A cross-sectional study of oral health and oral health-related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark

doi: 10.1111/j.1741‐2358.2011.00486.x
A cross‐sectional study of oral health and oral health‐related quality of life among frail elderly persons on admission to a special oral health care programme in Copenhagen City, Denmark Aim: To describe the oral health and the oral‐health‐related quality of life (OHRQoL) of citizens in Copenhagen City on admission to a specific oral health‐care programme for disabled elderly persons. Further, to analyse how various factors influence the oral health and the OHRQoL among these patients. Methods: A cross‐sectional study of 189 persons (average 85 years) consecutively admitted to a special oral health‐care programme. Clinical data and data from interviews comprising social factors, life‐style, dental visit habits, oral hygiene practices and self‐perceived oral health were collected. A modified index on perceived dysfunction, discomfort and disability due to oral disorders was used. Results: Sixty‐eight per cent had natural teeth, among those 57% had decayed teeth and two out of three wore dentures. Smoking habits influence the number of teeth present and the OHRQoL (p < 0.05) of the patients. Edentulousness, decayed teeth, and presence of dentures did not seem to cause OHRQoL problems, while higher OHRQoL scores (more problems) were reported by those with 1–9 teeth and tooth mobility. Conclusion: OHRQoL of these patients can be increased by removal of loose teeth and provision of dentures to those with very few teeth rather than focus on traditional caries treatment.     

A cross-sectional analysis of the prevalence of dental anxiety and its relation to the oral health-related quality of life in patients with dental treatment needs at a university clinic in Switzerland

doi: 10.1111/j.1741‐2358.2011.00465.x A cross‐sectional analysis of the prevalence of dental anxiety and its relation to the oral health‐related quality of life in patients with dental treatment needs at a university clinic in Switzerland Objectives: The aim of this observational, cross‐sectional study was to analyse the relationship between dental anxiety (DA) and health‐related quality of life aspects associated with oral conditions of a population with dental treatment needs in Switzerland. Methods: The measurements of DA were collected by means of two questionnaires, the Dental Anxiety Scale (DAS) and a Visual Analogue Scale (VAS). Oral health‐related quality of life (OHRQoL) was assessed with the Oral Health Impact Profile (OHIP). The sample included 223 patients enrolled at a university clinic which specialises in oral prosthetic rehabilitation and temporomandibular disorders. Of them, 78.9% were at or above the age of 50. Results: No gender or age dependencies were observed. A comparison of answers regarding OHRQoL and DA revealed a significant interdependence (p = 0.0118); highly anxious patients were 3.55 times more likely to suffer from poor quality of life compared with less anxious ones. Conclusion: This cross‐sectional study of mostly elderly patients seeking dental treatment in Switzerland found that increased DA was associated with an impaired OHRQoL. The average DA was slightly higher than the results of other industrialised countries and the average OHRQoL was reduced.     

Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians

doi: 10.1111/j.1741‐2358.2012.00656.x Assessing changes in oral health‐related quality of life and its factors in community‐dwelling older Brazilians Objective: To describe changes in oral health‐related quality of life and to evaluate the associations of these changes in community‐dwelling older people. Materials and methods: In this longitudinal study a representative sample of 872 older people, living in Brazil, was evaluated during 2004. The follow‐up was carried out during 2008, with 587 older persons evaluated. A questionnaire assessing socio‐demographic information, health history, oral health‐impact profile and number of natural teeth was used. Changes in oral health‐related quality of life were categorized as improvement or deterioration. Data analysis was performed using a hierarchical approach based in a conceptual framework. A hierarchal approach was carried out using Poisson regressions. Results: Older persons living in rural areas, those who reported brushing once a day or less and older persons with fewer natural teeth had an increased chance of reporting deterioration in oral health‐related quality of life. Women and participants who received a minimum wage of less than US$219.50 were more likely to report improvement in oral health‐related quality of life. Conclusion: The results of this study suggest that changes in the oral health‐related quality of life are influenced by many of the variables that were included in the conceptual framework.     

