Oral health is central to physical and psychosocial well-being. Oral health deficits affect nutritional status through constraining dietary choices, and they can impair social interaction and integration due to pain, communication disorders, and embarrassment. While advances in preventive dentistry over the past half century have been dramatic, disparities in oral health continue to exist. Older rural adults are a particularly high risk population for oral health disparities; many have had limited access to oral health care services, high poverty rates and low socioeconomic status which place them at risk for oral health deficits relative to their urban and suburban counterparts. The high proportion of ethnic minorities among rural elders in some parts of the US makes disparities in oral health status within rural populations likely. This competing continuation application (R01 AG13469), which builds on eight years of community-based research on nutritional self-management and nutritional status in two rural, multi-ethnic North Carolina counties, has the overall goal of documenting the impact of oral health on multiple domains of life for rural adults > 60 years by accomplishing four specific aims: (1) to document the oral health status of older rural adults in a multi-ethnic population, and its association with gender, ethnicity, and other demographic predictors; (2) to delineate the nutritional impact of deficits in oral health, including food selection, food preparation, food consumption, nutrient intake, and nutritional status; (3) to document the relationship of oral health to social functioning, including communication and social interaction; and (4) to assess the impact of oral health on perceived well-being/quality of life (QoL, directly and as mediated by dietary intake and social functioning. Building on a foundation of community ethnography begun in 1996, this project will achieve its specific aims using a multi-method approach that integrates the results of qualitative research with older adults (in-depth interviews with 36 older adults experiencing oral health deficits) with a cross-sectional random epidemiological survey (n=750) and clinical examination (dentate only, n=450) of oral health and its consequences for nutritional status and quality of life among a tri-ethnic (African American, Native American and white) largely disadvantaged population of older adults.
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