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

Association between disability and cognitive function in older Chinese people: a moderated mediation of social relationships and depressive symptoms

Objective

Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and cognitive impairment, the present study aimed to investigate the moderating role of social relationships, including their role as mediators between disability and cognitive impairment in depressive symptoms.

Study design

This is a cross-sectional study.

Methods

A total of 5,699 Chinese older adults from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study, and PROCESS macro was used to perform simple mediator and moderator mediator analyses, which were used to analyze the relationship between depressive symptoms and social relationships between disability and cognitive impairment.

Results

The results of this study showed significant correlations between disability, cognitive impairment, depressive symptoms, and social relationships, and that depressive symptoms mediated the relationship between disability and cognitive functioning [B = -0.232; 95% CI: (-0.304, -0.164)], and that social relationships mediated disability and cognitive functioning through pathway a (Disability-Depressive Symptoms) [B = 0.190; 95% CI: (0.020, 0.036)], path b (depressive symptoms-cognitive impairment) [B = 0.029; 95% CI: (0.015, 0.042)], and path c' (incapacitation-cognitive impairment) [B = 0.492; 95% CI: (0.298, 0.685)] to modulate the effect of incapacitation on cognitive impairment. In addition, social activities and social networks moderated the mediation model directly or indirectly, whereas social support moderated only the direct effect.

Conclusion

This study explains the intrinsic link between incapacitation and cognitive impairment in Chinese older adults, and that social relationships and depressive symptoms can directly or indirectly modulate the effects between them. This provides a basis for healthcare professionals to be able to better develop interventions that can be used to improve the level of cognitive functioning and mental health of older adults.

Oral conditions associated with oral health related quality of life: A population-based cross-sectional study in Brazil

AIM

To investigate the association between 11 oral conditions and oral health related quality of life (OHRQoL).

MATERIALS AND METHODS

This cross-sectional study used a multistage sampling strategy to draw a representative sample of adults aged ≥35 years living in Porto Alegre, Brazil. OHRQoL was assessed using OHIP-14. Oral examinations were conducted to assess gingivitis, dental calculus, tooth loss, gingival recession (GR), dentine hypersensitivity (DHS), dental caries (DFT), dental erosion, and non-carious cervical lesions (NCCL). Questionnaires recorded the following self-reported oral variables: xerostomia, halitosis, and perceived need for dental treatment. Structural Equation Models were used to assess the associations adjusting to demographic and behavioral variables.

RESULTS

1022 individuals were analyzed. The overall OHIP mean equaled 9.2 ± 9.7 points. Xerostomia [coefficient (coef)=0.10], halitosis (coef=0.28), DFT (coef=0.16), and DHS (coef=0.19) were significantly and directly associated with negative impacts of OHIP-14. GR was significantly and indirectly associated with poor OHRQoL due to higher DHS. Perceived need for dental treatment was significantly and directly associated with higher OHIP-14 (coef=0,40).

CONCLUSIONS

Poor OHRQoL was observed in a sample of Brazilian adults and old people. Five important oral conditions were associated to poor OHRQoL. Tooth loss, gingivitis, calculus, dental erosion and NCCL did not associate with OHRQoL.

CLINICAL SIGNIFICANCE

Poorer oral health related quality of life is observed in a Brazilian urban area compared to other parts of the world. Xerostomia, halitosis, dental caries, gingival recession, and dentine hypersensitivity may be targeted to improve oral health and consequently oral health related quality of life.

Periodontitis stage and grade are associated with poor oral-health-related quality of life: Findings from the Porto Alegre cohort study

AIM

To determine the association between periodontitis stage and grade with oral-health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This cohort was derived from the Porto Alegre study. The original sample was representative of more than 3 million inhabitants of a Brazilian urban area. Full-mouth periodontal examinations at six sites per tooth were performed at baseline and 5 years later. Periodontitis grade was determined by direct evidence of progression of attachment loss over the follow-up. Stage of periodontitis and OHRQoL, determined by the oral health impact profile version 14 (OHIP-14), were recorded at the follow-up examination. Mean ratios (MRs) and 95% confidence intervals (95% CIs) were estimated adjusting for age, sex, smoking, systemic diseases, tooth loss, and baseline periodontitis diagnosis.

RESULTS

Five-hundred and ninety-nine individuals were analysed. Individuals with periodontitis grade C + stage II (MR = 1.49; 95% CI = 1.08-2.04) and stages III/IV (MR = 1.83; 95% CI = 1.25-2.66) had significantly higher OHIP scores than those without periodontitis or with periodontitis stage I/grade B. Individuals with periodontitis stages II and III/IV + grade B did not differ from those without periodontitis or with periodontitis stage I/grade B.