Association between oral health, cognitive impairment and oral health-related quality of life

doi: 10.1111/j.1741‐2358.2011.00542.x
Association between oral health, cognitive impairment and oral health–related quality of life Objective: Investigating oral health–related quality of life’s (OH‐QoL) relationship with cognitive state. Background: Oral health affects OH‐QoL and is poor in institutionalised and cognitively impaired people. Material and Methods: This was a cross‐sectional study involving 215 institutionalised elderly (82.9 mean age), who were interviewed, examined and cognitively screened using the Pfeiffer test. Results: Mean GOHAI score was 53.1; only 43.7% of the participants reported having a good OH‐QoL. Needing help with dressing or washing (OR 2.14; p = 0.004), having one to nine teeth (OR 4.65; p ≥ 0.001), eight or less occluding pairs (OR 2.74; p = 0.002), one to three caries (OR 1.85; p = 0.005) and being cognitive impaired (OR 0.54; p = 0.034) were significantly associated with altered OH‐QoL in bi‐variate analysis. Being edentulous (OR 3.18; p = 0.0046), having 1–9 teeth (OR 2.62; p = 0.056) and presenting mild cognitive impairment (MCI) (OR 0.32; p = 0.016) appeared as predictive variables in logistic regression for having an altered OH‐QoL. Conclusions: Participants having MCI had significantly better GOHAI score than cognitively normal residents. Performing cognitive screening parallel to applying any OH‐QoL instrument would make the results more reliable and would benefit cognitively impaired people.     

Factors associated with the oral health-related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI

Gerodontology 2011; doi: 10.1111/j.1741‐2358.2009.00360.x
Factors associated with the oral health‐related quality of life in elderly persons in dental clinic: validation of a Mandarin Chinese version of GOHAI Objectives: To translate the original English version of Geriatric Oral Health Assessment Index (GOHAI) into Mandarin Chinese and assess its reliability and validity for use among the elderly in inland China and to explore the factors associated with oral health‐related quality of life (OHRQoL). Methods: The original English version of GOHAI was translated, back‐translated and cross‐culturally adapted. The psychometric properties of GOHAI‐M were assessed in a sample of 263 people aged 60 years and over and OHRQoL was examined in 221 subjects using GOHAI‐M. Multiple regression analysis was conducted. Results: Internal consistency of the GOHAI‐M was excellent (Cronbach’s α : 0.81). Split‐half reliability coefficient was 0.80, and item‐scale correlation coefficient ranged from 0.25 to 0.71. Self‐rated oral health was significantly associated with OHRQoL (r_s = 0.505, p < 0.01). The relation coefficient between GOHAI‐M and self‐perceived need for dental treatment and number of missing teeth were 0.231 and ?0.653, respectively (p < 0.05). Multiple regression analysis found that better OHRQoL was significantly associated with better self‐ratings of oral health (β = 0.497, p = 0.01), number of missing teeth (β = 0.187, p < 0.01) and life satisfaction (β = 0.132, p < 0.05). Conclusion: The Mandarin Chinese version of GOHAI demonstrates acceptable reliability and validity. OHRQoL is associated with self‐rated oral health, number of missing teeth and satisfaction with life.     

A preliminary investigation into tooth care, dental attendance and oral health related quality of life in adult stroke survivors in Tayside, Scotland

Objective: The aim of this study was to investigate patterns of oral care, dental attendance and oral health‐related quality of life among adults who had suffered a stroke. Background: Stroke is the most common cause of adult disability in the UK. Seventy per cent of strokes occur in adults over 65 years of age. A mild stroke may leave little residual disability but in cases of moderate or severe stroke the disability may be significant and may impact on oral health and function. Materials and methods: A cross‐sectional survey was conducted among adults surviving 1 year after stroke, between January and July 2001. A medical screening was carried out which included an assessment of disability and handicap using the modified Rankin scale. A structured interview was conducted to identify normal patterns of oral care and dental attendance and to elicit if since suffering a stroke any changes had occurred or were likely to occur. The Short Form Oral Health Impact Profile (OHIP‐14) was administered prior to an oral examination. Analysis used SPSS 11.0 for Windows. Parametric and nonparametric tests were undertaken (t‐tests and chi‐squared tests with Yates correction where appropriate). Results: Forty‐one adults were recruited into the study comprising 21 female and 20 male. They ranged in age from 50 to 87 years and the mean age was 69 years (SD = 9.8). Forty per cent of participants experienced moderate disability or greater following their stroke. Thirty‐seven per cent had difficulty with tooth cleaning. The most frequently reported problem was being unable to use one hand properly as a result of the stroke. There was a significant association between the degree of disability following stroke and difficulty with tooth cleaning (P = 0.015). Disability as a result of the stroke was cited as the main reason for reported or projected attendance pattern change. The most frequently experienced OHIP‐14 dimension was functional limitation (39%). Conclusion: Individuals who have been left disabled after a stroke may require help with or advice on oral care and information on how to access dental services in a setting appropriate to their disability. Further research is needed to identify the dental needs of adults with stroke and to identify appropriate interventions to meet these needs.     

