Risk Factors of Orofacial Pain Symptoms Among Older Adults at the End of Life

Abstract The aims of this study were to examine the prevalence of orofacial pain symptoms in Chinese older adults at the end of life, and to investigate risk factors related to orofacial pain. The sample derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national respresentative sample of the oldest-old. The results showed that the 6-month prevalence of pain when chewing or biting at the end of life was 11.1%, and the rate was 5% for jaw joint pain/facial pain. Lower SES, smokers, and having chronic diseases were associated with having orofacial symptoms. Unexpectedly, the results revealed that dentate older adults (retain at least one natural tooth) who brushed their teeth more often were more likely to have orofacial symptoms. Older adults have poor oral health, particularly at the end of their life. This study highlights the importance of improving oral health for vulnerable older adults.


DISPARITIES IN OPIOID USE FOR PAIN CONTROL AMONG OLDER ADULTS: THE ROLE OF SOCIAL FACTORS Taylor Jansen, University of Massachusetts Boston, Boston, Massachusetts, United States
Over 50% of older adults (65+ years old) suffer from pain, and an estimated 25% of older adults use prescription opioids to treat their pain. Older adults are physiologically vulnerable to the effects of opioids; yet, they are prescribed more than all other age groups. This study used the Health and Retirement Study 2016 Core dataset (N=3,916) to analyze the moderation effect of social support on the association between pain and prescription opioid use in people aged 65+ using logistical regression analysis. Results show that older adults with severe pain were more likely to use prescription opioids (OR= 4.84) after considering covariates. Higher perceived social support was associated with higher likelihood of prescription opioid use for severe pain (OR=1.53). Older adults are at greater risk of pain and social isolation compared to younger age groups, making them a vulnerable group to consider as policy makers tackle this nationwide epidemic.

SOCIOECONOMIC STATUS, HEALTH BEHAVIORS, AND ORAL HEALTH OF OLDER ADULTS IN CHINA
Chair: Yaolin Pei Co-Chair: Xi Chen Discussant: Michele Saunders Many Chinese older adults suffer from oral health diseases and problems due to low oral health literacy, limited dental coverage and lack of dental care services for this segment of the population in China. However, so few studies have been conducted to examine social and behavior factors related to oral health among Chinese older adults. This symposium examines how socioeconomic status (SES) and health behaviors are associated with oral health among Chinese older adults. The first paper used the Nanjing Centenarians Study to examine the association between health behaviors and oral health among Chinese centenarians. The results showed that health behaviors were associated with self-rated oral health and edentulism. Using the Chinese Longitudinal Healthy Longevity Survey, the second one employed an 'after death' approach to examine risk factors for orofacial pain symptoms at the end of life among Chinese older adults. The third paper investigated the association between SES and tooth loss among middle-aged and older adults in ten cities of China. SES played a stronger role in tooth retention for non-migrants and migrants with high education vs those migrants with low education. The last paper examined the association between health behaviors and retention of teeth among Chinese older adults using data from the Chinese 4th National Oral health Survey. This symposium provides empirical evidence on the current status of oral health and health behaviors at the national level, and also suggests that is critical to improve oral health education and access to dental care.

RISK FACTORS OF OROFACIAL PAIN SYMPTOMS AMONG OLDER ADULTS AT THE END OF LIFE Yaolin Pei, and Bei Wu, New York University, New York, New York, United States
The aims of this study were to examine the prevalence of orofacial pain symptoms in Chinese older adults at the end of life, and to investigate risk factors related to orofacial pain. The sample derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national respresentative sample of the oldest-old. The results showed that the 6-month prevalence of pain when chewing or biting at the end of life was 11.1%, and the rate was 5% for jaw joint pain/facial pain. Lower SES, smokers, and having chronic diseases were associated with having orofacial symptoms. Unexpectedly, the results revealed that dentate older adults (retain at least one natural tooth) who brushed their teeth more often were more likely to have orofacial symptoms. Older adults have poor oral health, particularly at the end of their life. This study highlights the importance of improving oral health for vulnerable older adults.