CONCLUSION

Severity and progression rate of periodontitis are associated with poor OHRQoL.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Oral health-related quality of life and associated factors in the elderly: a population-based cross-sectional study

Abstract This study aimed to evaluate the oral health-related quality of life (OHRQoL) and associated factors in the elderly. A cross-sectional study was conducted with 287 elderly of Cruz Alta, Brazil. The following variables were collected: age, sex, ethnicity, level of education, marital status, retirement, medical/dental history, smoking/alcohol exposure, oral hygiene habits, use and need of dental prosthesis, missing teeth, temporomandibular disorder symptoms (TMD), nutritional status, and halitosis. OHRQoL was assessed by Oral Health Impact Profile-14 (OHIP-14). The sample was categorized into low impact (sum scores ≤6) and high impact (sum scores ≥7). Associations were analyzed by Poisson regression with robust variation. Mean scores of OHIP-14 was 5.92±8.54. Divorced individuals and those who did not use dental floss presented 77% and 54%, respectively, higher prevalence ratio (PR) of having higher OHRQoL impact. Elderly that did not need dental prosthesis demonstrated a lower impact on OHRQoL (P<0.01). Elderly with TMD presented a higher PR of having higher OHRQoL impact (P<0.01). It was concluded that higher impact on OHRQoL was associated with marital status, non-users of dental floss and those with TMD. No need dental prosthesis were associated with lower impact on OHRQoL.

Access to dental services and oral health-related quality of life in the context of primary health care

The aim of the present study was to evaluate the association between access to oral health care in the Primary Health Care (PHC) and Oral Health-Related Quality of Life (OHRQoL). The present study was a cross-sectional study, and the sample was composed of 412 users living in the areas covered by the public PHC services who visited a health unit for an oral exam or treatment in the last 24 months. Participants in the study responded to a home-based interview with questions that addressed socioeconomic status, behavioral, general health, dental prostheses, access to dental services in the PHC and their OHRQoL as measured by the Oral Health Impact Profile (OHIP-14) instrument. After the interview, a dental examination was performed to count the number of teeth. Chi-square tests, Student's t tests and multivariate analyses were performed using a hierarchical model and a Poisson regression with robust variance to evaluate the association between independent variables and OHRQoL. Access to oral health services in the PHC was statistically associated with OHRQoL, and the estimated prevalence rate was PR = 1.17 (CI 95% 1.00-1.37). In this study, the definition of access was based on the availability of dental consultations on demand. The study identified that lack of access to oral health services offered by the PHC was associated with a higher prevalence of impact on the quality of life of individuals.

Assessment of oral health-related quality of life as a function of non-invasive treatment with high-fluoride toothpastes for root caries lesions in community-dwelling elderly

PURPOSE

Non-invasive treatment of root caries lesions (RCLs) may impact oral health-related quality of life (OHRQoL), but no evidence is available. The purpose of the study was to assess changes in OHRQoL among patients exposed to non-invasive treatment of RCLs with conventional or high-fluoride dentifrices.

METHODS

To be eligible, subjects had to be ≥60 years of age, independently living, with at least five teeth and one RCL. The 14-item Oral Health Impact Profile for adults in Spanish (OHIP-14Sp), oral examination and sociodemographic data were documented at the beginning of the study (T0). The presence and activity of RCLs were detected and diagnosed. Subjects were randomly assigned to either the control (1,450 ppm fluoride) or the experimental (5,000 ppm fluoride) treatment group. A new set of measurements was obtained at 12 months (T1). Mean comparisons were carried out using the Student's t-test for total OHIP-14Sp scores. To determine whether T1 OHRQoL scores were different regarding sex, age, educational level and socio-economic status, mean OHIP-14Sp scores were obtained and compared with those variables at 12 months.

RESULTS

An overall improvement in OHRQoL after the non-invasive treatment of RCLs was verified when T1 was compared with T0 (P < 0.0001). Regarding treatment type, no significant differences were detected between groups (P = 0.114). Subjects with higher income and more years of formal education had better OHRQoL than those with a lower salary (P < 0.0001) and with fewer years of education (P = 0.0006).

CONCLUSIONS

Non-invasive treatment for RCLs in community-dwelling elders appears to cause a positive impact on OHRQoL. Better OHRQoL was associated with higher socio-economic status and educational level. No significant differences were detected regarding the fluoride concentration in the dentifrices.

The impact of nursing students on the health-related quality of life and perceived social support of a rural population in Ecuador: effects of a service-based learning course

BACKGROUND

Students seeking degrees in healthcare in Ecuador participate in community improvement projects and provide free health services under the supervision of faculty health professionals. The aim of this study is to determine the impact of a community-based intervention delivered by nursing students on health-related quality of life (HRQoL) and perceived social support of a rural population in Ecuador.

METHODS

A quasi-experimental non-equivalent control group design study was conducted in two rural communities in Tumbaco, Ecuador. Families from one rural community were invited to participate in the intervention, receiving 8 weekly home visits from nursing students. Families from a neighboring community were similarly recruited as wait-list controls. One member of each family was consented into the study; the final sample included 43 intervention participants and 55 control participants. HRQoL and perceived social support were assessed before and after the intervention in both groups. The SF-12 was used to measure HRQoL, including eight domain scores and two composite scores, and the Interpersonal Support Evaluation List was used as an indicator of perceived social support. Difference-in-differences (DD) analyses were conducted to mitigate the effects of any baseline differences in the non- equivalent control group design.

