|Year : 2019 | Volume
| Issue : 1 | Page : 18-24
Oral health-related quality of life and associated factors of elderly population in Port Harcourt, Nigeria
Omoigberai Bashiru Braimoh, Grace Onyenashia Alade
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||12-Mar-2019|
Omoigberai Bashiru Braimoh
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba, Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Aim: The objective of this study was to assess the impact of oral health on quality of life in a representative sample of elderly population in Port Harcourt, Nigeria, and to evaluate its associations with dental caries, periodontal disease, subjective oral measures, and sociodemographic factors.
Subjects and Methods: The study was a cross-sectional observational research design. Participants were selected by systematic random sampling, and data were collected using a self-developed questionnaire and oral examination. Data analysis was done using SPSS version 20. Chi-square and logistic regression analysis was used to establish association between variables. Significance was determined at 95% confidence interval and statistical significance inferred at P < 0.05.
Results: The prevalence of negative impact of oral health on quality of life was 38.1%. The mean Oral Health Impact Profile-14 score was 11.15 ± 8.36; the highest mean was recorded for physical pain (2.87 ± 1.17). Painful aching, 48.1%, was the highest impact on quality of life experienced by the participants. Female gender, younger elderly, poor self-perception of oral health, dental caries, and periodontitis produced a higher significant negative impact of oral disease on the quality of life.
Conclusion: The prevalence of negative impact recorded in this study was comparable to that obtained in other similar studies. The study revealed that sociodemographic variables and subjective and clinical oral measures impact significantly on the oral health-related quality of life of the participants. The study suggests the need for these factors to be considered when planning oral health intervention program for the elderly.
Keywords: Elderly, oral health, quality of life, self-perception, sociodemographics
|How to cite this article:|
Braimoh OB, Alade GO. Oral health-related quality of life and associated factors of elderly population in Port Harcourt, Nigeria. Saudi J Oral Sci 2019;6:18-24
|How to cite this URL:|
Braimoh OB, Alade GO. Oral health-related quality of life and associated factors of elderly population in Port Harcourt, Nigeria. Saudi J Oral Sci [serial online] 2019 [cited 2020 Nov 28];6:18-24. Available from: https://www.saudijos.org/text.asp?2019/6/1/18/254026
| Introduction|| |
Globally, the number of persons aged 60 years and above is expected to triple. This population group with varied educational, socioeconomic, cultural, and psychological experiences is expected to increase from 810 million in 2012 to 2.03 billion by 2050. The growth in population has provoked research interest in this group to ensure that they age healthfully and have good quality of life. Recently, researches have demonstrated the impact of oral health on quality of life. Poor oral health has a profound effect on the quality of life and can adversely affect people's daily lives and well-being. It causes discomfort, pain, difficulty with eating and chewing, speech and esthetic problems as well as social embarrassment.,,
Oral health-related quality of life (OHRQoL) is a multidimensional concept used to assess people's comfort when eating, sleeping, and engaging in social interaction, self-esteem, and their satisfaction with respect to their oral health., Therefore, OHRQoL is associated with functional, psychological, and social factors and experience of pain or discomfort. Multiple item questionnaires such as Oral Health Impact Profile-14 (OHIP-14) are the most widely used method to assess OHRQoL. The OHIP-14 is a good indicator of patients' perception concerning their oral health and expectations/satisfaction with treatment. It is valid, reliable, and most universally acceptable OHRQoL indicator designed to measure self-reported functional limitation, discomfort, disability, and psychosocial impacts attributed to oral disorders. The psychometric property of the OHIP-14 has been evaluated among adult population in Nigeria and was reported to be valid.
Although clinical oral health measures have been used mainly to assess oral health needs and plan public health interventions, subjective oral health measures have also been used to achieve the same purpose. However, evidence exist that there are differences between clinical and subjective oral health measures. According to the evidence, the differences could be due to the fact that clinical measures assess morbidity, while subjective measures represent one's health perceptions and judgment which are individual and social. Therefore, subjective measures are suggested to complement clinical measures in evaluating how oral health affects functional and psychosocial well-being and how individuals perceive their oral health. In addition, sociodemographic conditions can determine oral morbidities and the use of health services, which in turn may have an influence on one's perception of oral health. Consequently, the present study was designed to investigate the association between clinical oral measures, subjective oral measures, and sociodemographic factors and OHRQoL.
