Courtney Campbell

Kim Le
Needs Assessment:
A. General Data
1. Description of Site:
Nutrition & Services for Seniors main office is located at 4590 Concord Road
Beaumont, Texas. There are several dining sites located throughout the Beaumont, Port
Arthur/Mid County, and Hardin County areas. Nutrition & Services for Seniors is a nonprofit agency dedicated to providing effective programs that assist older adults in leading
quality lives while maintaining dignity and independence. This facility first opened in
1983 when a group of civic-minded residents, concerned for the well being of seniors in
the community set upon a path to expand services to local seniors. The group intended to
help by providing congregate meals, home delivered meals, transportation, nutrition
education and information on referrals helping to give seniors the opportunity to remain
independent in their own homes. With the help of the Older Americans Act (OAA) being
passed in 1965 these citizens were able to get this organization started and it is a big part
of the communities of Jefferson and Hardin counties. The organization is governed by
Board Members, composed of people in the community. Every day operations are run by
the Executive Director. Each dining site has their own day coordinators which help set up
the weekly activities available to the seniors. One of the main roles of this organization is
Meals on Wheels. Nutrition & Services for Seniors has provided over 5 million hot
noon meals to hungry seniors in the Jefferson and Hardin counties since 1983. Noon
meals are also provided at 17 dine in locations within Hardin and Jefferson County. At
these facilities Seniors also have the opportunity to participate in games and programs
that improve health and reduce their risk of disability through lifestyle behaviors.
Transportation is also provided to ensure that clients are not cut off from the world and
able to access vital life sustaining services. This site also provides the services of Carenet
and Animal, which provides food to any pets of participating senior free of charge.
Nutrition & Services for Seniors is a non-profit organization that receives funding from
the government and state. The sites also ask seniors 60 years of age and older for $2.00
contribution, however no one is turned down if they do not contribute. The cost for guest
under 60 years of age are charged $4.00 for meals. The organization also does various
fundraisers through the year to help raise money. There 4 dinning sites in the Beaumont
area, 7 in Port Arthur/Mid-County area, and 6 in the Hardin County area.

2. Description of Target Group:

The target group for this particular oral health program consists of the seniors 60 years of age
or older that use the dine in eating facilities at various site locations. The group is expected to
range from 20-35 members depending on the site. All ethnic groups are served however majority
of the seniors that dine in are war veterans or widows of war veterans.
3. Description of Staff Population:
There are 17 dining room managers and about half that many volunteers that help in the
centers. Most of the managers are seniors over 60, as well as the volunteers. Several the office
and kitchen staff are also seniors. There are no educational requirements for being a manager at
the site. The organization follows state regulations provided by Area Agency on Aging for hiring
of permanent staff. Majority of the drivers that take meals to the homes in Jefferson and Hardin
Counties are seniors that volunteer their time. The amount of volunteers depend on the sites
location and vary from day to day.
4. Description of Services Provided:
Each dining site has their own center manager who is responsible in organizing the centers
activities for the seniors. The sites do not have a nutritional counselor, however the state requires
each center manager to provide the clients with nutritional education monthly. This information
is obtained through Lamar Dietician Interns. The information obtained through the Dietetic
Interns is signed off and verified by a Dietician instructor from Lamar University. Lunch is served
to the senior clients Monday-Friday between 11:30 and noon. During the afternoon or mornings
before lunch clients participate in activities such as dominos, card games or bingo. The Day
Coordinator at the main site on Concord Road is interested in providing the seniors at all sites
with more dental care information and referrals to where care be obtained in the community.
Other Pertinent Data
The water fluoridation in both Jefferson and Hardin Counties is .7ppm.
B. Information Related to Dental Health
At this time this organization does not provide any dental or dental hygiene care. The
organization were unaware about cleanings provided at LIT or any clinics throughout the community.
This organization does not provide any preventive measure to the clients. State funding does not
allow for the organization to provide the Senior clients with any dental material. This facility has
never had a dental program in the past.