Tooth loss and dental caries in community-dwelling older adults in northern Manhattan

doi: 10.1111/j.1741‐2358.2011.00502.x Tooth loss and dental caries in community‐dwelling older adults in northern Manhattan Objective: To examine tooth loss and dental caries by sociodemographic characteristics from community‐based oral health examinations conducted by dentists in northern Manhattan. Background: The ElderSmile programme of the Columbia University College of Dental Medicine serves older adults with varying functional capacities across settings. This report is focused on relatively mobile, socially engaged participants who live in the impoverished communities of Harlem and Washington Heights/Inwood in northern Manhattan, New York City. Materials and Methods: Self‐reported sociodemographic characteristics and health and health care information were provided by community‐dwelling ElderSmile participants aged 65 years and older who took part in community‐based oral health education and completed a screening questionnaire. Oral health examinations were conducted by trained dentists in partnering prevention centres among ElderSmile participants who agreed to be clinically screened (90.8%). Results: The dental caries experience of ElderSmile participants varied significantly by sociodemographic predictors and smoking history. After adjustment in a multivariable logistic regression model, older age, non‐Hispanic Black and Hispanic race/ethnicity, and a history of current or former smoking were important predictors of edentulism. Conclusion: Provision of oral health screenings in community‐based settings may result in opportunities to intervene before oral disease is severe, leading to improved oral health for older adults.     

Factors associated with negative self-perception of oral health among elderly people in a Brazilian community

Objective: Self‐perception of oral health is an important measurement for assessing the health and quality of life of elderly people. The aim of this study was to analyse associations between negative self‐perception of oral health and poor oral state, socio‐demographic variables, depression and use of medications. Method: In this cross‐sectional study, elderly people aged 60 to 74 years living in the urban zone of a city in southern Brazil were interviewed and examined. Functionally dependent individuals were excluded. Self‐perception was measured using the General Oral Health Assessment Index, and scores of 30 points or less were considered to represent negative perception. The physical, social and worry dimensions of this indicator were also analysed. Results: Two hundred and sixty‐seven elderly people (mean age 66.5 years, 59.9% female) were included in the study. Most of them had had little schooling. Negative self‐perception was identified in 18.7%, although none of the poor oral state was associated with this variable. In multivariate analysis, negative self‐perception was associated with female gender and depression. The women presented significantly lower means in the three dimensions analysed and individuals with depression, in the physical and social dimensions. Poor oral health (edentulism and absence of posterior occlusion) were associated with the physical dimension. Conclusion: Negative self‐perception of oral health was associated with gender and depression, but not with poor oral health. Therefore, gender and the presence of depression are factors to be taken into account in assessments involving this age group.     

The importance of oral health to older people's quality of life

Objectives This study was designed to determine whether older people perceive oral health as being important to Quality of Life (QoL) and if so, to identify the most important ways in which their lives are affected. In addition, to identify if subgroups of older people perceive its importance differently. Design: Nationwide qualitative face to face interviews with older people were carried out utilising the Office for National Statistics Omnibus survey in Great Britain. Subjects and methods 454 adults aged 65 or older took part in this study, part of a random probability sample of adults in the UK. Setting Respondents were interviewed in their homes. Results 72% (313) perceived their oral health status as important to their QoL through a variety of physical, social and psychological ways. Most frequently its impact on function: eating (29%, 126) and symptoms: comfort (14%, 59) were considered most important. Gender and social class variations were apparent (P<0.05). Conclusion Older people perceive oral health as being important to life quality in a variety of different ways. There are significant social class and gender variations which must be taken into consideration when assessing oral health needs of older people.     

Oral health behind bars: a study of oral disease and its impact on the life quality of an older prison population

Objective: The principal aims of this study were to report on the prevalence of oral disease and its impact on the life quality of older (aged 60 and above) prisoners at Hong Kong SAR's elderly detention centre, China. Design: A cross‐sectional epidemiological survey involving clinical oral examinations and face‐to‐face interviews with 64 older prisoners at the centre. Clinical oral examinations were carried out following WHO criteria. The impact of oral health on life quality was assessed using the 14‐item Oral Health Impact Profile measure, OHIP‐14 Results: The prevalence of oral disease was high, the mean DMFT was 22.5 (SD 10.6) and 40% (18) of the dentate prisoners had shallow or deep periodontal pockets. Most (75%, 48) were in need of prosthetic treatment. Over half the prisoners experienced one or more oral health impacts on life quality during the previous year. This was associated with socio‐demographic factors: employment status prior to incarceration (P<0.01), oral health behaviour: smoking habits (P<0.01) and clinical oral health status: DMFT (P<0.05) and prosthetic need (P<0.05). Conclusion: Among inmates at Hong Kong's elderly detention centre, the prevalence of oral disease was high and the impact of oral health on their life quality was substantial. The impact of oral health on the life quality of the older prisoners was associated with prisoners socio‐demographic background, oral health behaviour and oral health status.     

