and social workers (1%).

In adult day services centers, aides provided 39% of all staffing hours, followed by activities staff members (30%), registered nurses (15%), licensed practical or vocational nurses (9%), and social workers (6%).

Source: National Study of Long-Term Care Providers, 2016. https://www.cdc.gov/nchs/nsltcp/index.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6717a6.htm


QuickStats: Percentage of Residential Care Communities That Use Electronic Health Records, by Community Bed Size — United States, 2016

February 6, 2018

In 2016, one fourth (26%) of residential care communities used electronic health records (EHRs).

The percentage of communities that used EHRs increased with community bed size.

The percentage was 12% in communities with 4–10 beds, 28% with 11–25 beds, 35% with 26–50 beds, 43% with 51–100 beds, and 50% with more than 100 beds using EHRs.

Source: National Study of Long-Term Care Providers, 2016

https://www.cdc.gov/mmwr/volumes/67/wr/mm6704a8.htm


Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015

June 28, 2017

Questions for Tina Norris, Ph.D., Health Statistician and Lead Author of “Vaccination Coverage Among Adults Aged 65 and Over: United States, 2015

Q:  Why did you conduct this study?

TN:  We produced this report because vaccination is an important preventive health measure. Older adults have greater susceptibility to—and complications from—disease, and so they stand to benefit greatly from vaccinations as a preventive health measure. This study explores how the percentage of adults aged 65 and over, who received these recommended vaccinations, varied by sex, age group, race/ethnicity, and poverty status.


Q: What finding in your new study most surprised you and why?

TN:  While not unexpected, it was quite striking to see the overall variation in rates by vaccination type. We observed quite a range in the rates of vaccine coverage for influenza, pneumococcal disease, tetanus, and shingles. For example, more than two-thirds of adults aged 65 and over had an influenza vaccine in the past 12 months, while one-third had ever had a shingles vaccine.


Q:  Your report indicates you’ve examined receipt of vaccinations among community-dwelling adults aged 65 and over. What do you mean by “community-dwelling adults?”

TN:  By community-dwelling, we mean those individuals who are not living in any type of institutional setting (ex. nursing homes, hospitals, etc.).


Q:  What differences did you see among race and ethnic groups, and between the sexes?

TN:  We did see a number of significant differences in vaccination coverage among race groups and between the sexes. In terms of race, Non-Hispanic white adults were more likely than Hispanic and non-Hispanic black adults to have had an influenza vaccine in the past 12 months. Non-Hispanic white adults were more likely than Hispanic, non-Hispanic black, and non-Hispanic Asian adults to have had a tetanus vaccine in the past 10 years or to ever have had a vaccination for pneumococcal disease or shingles.

Vaccination also varied by sex. Among adults aged 65 and over, men were more likely than women to have had a tetanus vaccine in the past 10 years. However, men were less likely than women to have had a shingles vaccine at some point in the past.


Q:  What would you say is the take-home message of this report?

TN:  I think the take-home message of this report is that many adults aged 65 and over are not receiving recommended vaccinations. For example, two-thirds of adults never had a shingles vaccine, and nearly one-half did not have a tetanus vaccine in the past 10 years. We also see gaps in coverage for all four vaccinations—influenza, pneumococcal, tetanus, and shingles—by sex, age group, race and ethnicity, and poverty status.


Q:  Did you look at any titer-level testing for adults prior to vaccination receipt as a factor in vaccination coverage?

TN:  While titer-level testing is an interesting component in the strength of a body’s immune response to disease, titer-level testing was out-of-scope for this project.


Q:  Did your survey look at the different Medicare types of insurance as a factor in vaccination coverage for the population you studied?

TN:  No, insurance coverage was not included due to the cross-sectional nature of the survey and the long recall period for some of the vaccinations.  However, direct costs—and when the cost is incurred for vaccinations—have been shown to vary according to insurance coverage, and have been linked to financial burden for older adults.