C. Dental Health status:

1. Dental Caries
Approximately 91% of U.S adults aged 2064 suffer from dental caries in their permanent teeth
[5]. Dental caries among adults aged 3564 was found to be at a higher percentage when compared with
adults aged 2034 (82%) [5]. Of these 91% of adults aged 20-64 27% had untreated tooth decay in
permanent teeth. Of U.S. adults aged 65 and over with any permanent teeth 93% had dental caries [6].
Caries prevalence was lower for non-Hispanic black (91%) and Hispanic (86%) adults compared with
non-Hispanic white adults (98%). It was seen that white adults and those living in families with higher
incomes and more education have had more decay [6]. Approximately 19% of adults aged 65 and over
had untreated caries in 20112012[5]. No difference was seen in untreated dental caries prevalence
between adults aged 6574 and adults aged 75 and over. Untreated tooth decay was significantly higher
for non-Hispanic black adults (41%) compared with Hispanic (27%), non-Hispanic white (16%), and nonHispanic Asian (27%) adults. Older non-Hispanic Asian and Hispanic adults were more likely to have
untreated dental caries compared with older non-Hispanic white adults.
Older Americans with the poorest oral health are those who are economically disadvantaged, lack
insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or
institutionalized also increases the risk of poor oral health [3]. With an increase in dental health
knowledge, older adults are keeping their permanent dentition longer. Most older Americans take both
prescription and over-the-counter drugs. Over 400 commonly used medications can be the cause of a dry
mouth. Reduction of the flow of saliva increases the risk for oral disease, since saliva contains
antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing
bacteria [3]. Individuals in long-term care facilitiesabout 5 percent of the elderlytake an average of
eight drugs each day [3]. Taking a variety of medications may lead to a reduction in salvia in the oral
cavity putting the older adult at a higher risk for dental caries.
2. Periodontal Disease
Periodontal Disease has been shown to increase with age, 17.2% of adults 65 years and older
have periodontal disease [6]. Severity of periodontal disease increases with age; about 23% of adults
65- to 74-year-olds have severe disease, which is measured by 6mm loss of attachment of the tooth to
the adjacent gum tissue [ 3]. At all ages periodontal disease is more common in men than women

(56.4% vs 38.4%). At all ages those Black and Hispanic seniors, current smoker, and those with
lower income and less education are more likely to have periodontal disease.
Many older Americans do not have dental insurance. Medicaid, the jointly-funded Federal-State
health insurance program for certain low-income and needy people, funds dental care for low income
and disabled elderly in some states, but reimbursements for this care are low [3]. Medicare, which
provides health insurance for people over age 65 and people with certain illnesses and disabilities,
does not provide routine dental care.
3. Oral Hygiene

Oral health is an important and often overlooked component of an older persons general health
and well-being. Painful conditions that affect the facial nerves are more common among the elderly and
can be severely debilitating. These conditions can affect mood, sleep, and oral-motor functions such as
chewing and swallowing. Neurological diseases associated with age, such as Parkinson's disease,
Alzheimer's disease, Huntington's disease, and stroke also affect oral sensory and motor functions, in
addition to limiting the ability to care for oneself [3].
4. Oral Cancer
Yearly, more than 30,000 cases of oral and pharyngeal cancers are diagnosed in Americans,
resulting in about 8,000 deaths [7]. These cancers are primarily diagnosed in the elderly aged 60-70, with
a poor prognosis [3]. The five-year survival rate for white patients is 56 percent and for African American
patients is only 34 percent [3]. Methods used to treat oral cancers (surgery, radiation, and chemotherapy)
are disfiguring and costly [7]. Preventing high risk behaviors, that include cigarette, cigar or pipe
smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers.
Early detection is key to increasing the survival rate for these cancers [7].

Goal and Objectives

Our goal for this oral health program is to provide the knowledge and skills to maintain
optimal oral health for the staff and clients of the sites of Nutrition and Services for Seniors.

Objectives

To increase the dental knowledge of the staff by 20%.

To increase the dental knowledge of the senior clients by 15%.

To decrease dental plaque of the senior clients by 15%.

Provide oral cancer screenings.

