The NINR has recognized the importance of understanding risk factors for diseases, especially in areas where there are health disparities. Health and Human Services as well as the National Instituted of Dental and Craniofacial Research, through Health People 2010, have specifically identified oral health disparity as a key initiative. Pneumonia, the most common nosocomial infection in the intensive care unit (ICU), is the leading cause of morbidity and mortality in the ICU and has an associated high mortality risk for older ICU patients in particular. The subgroup of ICU patients, those who receive mechanical ventilation, are particularly susceptible to developing what is referred to as ventilator associated pneumonia (VAP). Poor oral health has been linked to the development of VAP. Over the past thirty years, oral health disparities for the most vulnerable populations such as older patients, have been growing. The surgeon general's report on Oral Health in America declared poor oral health to be a """"""""silent epidemic"""""""" especially in the poor, elderly, and racial and ethnic minorities. This predictive correlation study will be the first to examine pre-hospital oral health status as a risk factor for VAP in older adult ICU patients. Understanding the role of pre-hospital oral health in the development of VAP for older ICU patients will provide a more precise risk profile and greatly enhance the ability to establish targeted interventions for this vulnerable patient population. The training program outlined in this application will support me in my career goal as a nurse scientist by providing me with additional educational courses and experiences in the areas of oral health as well as clinical research. These courses and experiences will enable me to develop a program of research in this vital area and further my progress towards conducting nursing research. Relevance of Research to Public Health: With the well known growth in the population of older adults and the increase in disparities in oral health care, many older adults are at risk for a lethal pneumonia acquired when they are hospitalized. This study will examine the oral health of older patients prior to being admitted to the hospital to help understand their risk for developing pneumonia while in an intensive care unit on a mechanical ventilator. Understanding risk factors will allow for the development of nursing intervention strategies, especially for older people who lack adequate oral health care.
