Oral Self-Care Capability is Associated with Mortality in Nursing Home Residents

Background Nursing home (NH) residents often have limited life expectancy and high medical complexity, making it important to align oral health care with prognosis. We examined survival after a comprehensive dental examination among NH residents and identified predictors of mortality to support prognosis-informed oral care planning. Methods We performed a retrospective cohort study using existing clinical data from 902 NH residents who received care from a community-based geriatric dental clinic affiliated with the University of Minnesota School of Dentistry (1999–2006). Mortality was ascertained by linkage to the National Death Index. The primary outcome was time to death after the initial comprehensive dental examination; residents alive at the end of follow-up were censored (December 31, 2010). Candidate predictors were pre-specified from clinical records and grouped into sociodemographic, medical history, functional status, and oral health domains. Analyses used complete cases (n = 665). Predictors were standardized; variable selection used LASSO-penalized Cox regression with 10-fold cross-validation, followed by an unpenalized Cox proportional hazards model for inference. Results The median survival time was 36.0 months (95% CI 32.4–40.5), and the estimated 1-year survival probability was 79% (95% CI 0.75–0.82). In the final multivariable model, higher mortality risk was associated with renal disease (HR 3.31, 95% CI 2.25–4.88; p < 0.001), older age category (HR 1.48 per one-category increase, 95% CI 1.28–1.69; p < 0.001), impaired oral self-care capability (supervision/need assistant vs self-sufficient: HR 1.58, 95% CI 1.27–1.96; p < 0.001), congestive heart failure (HR 1.33, 95% CI 1.07–1.64; p = 0.010), a higher number of comorbidities (HR 1.03, 95% CI 1.01–1.05; p = 0.002), and poorer mobility category (HR 1.25 per one-category increase, 95% CI 1.07–1.47; p = 0.005). Conclusions Among NH residents receiving a comprehensive dental examination, survival was limited, and mortality risk was associated with medical burden and functional dependence, including impaired oral self-care capability. Integrating prognosis and functional assessment into oral care planning may help align treatment intensity with expected outcomes.