HEALTH BEHAVIORS AND ORAL HEALTH AMONG CENTENARIANS IN NANJING, CHINA: A CROSS-SECTIONAL STUDY
Xin Xu, 1 Yuan Zhao, 1 Danan Gu, 2 Yaolin Pei, 3 and Bei Wu, 3 1. Nanjing Normal University, Nanjing, Jiangsu, China,2. United Nations,New York,New York,United States,3. New York University,New York,New York,United States The aim of this study was to examine the association between health behaviors and oral health among Chinese centenarians. Data from the Nanjing Centenarians Study (NCS) in China was used (N=185, Mean age = 102). Oral health status was measured by self-reported oral health and edentulous status. Results from ordinal regression and logistic regression models indicated that centenarians who were male, smoking, normal weight (18.5-24.9kg/m2), participated in more activities, and brushed teeth more frequently were more likely to report better oral health. Those who ate fruits daily and brushed teeth more frequently were more likely to be dentate. The association between frequent toothbrushing and oral health was stronger for those who had some formal education and were living with family members. Our study demonstrated the significance of health behaviors on oral health in very old age, and the importance of lifestyle on healthy aging.  Duyun,Guizhou,China,4. School of Sociology and Political Science,Shanghai University,Shanghai,China This study investigated the association between socioeconomic status (SES) and tooth loss in middle-aged and older adults by migrant status. The sample included 2,390 participants aged 45-65 from the 2017 Urbanization and New Migrant Survey conducted from 10 cities in China. Results from the negative binomial regression and the marginal effect analysis showed that education, income, and residence in a developed city were negatively associated with tooth loss for non-migrants and migrants with high levels of education. These associations were not found to be significant for migrants with low education levels. The findings suggest that SES plays a more significant role in tooth retention for migrants with higher education levels compared to those with lower education levels. These results may largely be due to different levels of health literacy and unequal access to dental care services. Tailored intervention needs to be target migrant populations with low SES.

TOOTH RETENTION AND HEALTH BEHAVIORS: FINDINGS FROM THE 4TH CHINESE NATIONAL ORAL HEALTH SURVEY
Xiaoyan Ou, 1 Liwei Zeng, 2 Yixuan Zeng, 2 Yaolin Pei, 3 and Bei Wu, 3 1. Nanchang University,Nanchang,Jiangxi,China,2. Affiliated Stomatological Hospital of Nanchang University,Nanchang,Jiangxi,China,3. New York University,New York,New York,United States This study aimed to investigate the association between tooth retention and health behaviors among Chinese older adults. Data was used from the Chinese 4th National Oral Health Survey, a national representative sample. The sample included 9054 older adults age 55-74. The control variables included age, gender, residence, region, education level, occupation, periodontal health, self-reported oral health, and selfreported general health. Logistic regression models shows that older adults who used tooth picks (OR=3.37, 95% CI: 2.94-3.85), dental floss (OR=1.93, 95%CI: 1.05-3.53), and toothpaste (OR=3.89, 95%CI: 3.14-4.83), and never smoked (OR=1.43 95%CI: 1.20-1.70) were more likely to retain more than 20 natural teeth; while having dental visit had the opposite association (OR = 0.45, 95% CI: 0.39-052). Unexpectedly, this study did not find frequency of toothbrushing was associated with tooth retention. This study suggest that improving oral hygiene and preventive dental care are key for good oral health. .

BRIDGING THE PAST AND THE FUTURE: WHY AGE MATTERS IN BEHAVIORAL HEALTH TRAINING
Chair: Rebecca Allen Co-Chair: Keisha Carden This symposium presents data from three applied clinical research projects that involve intergenerational interaction as one component of effective treatment. The first paper describes learner outcomes in an intergenerational art therapy and reminiscence program provided in an adult day service facility. Results show that, in comparison with students in a didactic psychology of aging course or an introductory psychology course, learners in the experiential learning course demonstrated increased empathy, as well as better attitudes toward and increased interest in working with persons with dementia (PWD). The second paper focuses on observed outcomes for older PWD participants in this art therapy and reminiscence program, showing that intergenerational communication engagements exceed engagements with art. Mixed method data across time indicated that PWD benefitted from the treatment, facilitated by undergraduate student learners. The third paper focuses on cultural humility and the importance of racial diversity in providers conducting behavioral health screening in an integrated geriatric primary care clinic. Training issues and behavioral health outcomes regarding assessment of cognitive status, cultural mistrust, and test