The number of teeth, dental caries, periodontal disease and use of dental prostheses,, as well as educational level and gender have been reported to impact on quality of life. These studies among the elderly are sparse in Nigeria, more so, in Port Harcourt, Nigeria. The aim of this study was to assess the impact of oral health on quality of life in a representative sample of elderly population in Port Harcourt, Nigeria, and to evaluate its associations with dental caries, periodontal disease, subjective oral measures, and sociodemographic factors. The working hypothesis for this study was that dental caries, periodontal disease, subjective oral measures, and sociodemographic factors are not associated with OHRQoL of the elderly. The results of this study would enable the researchers to plan and evaluate oral health care and treatment necessary to meet the needs and concerns of the elderly.
| Subjects and Methods|| |
The study was an observational research design in which data on dental caries and periodontal health status were collected by clinical oral examination. The population of the study were pensioners in Port Harcourt, Rivers State. A minimum sample size of 382 was estimated to be adequate. The assumptions made were as follows: the proportion of participants who reported impact of oral health disease on daily activities was 46%, precision (d) 5%, and confidence interval of 95%. Although the calculated minimum sample size was 382, a total of 543 elderly participants were involved in the study.
The participants were selected by systematic random sampling. The register of the pensioners constituted the sampling frame and every second participant was selected from the register. Participants selected who were not present in a particular visit were contacted through their phone numbers for subsequent visit.
Data were collected by the use of questionnaire. A section of the questionnaire contained information on sociodemographics (gender, age, educational status, and retirement grade level) and subjective self-perception of general and oral health assessed on a scale of good, fair, and poor. The retirement grade level serves as a measure of the economic class, since this determined the income of the participants.
The periodontal health and dental caries status were recorded in another section of the questionnaire using the community periodontal index (CPI) and the decayed, missing, and filled teeth index (DMFT) as recommended by the World Health Organization. The last section of the questionnaire assessed the OHRQoL using the OHIP-14 variables. OHIP-14 has seven conceptual dimensions of impact, and each dimension has two questions. Participants were asked how frequently in the past 12 months they had experienced negative impacts in these dimensions. Each question was assessed based on the following response on a Likert-like scale: 4 = “very often,” 3 = “fairly often,” 2 = “occasionally,” 1 = “hardly ever,” and 0 = “never.”
The reliability of the instrument was done using old people other than those recruited for the study. Twenty of them were selected; the selected participants completed the questionnaire and were examined by the researcher. The filling of the questionnaire and examination was repeated after an interval of 1 week. The reliability of the instrument was determined using the Cronbach's alpha, and alpha coefficient of 0.82 was obtained. The recording of periodontal health was done by the first author over a period of 2 years from April 2015 to March 2017. The intra-examiner reliability for recording of periodontal health was determined by intraclass correlation and reliability coefficient of 0.79 was obtained and that of dental caries was determined using the Cohen's kappa statistics and a Cohen score of 0.9. The reliability testing also served as the pilot test for this study, from the reaction of the participants to the questionnaire, it was evident that they quite understood the question items.
The study was approved by the Research Ethics Committee, University of Port Harcourt, and informed consent was obtained from each participant before data collection. Pensioners who retired from public service of Rivers State government voluntarily or retired as a result of years of service, who were below the age of 60 years, were excluded from the study, since they do not meet the age to be classified as elderly.
A total of 543 copies of the questionnaire were administered to the respondents, and all were retrieved. The participants who completed the questionnaire were examined for caries gingivitis and periodontitis. The indexed teeth in each sextant were examined by running the CPI probe around the whole circumference of the tooth, and pocket depths were measured at six sites per tooth. According to the CPI scoring criteria, the absence of bleeding on probing, calculus, and periodontal pockets was scored 0, bleeding on probing was scored 1, the presence of calculus (sub/supra) was recorded as 2, pocket depth 4–5 mm was recorded as 3 (shallow pocket), and pocket depth ≥6 was scored 4 (deep pocket). Dental caries, on the other hand, was recorded by counting the number of decayed (D), missing (M), and filled (F) teeth.
