|Year : 2015 | Volume
| Issue : 1 | Page : 29-33
Self-perceived oral function and factors influencing oral health of elderly residents in Bengaluru city, India
B Kumara Raja, G Radha
Department of Public Health Dentistry, V S Dental College and Hospital, Bengaluru, Karnataka, India
|Date of Web Publication||4-Jun-2015|
B Kumara Raja
Department of Public Health Dentistry, V S Dental College and Hospital, Bengaluru - 560 004
Source of Support: None, Conflict of Interest: None
Context: Oral health status plays an import role in patient quality of life, affecting mental, physical, and psychological wellbeing and complete social development by interfering with word pronunciation, social life, and alimentary function. Aims: To evaluate self-perception of elderly about the effect of oral health on quality of life using the geriatric oral health assessment index (GOHAI) index. Settings and Design: A cross-sectional study was carried out among 376, elderly individuals aged 60 years and above, residing in residential homes of Bengaluru city. Materials and Methods: The data were collected using GOHAI scale comprising of 12 items to measure the patient-perceived oral functional problems. In addition, a self-reported questionnaire was used to elicit demographic information. Statistical Analysis Used: A descriptive statistics along with Chi-square test was used. Results: Out of 407 individuals, only 376 fulfilled the inclusion criteria and constituted the final number of the participants. GOHAI was statistically significant with age (0.036*), gender (0.045*), dentition status (0.019*), and smoking status (0.042*), which showed a predictor for low oral health functional status. A majority of the subjects (66.1%) were "always" unhappy with their appearance of their teeth gums or dentures and 74.5% of the subjects were "always" concerned about their problems with their teeth, gums, or denture. Conclusions: The GOHAI final score was considered low, indicating a low self-perception by the elders of Indian residential homes.
Keywords: Elders, geriatric oral health assessment index, oral health-related quality of life, residential homes, self-perceived oral function
|How to cite this article:|
Raja B K, Radha G. Self-perceived oral function and factors influencing oral health of elderly residents in Bengaluru city, India. J Health Res Rev 2015;2:29-33
|How to cite this URL:|
Raja B K, Radha G. Self-perceived oral function and factors influencing oral health of elderly residents in Bengaluru city, India. J Health Res Rev [serial online] 2015 [cited 2020 Jan 23];2:29-33. Available from: http://www.jhrr.org/text.asp?2015/2/1/29/158126
| Introduction|| |
The size of the elderly population in India has risen from 12.1 million in 1901 to approximately 77 million in Census 2001. According to official population projections from government in 2011, the number of elderly persons will rise to approximately 140 million by 2021. 
This increasing population of older people will result in an increasing demand for dental care services, but there is an extensive attention at the national level directed at oral health in children, which has overshadowed the concerns of older people. The lack of appropriate public health or policy interventions focusing on older people in India has resulted in deterioration in their health. Thus, unless there is a paradigm shift in the dental care, older people will continue to suffer and the demands for dental care will surge. 
Measurements of oral health historically derived from disease-based models. Hence, objective and quantitative indicators have mostly been used when assessing oral health conditions in epidemiological studies. However, nowadays, quality-of-life measurements are being used in assessments of oral conditions, which reflects the growing interest in subjective information regarding the significance of oral diseases for the individual.  According to Llewellyn and Warnakulasuriya,  the clinical diagnoses of stomatological diseases may indicate their causes and prognoses, but provide limited information about the level of impact they have from the patient's perspective.
Clinical measures are related to disease indicators (e.g., tooth loss, number of decayed teeth, need for prostheses) and are thought to be difficult to interpret in the planning and evaluation of public health programs, as it is impossible to determine who among a large number of affected subjects will seek care.  The levels of oral health vary among people and that this variation can be demonstrated using measurement based on a person's self-perception that self-perception has been identified as predictive of oral health.
Several instruments have been developed for measuring the impact of oral health conditions on daily life. Among the most used of these is the Geriatric Oral Health Assessment Index, which was subsequently renamed as the General Oral Health Assessment Index (GOHAI). Thus Geriatric Oral Health Assessment Index (GOHAI), which was developed by Atchison and Dolan, aims to complement clinical measures by paying special attention to problems related to physiological, physical, and psychological needs.  There are several studies reported on dental status of institutionalized elders throughout the world indicating that there exist poor oral health status and treatment needs among those populations. ,,,,,,,,,,,, Because the measures of oral health-related quality of life (OHQoL) are essential for epidemiological and clinical studies to provide accurate data for health promotion, disease prevention programs, and allocation of health resources,  GOHAI has been the most commonly used instrument for measuring OHQoL.  The present study aimed to evaluate the oral health self-perception on quality of life in the elderly using GOHAI index and with objectives to assess the influence of demographic factors on oral health-related quality of life.
| Materials and methods|| |
This cross-sectional study was done among 407 elders residing in residential homes of Bengaluru city and all subjects who were present at the time of survey were included. After meeting the inclusion and exclusion criteria, a final sample of 376 elders participated. The study was conducted from the month of June to August 2014. An informed consent was taken from all the participants. The ethical approval for the study was obtained before the commencement of study from the institution and the required official permission was also obtained from the chairman or trust member of each residential age homes.
