Rural older adults constitute an oral health disparate population. The disparities in oral health conditions experienced by older rural adults impact dietary quality and nutritional status, as well as social integration. We propose to continue a productive program of research that has focused on nutritional self-management among older rural adults in a multi-ethnic population (African American, American Indian, and white). In the grant cycle now concluding, we have demonstrated that these older adults suffer from high rates of oral health deficits. Associated with these deficits we find that (1) older adults actively manage their food intake through behaviors such as avoiding and modifying selected foods, practices that affect dietary quality;and (2) they have reduced social integration associated with oral health disparities, which reduces their quality of life. The cross-sectional nature of the research conducted to date limits our understanding of how the observed patterns of self-management develop and the causal linkages among oral health deficits, self-management behaviors, and outcomes such as dietary quality and oral health-related quality of life (OHRQoL). The proposed renewal of this grant will extend our previous work by (1) using a mixed methods approach to develop a detailed assessment tool for documenting oral health-related nutritional self-management behaviors, and (2) constructing a cohort of surviving members ages 65-79 of the original population-based sample and supplementing it to achieve a total sample of 750 for conducting repeated measures study of oral health- related nutritional self-management. This larger sample will be assessed twice, with a two year interval. The goal of the research proposed for the next funding period is to better understand how changes in oral health status affect dietary quality, as mediated by oral health-related nutritional self-management. To do this, we will accomplish three specific aims: (1) describe changes in oral health status and OHRQoL over time in older rural adults, comparing the changes by racial/ethnic group and by utilization of dental care, (2) specify the role of self-management strategies in mediating the relationship of oral health to dietary quality and to OHRQoL, and (3) construct components for a future intervention that will identify and assist older adults at nutritional risk due to oral health deficits in improving their dietary quality. Accomplishment of these aims will extend conceptual work on health self-management to oral health and specify the pathways by which oral health deficits impact dietary quality and nutritional status, providing points for future intervention to reduce health disparities.

Public Health Relevance

Older adults in rural communities have significant oral health problems, compared to younger people and those in urban and suburban communities. This research will identify pathways by which oral health deficits in these older adults lead to reduced dietary quality. It will study how these older adults deal with oral health problems, particularly ways that they adapt their food preparation and meal patterns to maintain their preferred ways of eating. This research will produce components to be tested in future interventions to reduce oral health disparities.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Research Project (R01)
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Special Emphasis Panel (ZRG1-HDM-Q (02))
Program Officer
Clark, David
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Wake Forest University Health Sciences
Public Health & Prev Medicine
Schools of Medicine
United States
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