The completed copies of the questionnaires were collated, coded, and entered into the Statistical Package for Social Sciences (SPSS) spreadsheet. The data were subsequently analyzed using SPSS version 20 (IBM SPSS, Armonk, New York). Descriptive statistics of frequency and percentage were used to present the results. Analysis of OHIP-14 was done using the simple count and additive method. In the simple count method, count of the number of items to which participants responded “never,” “hardly ever,” “occasionally,” “fairly often,” and “very often” was performed and this was used to generate frequencies. Response of “never” and “hardly ever” was reported as no impact while “occasionally,” “fairly often,” and “very often” was reported as impact. In the additive method, the response codes for each item OHIP-14 were summed up for each individual, and individual score varied from 0 to 56. OHIP-14 score was dichotomized into no negative impact (0–14) and negative impact (15–56). In addition, the mean score for each OHIP-14 domain was also calculated. According to CPI, the participants were categorized such as code 0 = healthy periodontium, codes 1 and 2 = gingivitis, and codes 3 and 4 = periodontitis. For dental caries, participants were dichotomized into DMFT = 0 and DMFT >0. Chi-square and logistic regression analysis was used to test association between variables. Significance was determined at 95% confidence interval and statistical significance inferred at P < 0.05.
| Results|| |
The response rate was 100%. The age of the participants ranged from 60 to 82 years with a mean of 67.6 years. Male participants constituted 295 (54.3%) of the study population. Most of the respondents (234, 43.1%) were 60–64 years old. Regarding educational status, 226 (41.6%) had tertiary education. A total of 277 (51%) participants retired on grade level 1–6, while 266 (49%) of the participants retired on level 7–17. In relation to subjective oral measures, 32.8%, 50.6%, and 16.6% of participants perceived their general health as good, fair, and poor, respectively, whereas 35.9%, 50.8%, and 13.3% perceived their oral health as good, fair, and poor, respectively.
When considering clinical oral measures, the prevalence of dental caries was 34.3%, that is, 186 participants had at least one carious tooth and mean DMFT score was 5.85 (standard deviation = 1.03). Approximately, only 26 (5%) of the old people had healthy gingival, 34 (6.3%) had bleeding on probing, and more than half (293, 53.9%) of the participants had calculus on their teeth. Shallow and deep pockets were recorded in 137 (25.2%) and 53 (9.8%) participants, respectively. Therefore, of the 517 participants with periodontal disease, 327 (60.2%) had gingivitis and 190 (35.0%) had periodontitis.
[Table 1] shows the distribution of participants' responses to OHIP-14 items. The most common response to the OHIP-14 variables among the participants was “never.” Where there was impact, “occasionally” was the most common response. The prevalence of negative impact (OHIP score: 15–56) of oral health on quality of life was 38.1% (207). The mean OHIP-14 score was 11.15 ± 8.36. Painful aching (48.1%), uncomfortable to eat (46.2%), self-consciousness (40.1%), and difficulty pronouncing words (36.3%) were the highest impact on quality of life experienced by the participants as a result of oral disease. Regarding OHIP-14 dimensions, the highest means were recorded for physical pain (2.87 ± 1.17), psychological discomfort (2.31 ± 1.07), functional limitation (2.05 ± 1.65), and physical disability (1.63 ± 1.11).
|Table 1: Distribution of responses to Oral Health Impact Profile-14 items among the respondents|
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The negative impact of oral disease on the quality of life of the research participants was significantly higher among the female gender, the younger elderly, and among the junior staff. Although the impact was more among those with primary level of education than those with other levels of education, the difference was, however, not significant. Furthermore, the impact was significantly higher in participants with poor perception of oral end general health [Table 2]. In relation to clinical measures, the impact of oral disease on quality of life of the participants was significantly higher in participants with at least one decayed tooth and those with periodontitis [Table 3]. Logistic regression analysis shows that the impact of oral disease on quality of life was 27.2% more likely in women than in men and 17.1% more likely in younger elderly than older elderly. Similarly, the impact of oral disease on quality of life was 46.8% more likely in participants with dental caries than those without caries and 33.7% more likely in participants with periodontitis than those with gingivitis [Table 4].
|Table 2: Relationship between sociodemographics, subjective oral measures, and Oral Health Impact Profile-14 scores among the elderly|
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|Table 3: Relationship between clinical oral measures and Oral Health Impact Profile-14 scores among the elderly|
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|Table 4: Logistic regression analysis of factors associated with Oral Health Impact Profile-14 scores|
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| Discussion|| |
The present study revealed that the prevalence of negative impact of oral health on quality of life was 38.1%. This is comparable to the prevalence reported among elderly population in Brazil. This prevalence is, however, very low when compared to 82.8% recorded in another study among adult Nigerians in a dental clinic. The high prevalence reported in the previous study may be unconnected to the fact that the sample consisted of patients being seen in a dental clinic. It is expected that participants who have oral symptoms severe enough to prompt dental visit will attribute a greater impact on quality of life as a result of oral health problem. Difference in the impact assessment methods between the two studies may also account for the difference. In the previous study, impact was reported as OHIP-14 score >0 compared to >14 used in the present study. Again, the prevalence in this study is high when compared to 20.5% reported among public service workers aged 21–60 years in Port Harcourt, Nigeria. The age of the sample in the present sample varied from 60 to 82 years. Therefore, the difference may be due to fewer numbers of teeth that may be found in the elderly as compared to the adult population. OHRQoL has been reported to be poor in participants with fewer numbers of teeth and those that are edentulous.