Establish a bi-yearly schedule for oral hygiene care through LIT Dental Hygiene
Clinic

Rationale
With older Americans living longer oral health education in the elderly population is just as

important as informing the younger populations. In 2001, the population of the United States was
almost 278 million, and 12.6% of the population was 65 years of age or older. By 2015, the
population was expected to increase to 312 million, and 14.7% of the population would be aged
65 years or older [12]. The reason oral health is suffering in the elderly population is due to the
lack of oral health knowledge on its affect on overall general health and how to properly care for
your oral cavity; in combination with medications and various systematic diseases. The elderly
may also have difficulty performing routine oral hygiene procedures because of physical
limitations making it even more critical to be informed about alternatives and modifications to
help obtain optimal oral health. The elderly population are retaining more of their natural
dentition as they age so it is imperative to keep them informed on oral health education and
prevention.
Due to the elderly population dealing with more perceived serious diseases and various
barriers: transportation, financially, physical ailments, and insurance; dental care is not a top
priority in the elderly population. Normative aging processes alone have little effect on the oral
cavity, however lack of education and attentiveness to the oral cavity leads to tooth loss, dental
caries, periodontal diseases, and oral mucosal diseases: candidiasis and squamous cell carcinoma
[11]. According to the reports by the CDC many elderly Americans are affected by untreated
caries and periodontal disease. One-third of adults aged 65 years and over have untreated dental
caries and slightly over 40 percent have periodontal disease [11]. Without the push for more
preventive measures and oral health education the elderly population will continue to experience
missing teeth, ill-fitting dentures, cavities, gum disease or infections, which can force the elderly
to adjust the quality, consistency, and balance of their diet [9]. A decline in a healthy diet can lead
to malnutrition and increase the risk of contracting certain systematic diseases. Oral infections
are now recognized as a risk factor for a number of systemic diseases, including cardiovascular

and cerebrovascular diseases, diabetes mellitus, and respiratory disorders [12]. Systemic diseases
and their medical treatments frequently affect salivary, oral motor, and oral sensory functions
[11].
The state of oral health in the older American is largely affected by only 22% of older person
being covered by dental insurance [10]. It is also important to emphasize that once people have
become edentulous (toothless) and are using complete dentures, their oral health needs do not
cease [12]. People without teeth remain susceptible to oral cancer, mucosal diseases, and
alterations in salivary gland function.
Occupations caring or having daily interaction with the elderly population need to recognize
the importance of oral health, support the education of patients on aspects of dental health, and
advocate the expansion of personal and public oral health benefits for older adults [10]. Our oral
health program will focus on alerting non-dental health personnel on the significance of oral
health and various oral diseases seen in the elderly population.

Program Design
A. Activities
The oral health program is focused on educating staff members and senior clients at Nutrition
& Services for Seniors. During the session with the senior clients and Staff, we will be discussing
the importance of oral care and how to properly care for their oral cavity.

Session:

Staff Members:

During this session we will discuss general oral health information. Topics will
include plaque, brushing, gingival disease, denture care, oral cancer screening,
xerostomia, and a pre/post-test.

Pre-test on basic oral health knowledge.

Describe plaque and how it forms.

Use pictures for Staff Members to identify difference between healthy and
diseased gingiva.

Demonstrate proper brushing technique on a typodont.

We will pass around the typodont so that the staff members can practice the bass
method.

Stress the importance of adequate oral hygiene care.

Describe how to properly care for dentures/partials.

Use pictures to identify signs of oral cancer.

Stress the importance of applying the information learned into their daily routine
with senior clients.

Explain risk of xerostomia and aids to help with it.

Post-test.

Session:

Senior Clients:

During this session we will discuss general oral health information. Topics will
include plaque, brushing, gingival disease, denture care, oral cancer, xerostomia, and
dental word search and bingo.

Dental word search to assess basic oral health knowledge.

Describe plaque and its formation.

Use pictures for seniors to identify difference between healthy and diseased
gingiva.

Demonstrate proper brushing technique on a typodont.

Measure plaque score by using disclosing solution.

Residents will then practice brushing techniques on themselves.

Re-disclose residents.

Modify techniques if needed.

Stress the importance of adequate oral hygiene care.

Explain and demonstrate proper denture/partial care.

Practice cleaning their dentures with learned techniques.

Use pictures to identify signs of oral cancer.

Stress the importance of being able to identify oral disease and oral cancer at
home and where treatment can be received.

Explain risk of xerostomia and aids to help with it.

