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Romanian Journal of Oral Rehabilitation

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

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 Mihailovici3
Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,
Department of Community Dentistry
2
Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,
Department of Dental-Alveolar Surgery
3
Grigore T. Popa" University of Medicine and Pharmacy Iai, Romania, Faculty of Dentistry,
Department of Preventive Dentistry
1

*Corresponding author:

Alice Murariu, Lecturer


Grigore T. Popa" University of Medicine and Pharmacy
Iai, Romania
e-mail: murariu_alice@yahoo.com

ABSTRACT
Aim of the study To 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 healthrelated 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

people (3, 4,5).Unfortunately, the economicfinancial 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

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

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).

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 questions
that 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

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%)
noninstitutionalized patients reported chewing
problems 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 by
pain and discomfort (GOHAI 5, 8, 12); the
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Vol. 6, No. 2, April - June 2014
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 sociodemographic 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

1.983

0.012*

2.154-3.422

Self
perception of general health:
Negative
Positive
*significance level at p<0.05

The following step in the statistical


analysis algorithm was to investigate the
relationship between pain and oral discomfort
dimension and the same clinical and sociodemographic variables.
Table 2 shows statistical significance
(p<0.05) for the following variables:
- for socio-demographic indicators: residence

area-institutionalized
(OR=6.329)
and
education level-primary and secondary
school (OR=2.113); self perception of general
health have a low level of Odd ratio, only
1.782;
- clinical variables represented by the need
for removable denture have a OR = 3.278.

Table 2. Logistic regression for pain and oral discomfort dimension


Variables

OR

Sig.

95% CI

Gender:
Female
Male

0.023

0.165

0.978-1.256

6.329

0.001*

7.427-35.899

Residence area: Institutionalized


Non-institutionalized

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Romanian Journal of Oral Rehabilitation


Vol. 6, No. 2, April - June 2014
Education level
Primary and secondary school
University
Denture status:
Denture need
No denture need
Self perception of general health:
Negative
Positive

2.113

0.031*

3.442-7.752

3.278

0.002*

1.567-6.856

1.782

0.043*

1.023-2.156

* significance level at p<0.05

The relationship between oral status and


social limitation is presented in table 3. The
risk to feel social discomfort is higher for
institutionalized subjects (OR=2.852), and for
female subjects (OR=3.899). No clinical

variable passed the statistic level of 0.05.


Negative perception of general health
presented statistical significance, but the risk
is lower (OR=1.245).

Table 3. Logistic regression for social dimension


Variables

OR

Sig.

Gender:
Female
Male

3.899

0.001*

2.044-7.436

Residence area:
Institutionalized
Non-institutionalized

2.852

0.002*

1.350-6.025

Education level
Primary and secondary school
University

0.208

0.122

0.233-4.458

Denture status:
Denture need
No denture need

0.344

0.168

0.727-1.023

1.245

0.023*

1.033-2.316

Self
perception of general
health:
Negative
Positive

95% CI

oral cavity (GOHAI 9) limiting their contact


with other persons as well (GOHAI 6).
One possible explanation might be that the
persons residing at St Parascheva Center do
not have the financial means to cover the
costs of prosthetic treatments and medication
necessary, and the aspects related to esthetics
are considered as much less important as
compared to the old people living integrated
in their own families.

DISCUSSIONS
After having applied the chi-square test,
we noticed significant statistic differences
(p<0.05) between the answers of the 2
categories of old people: if the independent
ones are unsatisfied with the aspect of their
teeth and gums (GOHAI 7) and use more
drugs for oral pains (GOHAI 8), the
institutionalized old people are more
concerned with the current situation of their

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Romanian Journal of Oral Rehabilitation


Vol. 6, No. 2, April - June 2014
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 the
study, 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) and
a 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 that
many 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 psychosocial 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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Vol. 6, No. 2, April - June 2014
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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