In the present study, the OHIP dimensions of “physical pain,” “psychological discomfort,” and “functional limitation” recorded the highest scores i that order. Painful aching in the mouth and uncomfortable to eat, the two subscales of the “physical pain” domain, respectively, were the most frequently reported activity affected by oral impacts with OHIP-14. This was followed by being conscious about one's oral health in the “psychological discomfort” domain and difficulty pronouncing words in the “functional limitation” domain. The findings of this research are in tandem with the findings of other similar studies.,, Pain is a major concern of patients with oral health problems, and it is reported as the major reason why patients visit the dental clinics. This probably explains why pain is the most commonly reported impact of oral health on the quality of life of the participants. This study also showed that difficulty with eating, conscious about one's oral health, and difficulty pronouncing words also occupies a predominant position on the OHIP-14 scale and has been reported as reasons why individuals visit the dentists.,,
The present study showed that significant association existed between OHRQoL and demographic characteristics. Female gender had more negative impact on OHRQoL, and the impact of the female gender was 3 times that of the male gender. Ulinski et al. and Lawrence et al. reported similar findings. Women under similar clinical conditions with men have been reported to be more unsatisfied with their appearance, exhibited greater perception of oral health problems, and had higher complaints with regard to the ability to chew and pain. Inverse relationship existed between age and OHRQoL in the present study, indicating that the lower the age, the higher the OHIP-14 scores and vice versa. The negative impact of age on OHRQoL was about 2 times more in the younger elderly than the older elderly. Similar observations have been documented in other studies which reported that adults perceived a greater impact than the elderly, and that younger elderly perceived greater impact than older elderly. This inverse association is attributed to the elderly becoming more tolerant of oral health problems arising from aging. Educational status produced impact on OHRQoL in the population under this study. Individuals with primary level of education perceived higher impact than individuals with other levels of education. However, this impact was nonsignificant. Nonsignificant relationship was also reported by Ulinski et al. Atchison and Gift contrarily reported a significant relationship between educational status and OHRQoL. The grade level at retirement serves as measure of the economic class in this study because grade level determines the monthly income of the participants. The relationship between OHRQoL and lower economic class of the elderly in the present study is in agreement with findings of previous studies., This relationship is accounted for by the fact that individuals in the lower economic class, despite their worse oral health condition, had less access to the dental services; consequently, the accumulated and aggravated oral condition may negatively impact on their quality of life.
Considering the relationship between subjective measures and OHRQoL, this study showed that self-perception of oral and general health significantly influenced OHRQoL. Higher rates of negative impact on OHRQoL were found in old people with poor self-perception of oral and general health compared to those with fair and good self-perception. The relationship between poor self-perception of oral health and its negative impact on OHRQoL has been in previous studies.,
Researches have documented association between dental caries, periodontal disease, and OHRQoL.,, Individuals with at least one carious tooth were reported to produce higher impact on OHRQoL than those without dental caries,, and people with periodontitis recorded higher impact on quality of life than those with gingivitis. The results of this study are in line with these findings; elderly participants with at least one carious tooth were likely to experience negative impact of oral health on quality of life approximately 5 times more than the participants with no carious lesion. Similarly, elderly participants with periodontitis were likely to have negative impact of oral health on quality of life about 3 times more than participants with gingivitis.
| Conclusion|| |
The prevalence of negative impact recorded in this study was comparable to that obtained in other similar studies. Physical pain and psychological discomfort recorded the highest scores of the OHIP-14 dimensions. The subscales of painful aching in the mouth and difficulty with eating were the most frequently reported activity affected by oral impacts with OHIP-14. Gender, age, retirement grade level, self-perception of oral and general health, as well as dental caries and periodontitis impact significantly on the OHRQoL of the participants. This suggests the need to take all these factors into consideration when investigating the oral health-related quality of life of all population groups and the need to put these factors into consideration when planning oral health intervention program for the elderly.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]