Sampling method and sample size
- A total of 70 old age homes were registered under elder's helpline office of Bangalore city, a stratified sampling method was done to select the study setting
- Among which 33 were run by private, 26 by trust, and 11 by society. From these three groups of strata, 20% of samples were taken for the study
- Thus a sample of 7 from private, 6 from trust, and 2 from society, a total of 15 old age homes were randomly selected from a numbered list of 70 homes. Thus a total of 15 homes were included in the study.
- Individuals older than 60 years
- Both dentulous and edentulous subjects were included.
- Subjects who were uncooperative, unwilling, and suffered from psychiatric problems.
Instruments and measures
A pilot study was done in 50 subjects who were 60 years and older among patients visiting to Department of Prosthodontics, V.S Dental College, Bengaluru, for proper planning and execution of the main study. These subjects were not included in the main study. A self-administered questionnaire dealt with sociodemographic characters, oral hygiene, and oral health behaviors. Then the questionnaire was translated into Kannada language. The validity was checked by back translation method, involving blind re-translation into English. The validity of translation was verified by experts in both languages. The questionnaires were administered personally by the researcher to the participants.
The dependent variables
The GOHAI  consisting of 12 items, which was developed by Atchison and Dolan was used.
The GOHAI features 12 questions on a 5-point Likert scale rating: Always, often, sometimes, seldom, and never. The questions covered three dimensions: (a) psychosocial (concern about oral health, self-image, and limited social contacts due to oral problems), (b) physical (eating, speaking, and swallowing), and (c) pain or discomfort associated with oral health.
Individuals with a GOHAI score of 12-56 were identified as having "low/moderate perception" on oral health, and those with a score of ≥57 were identified as having "high perception." The higher the final score, the better the individual's perception about oral health and vice versa. 
All the statistical analyses were carried out using the Statistical Package for Social Sciences software, SPSS software version 19.0 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered as statistically significant. Chi-square tests were used to compare sociodemographic variables. Variables that showed a significant association with GOHAI in univariate analysis were subjected to multivariate analysis and Low GOHAI was taken has outcome variable.
| Results|| |
A total of 376 elderly were included in the study of whom 150 (39.9%) were males and 226 (60.1%) were females. The mean age and standard deviation (SD) of elderly subjects was 69.24 ±6.4. In the study group 304 (80.9%) were married and 72 (19.1%) were unmarried, 83 (22.1%) of them were illiterate, 194 (51.6%) had a schooling experience, 99 (26.3%) of them had attended college, and none of the elders had a professional degree [Table 1].
|Table 1: Comparison of GOHAI scores with sociodemographic characteristics |
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In the study group 370 (98.4%) brushed with toothbrush and 6 (1.6%) brushed with finger, in which 340 (90.4%) subjects brushed once daily, 35 (9.3%) brushed twice daily, and 01 (0.3%) brushed thrice a day. Majority of the subjects 331 (88%) brushed in horizontal method and 26 (06.9%) subjects had a habit of mouth rinsing after every meal, 289 (76.9%) occasionally rinsed their mouth, and 61 (16.2%) were not in the habit of mouth rinsing. Only 306 (81.4%) subjects had a practice of tongue cleaning and none of the subjects used any oral hygiene aids. Regarding oral health behavior 72 (19.1%), 61 (16.2%), and 59 (15.7%) had a habit of smoking, pan chewing, and alcohol consumption, respectively.
In the multivariate analysis [Table 2] for GOHAI, age, dentition, and smoking status were the major factors found to be associated with low GOHAI status, that is, they had more oral health functional problems such as functional limitation, pain, and discomfort. The other variables such as marital status, education, pan chewing, and alcohol status did not show any significant association with oral health functional problems.
|Table 2: Multivariate logistic regression analysis showing adjusted odds ratios with 95% confidence intervals for low GOHAI score |
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The various responses to the different questions of the GOHAI questionnaire are listed in [Table 3]. The mean GOHAI score was 26.02 ± 12.74. Results showed that 39.6% of the subjects reported "always" limit the kind of food due to problem of their denture or teeth and 44.1% had trouble while biting or chewing. It is also seen that 42.5% of the subjects reported they had trouble while swallowing and 40.4% had discomfort when eating. On the other hand, a small number of participants (8.5%) were found to use medications "always" to relieve dental pain. A 14.0% of participants "never" had sensitivity of the teeth. A 35.03% of the subjects had "never" limited their contact with others due to their conditions of teeth or denture. A majority of the subjects (66.1%) were "always" unhappy with their appearance of their teeth, gums, or dentures and 74.5% of the subjects were "always" concerned about their problems with their teeth, gums, or denture.
| Discussion|| |
This article describes the self-reported oral health characteristics of older adults in various residential homes of Bengaluru city and attempted to analyze the association between sociodemographic factors with OH-QoL as measured using the GOHAI.
