Social and Clinical Factors Associated With Oral

7/26/2019 Social and Clinical Factors Associated With Oral

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Romanian Journal of Oral Rehabilitation

Vol. 6, No. 2, April - June 2014

52

SOCIAL AND CLINICAL FACTORS ASSOCIATED WITH ORAL

HEALTH RELATED QUALITY OF LIFE IN ELDERLY POPULATION

IN IASI, ROMANIA

Alice Murariu1, Carmen Stela Hanganu1, Adina Armencia1, Gabriela Geleu2,

Livia Mihailovici31Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,

Department of Community Dentistry2Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,

Department of Dental-Alveolar Surgery3Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,

Department of Preventive Dentistry

*Corresponding author: Alice Murariu, Lecturer

Grigore T. Popa" University of Medicine and Pharmacy

Iai, Romania

e-mail:[email protected]

ABSTRACT

Aim of the studyTo investigate the impact of oral health conditions and social factors on quality of life of older

people in Iasi. Material and methods Data were collected from 336 subjects aged 65 to 74 years,175 addresed

the dental office for treatment and 161 institutionalized in the Social Center St. Parascheva. Oral health -

related quality of life was assessed with the Geriatric Oral Health Assessment Index questionnaire. Results The

risk for poor quality of life in terms of physical dimension was higher for females (OR=6.342) and for subjects

who needed removable dentures (OR=5.043). In terms of oral discomfort the risk was higher for

institutionalized (OR=6.329), and social limitation were correlated with female subjects (OR=3.899) and

institutionalized subjects (OR=2.852). Conclusions Institutionalization can be considered as a factor with

negative impacts on the quality of life of the elderly, affecting all the dimensions of the quality of life .

Keywords:elderly; GOHAI; social, clinical factors

INTRODUCTIONHealth is an essential dimension of human

communities quality of life, which means

more than only absence of disease. WHO

defines health as a complete physical,

mental and social well-being, and not merely

the absence of disease or infirmity (1).

Health is related to community welfare and

life standards, to what experts call a society

quality of life (2). Numerous studies have

documented poor oral and general health and

limited access to medical care among older

people (3, 4,5).Unfortunately, the economic-financial crisis from the recent years has

worsened many aspects of the social life and

the diminution of pensions, as an austerity

measure taken by Romania, has determined a

significant decrease of life quality for the

elderly people. On the other hand, in

Romania, the number of institutions

specialized to provided social and health

assistance is very low as compared to the

number of old persons needing help (6).

Though many institutions have medical
mailto:[email protected]:[email protected]:[email protected]:[email protected]


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office, the situation is much worse in terms of

dental office. In Iasi, for instance, there is no

dental office in the 2 special centers for old

people.

The main objective of this study is to draw

a parallel between the 2 categories of old

people in terms of life quality correlated

hypothesis that the institutionalized

environment may represent a risk factor for

the increase of vulnerability of this population

segment.

MATERIAL AND METHODS

The convenience sample population

included 336 subjects aged 65 to 74 years,

average years: 71.7 years 2.24 years.161

subjects aged 65-74 years were examined

from the 208 elderly institutionalized in the

St. Parascheva Retirement Center in Iasi

(Group A). Subjects suffering from incurable

terminal diseases or from senile dementia

were excluded, as well as people who refused

participation.

The group of non-institutionalized subjects(Group B) included 175 patients in the same

age group, who addressed the Community

Dentistry Clinic for dental care and

examination. The patients were clinically

examined by 4 calibrated dentists, then

invited to answer the questions in the

Geriatric Oral Health Assessment Index

questionnaire (GOIHAI). This is a

questionnaire described by Atchinson and

Dolan in 1990 and consists of 12 questionsthat reflect aspects considered to have an

impact on the 3 dimensions of life quality of

the elderly population, such as: physical, oral

pain and psychological and social limitation

(7).

The following socio-demographic factors

were considered in the study: sex distribution,

social status and educational level. The

clinical variables evaluated denture status and

for perception of the general health status, it

was use a brief questionnaire. Oral status

evaluation used the World Health

Organization criteria, based on clinical

considerations, without resorting to other type

of examinations (WHO, 1997). Clinical

examination were performed in the dental

office of Community Dentistry Clinic from

non-institutionalized subjects, and in the

medical office of St. Parascheva Center,

using mouth mirror, gloved hand and portable

lamp. Data were analyzed with the SPSS 17.0

system for Windows (SPSS Inc. Chicago, IL,

SUA).

RESULTS

The negative responses to the GOHAI-Ro

items from the participants and the most

serious problems (responses with often and

very often) were reported as it follows:

-108 (67.2%) institutionalized elderly

subjects and 114 (65.3%) independent elderly

reported hard foods limitations (GOHAI 1);

-103 (64.1%) institutionalized elderly

subjects and 107 (61.3%) non-

institutionalized patients reported chewingproblems for hard foods (question GOHAI 2);

-the same trend is observed for GOHAI 5: 77

(48%) subjects in group A and 87 (49.5%)

subjects in group B felt discomfort when

chewing any kind of food;

-psychological dimension - worried about

teeth, gums or dentures (GOHAI 9) is

reported by 48 ( 30.1%) institutionalized

people and 45 ( 25.5%) independent people;

-social dimension is less affected (GOHAI 6):20 (16.7%) subjects from the St.

