Oral health for the older patient

Oral health-related quality of life and life-space mobility in community-dwelling older adults

OBJECTIVES

To quantify the associations between measures of oral health-related quality of life (OHRQoL) and life-space mobility (LSM) in community-dwelling older adults.

DESIGN

Cross-sectional study using a 54-item OHRQoL questionnaire.

SETTING

Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural).

PARTICIPANTS

The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community-dwelling adults aged 65 and older.

MEASUREMENTS

Participants completed an in-home interview about their OHRQoL and LSM. Life-space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity.

RESULTS

Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self-rated oral health.

CONCLUSION

OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well-being have a significant effect on mobility and the social participation of older adults.

Dental status, quality of life, and mortality in an older community population: a multivariate approach

OBJECTIVE

To evaluate the relationships between a functional measure of dental status (FDS), several variables belonging to a quality of life (QOL) profile, and mortality in an older community population.

DESIGN

Cross-sectional analysis for FDS and QOL; 10-year prospective study for mortality.

SETTING

The historical and central district of the city of Brescia, northern Italy.

PARTICIPANTS

The entire cohort of 70 to 75-year-old people living in the above-mentioned district (n = 1303): 1201 subjects were eligible for interview at baseline; 11 refused the physical examination; 52 were lost to follow-up; data are presented for the remaining sample of 1137 subjects.

MEASUREMENTS

FDS examination was used to classify the subjects into three groups: naturally adequate (ADS) (25.2%), naturally inadequate (IDS) (14.3%) dental status, and denture wearers (DW) (60.4%). Various QOL domains were assessed: mood level, cognitive status, instrumental activities of daily living (IADL), social relationships, indexes of somatic health, and health behaviors. The demographic and socioeconomic parameters were used as covariates.

RESULTS

Univariate analysis showed that both the ADS and the DW groups had a better QOL profile than the IDS group. Multiple logistic regression indicated that ADS and DW conditions were predicted independently by better educational and financial conditions, higher social relationships and a better IADL level in comparison with IDS. Moreover, compared with IDS, DS was a significant predictor of a better level at the SELF, IADL, and HCU scales whereas DW predicted only a better IADL level. Crude survival analysis showed that ADS was associated with a lower mortality risk compared with both DW and IDS, which did not differ from each other. FDS also remained a significant and independent predictor of mortality in a more general Cox's regression model.

CONCLUSIONS

Within this cohort of 70 to 75-year-old urban residents, FDS is associated with several QOL domains and with long-term survival. A hierarchy of reciprocal relationships exists among these parameters. The present study provides a basis for encouraging more extensive use of dentures. Longitudinal studies using oral health outcomes are warranted before clinical recommendations can be made.