Post-test.

B. Constraints and Alternative Strategies

Constraints: There could be a lack of interest with the senior clients during the
presentation/lesson.

Alternatives: Keep each lesson interesting by asking questions, providing short videos
throughout the presentation, and involving senior clients as much as possible.

Constraints: Attendance may be partial depending on the senior clients that attend the site on
Tuesdays and staff may not be able to take time out of schedule to listen to a presentation.

Alternatives: Inform senior clients about oral health presentation prior to scheduled date via
flyer.

Constraints: There may be a lack of regular dental visits and many dental needs among the
residents due to financial constraints.

Alternatives: Inform the staff of the importance of having dental services to prevent dental
emergencies and to assist in maintaining a plaque-free oral environment, and provide
information of the utilization of the LIT Dental Hygiene clinic.

C. Resources
Personnel: Dining room site Supervisor, staff and senior clients.
Equipment: PowerPoint presentation projector.
Supplies: Toothbrushes, toothpaste, floss, safety glasses, gloves, masks, cups,
disclosing tablets, denture cleaning tablets, denture brushes, mouth rinse, paper
napkins, tongue depressors, plastic hand mirrors, plastic mouth mirrors, typodonts,
pre and post tests, plaque score sheet, program plan evaluation form, and screening
and assessment form.
Audio/Visual Aids: PowerPoint presentation, Typodonts, Disclosing solution
Evaluation Supplies: Pre and Post-test and plaque score sheet, director evaluation
D. Budget
Toothbrushes Donated by Colgate
Toothpaste Donated by LIT Dental Hygiene
Safety Glasses Provided by presenters

Gloves Provided by presenters

Masks Provided by presenters
Cups Donated by LIT Dental Hygiene
Disclosing solution Provided by presenters
Cotton tip applicators- Donated by LIT
Denture Cleaning tablets Provided by presenters
Denture Brushes Donated by Colgate
Mouth rinse Donated by Colgate
Paper Napkins Provided by LIT Dental Hygiene
Tongue Depressors Provided by LIT Dental Hygiene
Plastic Hand Mirrors Provided by presenters
Plastic Mouth Mirrors Provided by LIT Dental Hygiene
Typodonts Provided by presenters
Pre/Post-test Provided by presenters
Plaque Score Sheet Provided by presenters
Screening and Assessment Form Provided by presenters
Estimated total: $0.00

E. Timetable
This oral hygiene program will last four weeks. The days we plan to implement will
be as followed:
i. Session 1 will be the week of March 28th -April 1st
ii. Session 2 will be the week of April 4th 8th
iii. Session 3 will be the week of April 11th 15th
iv. Session 4 will be the week of April 18th- 22nd
Formative

Initial and final plaque indices will be measured and recorded to evaluate progress on the
chosen residents once prior to implementing sessions, and once on the day of the last session.
Review at the end of each session with each group.
Pre-test over general oral health knowledge.

B. Summative

The staff members will be given a pre/post-test to determine their dental IQ.
The senior clients will be given a pre/post-test to determine their dental IQ.
A pre/post plaque score will be performed on the residents to measure the effectiveness of
their oral hygiene.
A lesson plan will be provided to the Executive Director of the program to allow
implementation of the oral health program annually.
Receive a review from the Executive Director to determine the overall success of the
program.

REFERENCES
1.
2.
3.
4.

Elaine Shellenberger, Executive Director [Personal interview]. (2016, February 12).

Kathryn Garbee, Dining Site Supervisor [Personal interview]. (2016, February 12).
(n.d.). Retrieved February 12, 2016, from http://seniormeals.org/
Oral Health Data Systems My Water's Fluoride Safe, effective prevention of tooth decay for
people of all ages: Know if your water is optimally fluoridated. (n.d.). Retrieved February 15,
2016 from http://apps.nccd.cdc.gov/MWF/PWSDetailV.asp?
PWSID=1000002&State=TX&StartPg=1&EndPg=20&County=Hardin&PWSName=&Filter=0

&PWS_ID=&State_ID=TX&SortBy=1&StateName=Texas
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http://www.cdc.gov/nchs/fastats/dental.htm
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http://www.ncbi.nlm.nih.gov/pubmed/7490396
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