Functional Oral Assessment in Long Term Care Facilities Using the CIRS Stratification Algorithm

Abstract

According to the American Dental Association, functional oral health is important to the well-being and 
quality of life of people living in long-term care (LTC) settings. Nevertheless, standardized assessment 
tools to measure and manage oral function among LTC residents have yet to be appropriately developed. 
This study examined the feasibility of using the Cumulative Illness Rating Scale (CIRS) stratification 
algorithm to provide functional oral health assessment for this population. We aimed to utilize the CIRS 
medical complexity data, in conjunction with functional measures of oral health, including the ability to 
masticate, swallow, and wear dentures, to identify residents at a higher risk of oral dysfunction, thereby 
prioritizing the provision of dental care. To examine both 'traditional' oral health assessments and the 
CIRS stratification approach, a cohort of LTC residents was recruited. As expected, we found that those 
with higher CIRS scores correlated with impaired oral function, indicating CIRS algorithm merits use 
for predicting oral health decline. By doing so, resource allocation for oral health care across the 
spectrum of LTC will be more focused and efficient for this medically complex population. The CIRS 
algorithm can be incorporated into the evaluation process and integrated into existing assessment 
protocols for the purpose of improving oral health outcomes, mitigating complications of malnutrition 
and/or aspiration, and ultimately improving the quality of life for institutionalized older adults. Future 
research should investigate the validity and reliability of this approach in other healthcare settings and 
with diverse populations.