The indicators used to assess the subjective perspective were originally called "sociodental" or "oral health status" indicators. These terms have been replaced by the "Oral Health-Related Quality of Life" (OH-QoL), which emphasizes the impact of oral diseases and disorders on an individual's functioning and psychosocial wellbeing.  The OH-QoL has been studied in recent years using self-report instruments.  One of the instruments used to estimate the OH-QoL  is the GOHAI, , which was developed by Atchison and Dolan in 1990  to assess three dimensions of oral health as follows: Physical functioning, social functioning, and pain and discomfort. Thus in this present study GOHAI was used to assess the oral health of elderly residents of Bengaluru city.
A total of 407 study subjects were first included in the study, after meeting the inclusion and exclusion criteria a final sample of 376 elderly subjects participated in the present study. The age group considered for the study was 60-99 years with a mean age of 69.24± 6.4, because WHO defines older adults in developed countries as those who are aged 65 years or above and in developing countries, such as India, over 60 years.
Morbidity and mortality are heavily influenced by age, gender, and socioeconomic status. The prevalence of caries and periodontitis also differs by age and gender. Socioeconomic influences are also widely present in oral health. Sociodemographic status was widely recognized as being associated with oral health and related quality of life. , Evidence suggests the presence of ethnic, social, and demographic differences in OHRQoL after controlling for clinical measures of oral health status. ,,, However, not all studies have shown that sociodemographic levels such as gender, age, economic status, and educational level have a relationship with OHRQoL. The findings from this study suggested that educational level, pan chewing, and alcohol consumption have no association with GOHAI, and that age, gender, dentition status, and smoking status had an independent effect on OHRQoL.
More than half of the subjects in the present study were women, which was similar to that described by various other authors. ,,,,, This difference in gender ratio of the study group depicts a higher association of females with the elder's homes as a resident. It is also seen that women had a higher prevalence of low GOHAI score than men, which was similar to that described by Cornejo et al. 
Elders with natural teeth had stated to have a low GOHAI score when compared with ones who had a partial denture and who had complete denture. The possible reason for this might be elderly with natural dentition had a high rate of root caries or tooth decay, which had caused more oral health functional problems and would have resulted in low GOHAI score.
With regard to denture status, Wang et al.  found that denture status was the strongest predictor of a negative impact on OHRQoL and Agarwalet al.  also found that elderly individuals with dentures were more likely to have lower GOHAI scores than those without. 
Education variables had no statistically significant effect on the GOHAI final score for the four levels of education analyzed here. However, it must be considered that this sample included only 25% elderly with college or university degrees. A study by Atieh  in Saudi Arabia also found no considerable differences in GOHAI scores when sociodemographic variables such as gender, education, and socioeconomic status were taken into account.
Nearly three-fourths of the elderly individuals in the present study were classified as having low GOHAI scores of 26.02 ± 12.7, indicating a negative impact of oral health status on quality of life, which has also been reported in previous studies. ,,,,,
Thus clinical oral features alone are not an adequate measure for the assessment of dental treatment needs because self-perception also stimulates dental self-care and motivates the population to seek dental care. Hence, self-perception enquiries must be integrated into routine surveys in order to improve the quality of oral dental services.
- Although self-perceived oral health is related to clinical measures, discrepant results are reported and the evidence suggests that individuals place more importance on factors related to the psychosocial and functional impact of oral health on quality of life when self-assessing their oral health, so studies should be done involving the clinical status
- Despite including a representative sample of elderly, this study cannot yield conclusive data on causality because of its cross-sectional design. So, longitudinal studies will be required to further address the link.
- In view of depressingly low levels of oral health in residents, it is important to integrate the preventive, curative, and educational oral health care program into the existing health and educational infrastructure
- Measures should be developed to implement and improve the oral health care strategies in the elderly and to evaluate the effectiveness of these measures
- Oral health should be incorporated into routine assessment by care staff, and the continuing dental care should be available to the residents
- On the public health level, health education programs focusing on the special needs of these elderly populations should be made mandatory
- An integrated approach is needed, and elderly oral health education should include all stakeholders.
| Conclusion|| |
This sample of institutionalized elderly subjects in Bengaluru had a low self-perception of oral health as measured by GOHAI. The age, dentition status, and smoking status were found to be the risk indicators for a low GOHAI score
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[Table 1], [Table 2], [Table 3]