Parascheva Center and 30 (12.3%)

independent subjects limited contact with

people;

-only 15 (9.6%) subjects in group A and 27

(15.4%) in group B used medication for oral

pain often and very often (GOHAI 8).

Related to quality of life dimensions, the

most affected dimension was physical

dimension (GOHAI 1, 2, 3, 4), followed bypain and discomfort (GOHAI 5, 8, 12); the


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least affected dimension was psychological

and social limitation (GOHAI 6, 7, 9,10,11).

Logistic regression analysis was used to

investigate the relationship between physical,

social and psychological dimensions and

clinical and socio-demographic indicators.

Table 1 shows that the risk to exhibit a

physical dimension is higher for female

subjects (OR=6.342), institutionalized people

(OR=2.185), in what concerns socio-

demographic indicators; for clinical variables,

the risk is higher for people with removable

denture need (OR= 5.043). The variable

education level has no statistical significance,

p>0.05.

Table1. Logistic regresion for physical dimension

Variables OR Sig. 95% CI

Gender:

Female

Male

6.342 0.001* 3.075-13.079

Residence area:

Institutionalized

Non-institutionalized

2.185 0.026* 1.084-4.405

Education level

Primary and secondary school

University

0.034 0.231 0.551-2.114

Denture status:

Denture need

No denture need

5.043 0.001* 2.520-10.090

Self

perception of general health:

Negative

Positive 1.983 0.012* 2.154-3.422

*significance level at p


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Education level

Primary and secondary school

University

2.113 0.031* 3.442-7.752

Denture status:

Denture needNo denture need 3.278 0.002* 1.567-6.856

Self perception of general health:

Negative

Positive

1.782 0.043* 1.023-2.156

* significance level at p


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The present study showed that the most

affected quality of life dimension was the

physical dimension (limit the kind of food),

for 67.2% of the subjects in group A and

65.3% of the subjects in group B. This

percentage of negative answers was not found

in the literature. In Saudi Arabia, for example,

the most affected dimension is represented by

physical pain, for 43% of the elderly (8). In

Germany, Hassel reported a lower ratio of

negative answers, only 24% (9).

The self perception of general health has a

reduced negative impact, only 1.9 times

higher in subjects affected by physical

dimension limitation (OR=1.983). In

opposition, authors like Locker found in UK

that 72% of the elderly consider that general

health status can impact on physical and

social dimensions of the quality of life (10).

In a Brazilian community of older people,

Mesas find that negative self-perception of

oral health was associated with gender and

depression, but not with poor oral health (11).

Considering the initial hypothesis of thestudy, that social status can be a risk factor

for the quality of life depreciation, we found

that the percentage of institutionalized elderly

reporting social limitation caused by oral

diseases was 16.7% and lower, 12.3% for the

non-institutionalized subjects.

Analysis of logistic regression showed that

subjects in the social center had a 6 times

higher risk of a lower quality of life caused

by oral pain and discomfort (OR=6.329) anda 2 times higher risk of a poor quality of life

caused by deficient chewing, absence of

functional teeth and dentures (OR=2.185).

This can be explained by the particularities of

the environment these subjects live in. The

social center has no dental office, which

means subjects with disabilities have no

options. Besides, chronic diseases have

multiple pathology that impacts on oral health

status, and dentures require expenses thatmany subjects cannot afford. Analysis of the

impact on the social dimension of the

subjects lives showed that institutionalized

subjects have a 2 times higher risk of

reporting social contact limitation

(OR=2.852), explained by a poor oral health

status.

These results are not similar to the results

in other countries. In Hong-Kong, for

example, Mcmillan found that the psycho-

social impact over the quality of life was

similar in the 2 elderly categories, even

though oral status was worse in those found

in retirement homes (12). In other studies, in

Malaysia, for example, the percentage of

subjects in the same age group that gave

negative responses to the question GOHAI

11- social limitation- is much lower, only

6.4% (13).

As to sex distribution, statistics prove that

there are significant differences between

males and females in what concerns the

morbidity with some oral diseases (14). The

results of the present study showed that

female subjects are at a 3 times higher risk(OR=3.899) to present a negative impact on

the quality of life caused by social contacts

limitation than male subjects, and a 6 times

higher risk caused by hard food limitation

(OR=6.342). The same situation was

described by McGrath and Bedi who found

that female subjects reported oral pain and

uncomfortable eating in front of others much

more frequently than male subjects (15).

CONCLUSIONS

1. The risk for poor quality of life in terms of

physical dimension was higher for

institutionalized people (OR=2.185), for

females (OR=6.342), and for subjects who

needed removable dentures (OR=5.043).

2. In terms of oral discomfort the risk was

higher for institutionalized (OR=6.329) than

non-institutionalized people and for subjects

who needed dentures (OR=3.278).3. The negative effects associated with social


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limitation were correlated only with gender

distribution, especially female subjects

(OR=3.899) and institutionalized subjects

(OR=2.852).

4. The results of the study confirm the

hypothesis that institutionalized old people

have a low life quality in relation with oral

health. Thus, we noticed that this category of

persons is much more vulnerable to the

diseases of oral cavity, has a much worse

perception of their own health state and has

difficulties related to the lack of a dental

office in the institution.

Acknowledgements

This study was supported by a grant of the University of Medicine and Pharmacy Gr. T.

Popa Iasi, Romania.

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