RESULTS

When compared to the control group, the intervention group realized significant improvements in the physical component summary score of the SF-12 (4.20, p < 0.05) and the physical function domain of the SF-12 (4.92, p < 0.05). There were no statistically significant differences for any other components of the SF-12 or in the measure of perceived social support.

CONCLUSIONS

Nursing students completing their rural service rotation have the potential to improve the health-related quality of life of rural residents in Ecuador. Future research should continue to examine the impact of service-based learning on recipient populations.

Change in Quality of Life and Its Association with Oral Health and Other Factors in Community-Dwelling Elderly Adults-A Prospective Cohort Study

OBJECTIVES

To determine whether changes in oral health status were associated with decline in quality of life (QoL).

DESIGN

Prospective cohort study.

SETTING

Carlos Barbosa, southern Brazil.

PARTICIPANTS

A random sample of 872 community-dwelling individuals aged 60 and older was evaluated in 2004. The current study population consisted of 389 participants available for follow-up in 2012.

MEASURES

Change in QoL was assessed through the use of the short version of the World Health Organization QoL Assessment tool (WHOQOL-BREF) at baseline and follow-up. Each WHOQOL domain generates a score, with changes being calculated for each domain. Individuals with the same or higher scores at follow-up were categorized as having improved QoL, and those with lower scores were categorized as having a decline in QoL. Sociodemographic and health variables were assessed in an interview, and tooth loss, use of dental prostheses, and satisfaction with chewing ability and oral appearance were verified through oral examinations. Interviews and examinations were repeated. Risk ratios (RRs) relative to the outcome and independent variables were estimated using Poisson regression with a robust variance estimator.

RESULTS

Tooth loss was a risk factor for decline in the psychological domain of QoL (RR = 1.04, 95% confidence interval (CI) = 1.02-1.06). Improvement in satisfaction with chewing ability was a protective factor for decline in this same domain (RR = 0.69, 95% CI = 0.50-0.97). Greater satisfaction with oral appearance was a protective factor against decline in social (RR = 0.84, 95% CI = 0.72-0.98) and environmental (RR = 0.77, 95% CI = 0.61-0.97) domain scores.

CONCLUSION

Preventing tooth loss and recognizing and properly addressing concerns about chewing and dental appearance can affect the general well-being of community-dwelling elderly adults.

Testing the applicability of a model of oral health-related quality of life

The aim of this study was to test Wilson & Cleary's conceptual model of the direct and mediated pathways between clinical and non-clinical variables in relation to oral health-related quality of life. A random sample of 578 older people was evaluated. Wilson & Cleary's conceptual model was tested using structural equations modeling including: biological variables, symptom status, functional health, oral health perceptions, oral health-related quality of life. Oral health-related quality of life was assessed with the Oral Health Impact Profile-14 (OHIP-14). In the final model, edentulism was negatively correlated to dissatisfaction of appearance of their dental prostheses (r = -0.25). Worse functional status was correlated with poor oral health perception (r = 0.24). Being aged over 68 (r = 0.25), being a female (r = 0.39) and living in rural areas (r = 0.15) had a direct effect on the edentulism. Age had a direct effect on OHIP-14 (r = -0.15). There was an indirect effect of sex on OHIP-14 via functional status (r = 0.12). The present findings partially support Wilson & Cleary's model framework.

Oral Health Related Quality of Life in a Group of Geriatrics

BACKGROUND

A good quality of life in elderly population is related to different aspects of health including oral health. The aim of this study was to determine oral health-related quality of life (OHR-QoL) in elderly patients referred for dental or oro-maxillo-facial complaints to Mashhad dental school (MDS) and compare them with a group of normal population.

MATERIALS AND METHODS

A total of 99 patients from MDS (as case group) and 114 elderly people as control were enrolled in this cross-sectional study. Control group were chosen among the pilgrims who had come to the holy shrine of Imam Reza (Haram). Persian version of OIDP (Oral Impact of Daily Performance) index was used. Data were entered to SPSS 11.5 and Statistical analysis was performed.

RESULTS

A total of 213 (case =99, control=114) cases were enrolled. Mean Performance score (MPS) was 6.27±10.47 (7.96±11.95 in case group, and 4.80±8.77 in control group) and the difference was significant (p=0.015). Age was conversely correlated with MPS (r=0.0125, p=0.24) although this correlation was not significant. We found, in oro-maxillofacial functions, ill-fit dentures, oral ulcers, pain and tooth mobility were major determinants of OHR-QoL. Number of impaired functions was directly and significantly correlated with MPS (r=0.92, p<0.001).

CONCLUSION

Some daily functions like speaking, emotional status, cleaning teeth, physical activity were impaired in case group. Oral and maxillofacial diseases were more prevalent in case group and can be an important impairing issue in OHR-QoL.