Oral health-related quality of life: a critical appraisal of assessment tools used in elderly people

Objective: The purpose of this study was to undertake a critical appraisal of oral health‐related quality of life (OHRQoL) measurements used for research in the elderly. Background: A variety of OHRQoL measurements have been developed in the past 20 years as a result of increased concern about the impact of oral conditions on a person’s quality of life. There is need for an assessment aimed at prioritising the recommended measurements to be used for different purposes in the elderly. Materials and methods: Original English language papers using measurements to assess OHRQoL in the elderly were identified from Web of Science, EMBASE, PubMed, Medline and Lilacs databases. The search included all papers published from 1985 to February 2007. The criteria of assessment were: (i) measurement criteria (number of items and domains, and classification of the results found for each measurement); (ii) quantitative–qualitative criteria (frequency, acceptability, reproducibility, reliability, sensitivity and capability of being reproduced in other language versions). Results: In a total of 152 papers selected, 20 measurements were identified. However, only seven fulfilled all the measurement and quantitative–qualitative criteria. Conclusion: Geriatric Oral Health Assessment Index, Subjective Oral Health Status Indicators, Oral Health Impact Profile‐49, Dental Impact on Daily Living, Oral Health Impact Profile‐14, Oral Impact on Daily Performances and German Version of the Oral Heath Impact Profile were considered as instruments of choice to assess OHRQoL in the elderly. The other 13 instruments identified require further research aimed at a validation process and the use of a language other than English.     

Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders

doi: 10.1111/j.1741‐2358.2010.00402.x Experiences and perceptions of oral health and oral health care among a sample of older New Zealanders Background: Most research on older people’s oral health has been quantitative. A need for more in‐depth understanding of the oral health of that age group has pointed to a need for more qualitative investigations. Objective: To explore experiences and perceptions of oral health and oral health care among an ethnically‐mixed sample of older New Zealanders. Methods: In‐depth interviews were conducted with 24 older people in two communities in New Zealand’s South Island. Thematic analysis of transcribed data was undertaken. Results: Three main themes that emerged were: (1) the processes of negotiating a tension between cost and convenience of access; (2) the experiential constraining of oral health maintenance; and (3) trusting in dental professionals. These serve to organise processes such as normalising, justifying and social comparisons that create an equilibrium or tolerance and acceptance of what might otherwise be considered to be relatively poor oral health. Conclusions: We identified a number of shared experiences which affect older people’s ability to maintain their oral health in the face of material and social barriers to oral health care. Because expectations were generally lower, there was greater concordance between experience and expectation, and people tended to be fairly satisfied with their oral health and the care they had received.     

Culture,dental professionals and oral health values in multicultural societies: measuring cultural factors in geriatric oral health research and education

Culture has significant impacts upon professional practice and patient health behaviours, especially in multicultural societies. This paper introduces the concept of culture and examines how it may be of importance to dental health professionals. Using the Dental Impact Profile and other dental social science measures, dental researchers and students can be engaged in studying cultural values and characteristics as a way of dealing with cultural differences.     

A comparison of the dental health of Brazilian and Canadian independently living elderly

doi: 10.1111/j.1741‐2358.2009.00340.x
A comparison of the dental health of Brazilian and Canadian independently living elderly Objective: To compare the dental status of Brazilian and Canadian elderly populations with respect to socioeconomic and quality of life factors. Materials and methods: A total of 496 adults aged 60–75 years, having four or more teeth, and physically and cognitively suitable for a clinical oral examination were included. Subjects answered questions concerning their lifestyle and completed the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. Results: In all populations, the majority were females, aged between 60 and 65 years and married. Although the Canadian New Immigrant population had lower mean income, they had more remaining teeth (23.04 ± 6.1), more functional teeth (sound and restored teeth) (14.92 ± 5.7), more sound teeth (15.40 ± 7.6), but more carious teeth (2.97 ± 3.0). The Brazilian population had higher numbers of restored teeth (12.26 ± 6.8) and fewer remaining teeth (17.80 ± 7.6). In all populations, females, married and younger (60–65 years old) adults were more likely to retain 20 or more teeth. The mean GOHAI scores were similar for Canadians (40.55 ± 5.7) and Canadian New Immigrants (39.28 ± 6.5), but were higher than that among Brazilians (31.97 ± 8.9). Conclusions: The numbers of remaining teeth were related to greater education and higher income status for Brazilian and Canadian populations. However, Canadian New Immigrants with lower income and education retained more teeth than the other populations.