Oral Health in Adult Patients Receiving Palliative Care: A Mixed Method Study

Abstract Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Forty-nine PRPC were recruited. They first completed a structured oral symptom review, followed by an oral exam. A nested sample of 11 participants also completed an in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). About 40% of participants reported compromised quality of life due to oral conditions; however, the perceived impacts and treatment needs were modest. Oral disease was highly prevalent in PRPC, yet its overall impact was modest. Except for painful symptoms, most participants reported limited desire to seek treatment for oral health conditions.

Despite 20 years of research and numerous experts and associations advocating a palliative approach to care for nursing home (NH) residents with advanced dementia, research consistently demonstrate striking and persistent racial differences in the use of burdensome interventions such as feeding tubes and hospital transfer. Most notable is that Black NH residents experience more burdensome interventions at the end of life. The reasons for these differences are poorly understood. The purpose of this study was to examine NH staff members' perceptions of advance care planning with proxies of Black and White residents. We conducted thematic analysis of semi-structured interviews with 158 NH staff members gathered as part of the ADVANCE study. This is a large qualitative study in 13 NHs in 4 regions of the country aimed at explaining regional and racial factors influencing feeding tube and hospital transfer rates. We found that NH staff, regardless of region of the country, held several assumptions about Black proxies including: being attached or not wanting to let go; not wanting to talk about death, believing everything must be done; not wanting to play God; having large conflicted families, not trusting; putting on attitude, and tending not to use NHs. We found that these assumptions led some NH staff to feel that rather than engaging in shared decision making, they were engaged in a battle with proxies leading them to pick and choose their battles and at times even giving up trying. Whether these assumptions can be disrupted and transformed will be discussed.

ORAL HEALTH IN LATE LIFE: CHALLENGES AND SOLUTIONS
Chair: Xi Chen Co-Chair: Bei Wu Discussant: Stephen Shuman Older adults face a unique challenge in maintaining their oral health due to an increased disease burden, polypharmacy, functional impairment and other reasons. The five papers in this symposium describe the oral health issues in various groups of older adults and discuss different approaches to improve oral health for older adults. Using data from the Population Study of Chinese Elderly in Chicago, the first paper examined the relationship between self-reported discrimination and oral health related quality of life and investigated how resilience mediated such a relationship among foreign-born older Chinese Americans. The second paper described the oral health concerns and related treatment needs in older adults receiving palliative care using a mixed method design. The third paper demonstrated how to use behavior change techniques to improve oral self-care skills of individuals with mild dementia and support their family caregivers. The fourth paper described a project that integrates the age-friendly health system's principles into specialty dental care to address healthy aging and oral health. This initiative helped prevent and change the false belief that aging inevitably involves deterioration in oral health. The fifth paper described the impact of COVID-19 on the management of oral health problems and access to dental care in older adults. Transformative changes in care delivery and the impact of vaccination on access to care was also explored. This symposium helps better understand the oral health needs in older adults and provides new evidence to improve oral health for these individuals.
Oral disease is highly prevalent in persons receiving palliative care (PRPC). Yet, little is known about how PRPC perceive their oral health status and related treatment needs. Forty-nine PRPC were recruited. They first completed a structured oral symptom review, followed by an oral exam. A nested sample of 11 participants also completed an in-depth interview querying their perceived oral health concerns and related treatment needs. Quantitative and qualitative data was analyzed and integrated for interpretation. Eighty-six percent of participants reported at least one oral symptom, including dry mouth (83.7%), a pain-related symptom (40.8%), or oral function difficulties (51.0%). About 40% of participants reported compromised quality of life due to oral conditions; however, the perceived impacts and treatment needs were modest. Oral disease was highly prevalent in PRPC, yet its overall impact was modest. Except for painful symptoms, most participants reported limited desire to seek treatment for oral health conditions.

SELF-REPORTED DISCRIMINATION, RESILIENCE, AND ORAL HEALTH-RELATED QUALITY OF LIFE AMONG OLDER CHINESE AMERICANS
Weiyu Mao, 1 Bei Wu, 2 Iris Chi, 3 Wei Yang, 4 and XinQi Dong, 5 1. University of Nevada,Reno,Reno,Nevada,United States,2. New York University,New York,New York,United States,3. University of Southern California,University of Southern California,California,United States,4. University of Nevada Reno,Reno,Nevada,United States,5

. Rutgers University, Rutgers Institute for Health, New Jersey, United States
There is a lack of empirical evidence on self-reported discrimination and oral health-related quality of life (OHRQoL). Further, the mechanism linking the two constructs is not well understood. This study aimed to examine the relationship between self-reported discrimination and OHRQoL and investigate resilience as a mediator in such a relationship among foreign-born older Chinese Americans. Data came from the Population Study of Chinese Elderly in Chicago collected between 2017 and 2019. The working sample included 3,054 foreign-born Chinese Americans (60+ years of age). Mediation analysis was conducted to examine the direct and indirect pathways towards OHRQoL. Self-reported discrimination was directly and indirectly associated with poorer OHRQoL. Resilience mediated the relationship between selfreported discrimination and OHRQoL. Specifically, individuals experienced discrimination reported weaker resilience, and subsequently, reported poorer OHRQoL. Findings illustrate the importance of studying self-reported discrimination in relation to OHRQoL and further identify resilience as an intermediary pathway to promote OHRQoL.

REFINING AN ORAL HEALTH CARE PARTNER INTERVENTION USING BEHAVIOR CHANGE TECHNIQUES
Ashley Leak Bryant, 1 Rachel Hirschey, 2 Courtney Caiola, 3 Ya-Ning Chan, 4 Brenda Plassman, 5 Bei Wu, 6 Donald Bailey Jr., 7 and Ruth Anderson, 8 1. School of Nursing,Durham,North Carolina,United States,2. UNC School of Nursing,Chapel Hill,North Carolina,United States,3. East Carolina University,Greenville,North Carolina,United States,4. UNC Chapel Hill,Chapel Hill,North Carolina,United States,5. Duke University,Durham,North Carolina,United States,6. New York University,New York,New York,United States,7. duke University School of Nursing,Durham,North Carolina,United States,8. University of North Carolina at Chapel Hill,UNC Chapel Hill,North Carolina,United States Following a pilot, we refined an oral health carepartner intervention for individuals with mild dementia (IMD). In this intervention, we use behavior change techniques (BCTs) to foster changes by carepartners including using new oralcare techniques and developing skills for using cueing and communications approaches to support behavior changes by IMD (duration and frequency of toothbrushing and oral-hygiene skills); thus, improving plaque and gingival indices. We describe our approach to refining the intervention manual including a) completing the self-paced BCT taxonomy course, b) developing a coding schema, c) coding the original manual for evidence of BCTs, and d) refining the manual to improve use of BCTS in the refined intervention. Our results detail how BCTs can be applied to refine and improve interventions. This research demonstrates the value in using BCTs for interventions to address how carepartners and IMD can collaborate to improve oral hygiene care.