CONTENT DOMAINS OF ORAL HEALTH-RELATED QUALITY OF LIFE IN OLDER ADULTS: A SYSTEMATIC REVIEW AND CONCEPTUAL SYNTHESIS.

Understanding the interplay between nutrition and oral health-related quality of life (OHRQoL) in older adults is crucial amidst the global aging population. This systematic review and meta-analysis aimed to explore this association, recognizing the growing prevalence of older individuals and the imperative of addressing their health needs for enhanced well-being. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant studies were identified through electronic database searches and manual screening. Included were studies investigating the relationship between nutritional status, assessed via the Geriatric Oral Health Assessment Index (GOHAI), and OHRQoL in individuals aged 60 years and older. Quality assessment adhered to Joanna Briggs Institute (JBI) criteria, and statistical analysis was conducted using Comprehensive Meta-Analysis Software Version 3. Out of 566 initial records, 14 full-text articles were assessed, with 4 studies meeting the inclusion criteria for meta-analysis. A consistent association emerged between lower nutritional assessment scores and poor OHRQoL among the older adults. Significant relationships were identified between poor oral health indicators, as measured by GOHAI, and an elevated risk of malnutrition. Particularly noteworthy was the role of negative self-perception of oral health as a significant predictor of nutritional deficits, emphasizing the importance of OHRQoL instruments in complementing clinical measurements. The findings underscore the predictive capacity of oral health indicators in assessing nutritional well-being in older individuals. Despite previous studies reporting mixed findings, this review contributes to a comprehensive understanding of the association between nutrition and OHRQoL, highlighting the significance of addressing oral health concerns to enhance overall nutritional outcomes in the older adult population. This systematic review and meta-analysis emphasize the significant association between nutrition and OHRQoL among older adults. Highlighting the importance OHRQoL instruments that can complement objective clinical measurements and serve as predictors of malnutrition, particularly among this population. Offering vital insights for stakeholders, policymakers, and public health officials to promote the overall well-being and quality of life of older adults.

Instruments for assessing oral health-related quality of life (OHRQoL) in older adults: A meta-research study with standardized evaluation.

Oral health problems, particularly tooth loss, may impair nutrition and reduce oral health-related quality of life (OHRQoL) in older adults. However, the pathways linking these conditions remain unclear. We analyzed data from 112 older adults (≥60 years). We measured OHRQoL using the Geriatric Oral Health Assessment Index (GOHAI) and nutritional status using the Mini Nutritional Assessment (MNA), and used tooth loss as a clinical indicator. Bivariate analyses used Spearman's correlation, and structural equation modeling (SEM) with robust estimation was applied to assess direct and indirect pathways. Mediation was evaluated with bootstrap resampling. The prevalence of impaired OHRQoL (GOHAI > 0) was 25.9% (95% CI: 18.6 to 34.9). Tooth loss correlated with worse nutrition (ρ = -0.32; 95% CI: -0.48 to -0.15), and poorer nutrition was associated with worse OHRQoL (ρ = -0.22; 95% CI: -0.40 to -0.03). SEM showed that tooth loss negatively affected nutrition (β = -0.21; 95% CI: -0.43 to 0.00) and that nutrition was directly associated with OHRQoL (β = -0.21; 95% CI: -0.34 to -0.08). Bootstrap analyses confirmed a direct effect of tooth loss on OHRQoL (β = 0.19; 95% CI: 0.02 to 0.36), while the indirect pathway through nutrition did not reach statistical significance. Tooth loss and poor nutrition independently reduce OHRQoL in older adults. Although mediation by nutrition was not statistically significant, the findings highlight the interdependence of oral and general health and support integrated public health strategies for aging populations.

BackgroundDetermine the impact of poor oral health on the oral health-related quality of life (OHRQoL) in community-dwelling older adults.MethodsCross-sectional study of community-dwelling older adults in Mexico City. Sociodemographic characteristics were obtained and assessed their OHRQoL according to the Geriatric/General Oral Health Assessment Index (GOHAI). Clinical evaluation of their oral health: painful chewing, use of dentures, dry mouth, xerostomia, plaque, calculus, coronal and root caries, tooth loss and gingival bleeding. Finally, we determined the oral health of participants through Latent Class Analysis (LCA), excluding totally edentulous. The strength of association was determined (Odds Ratio [OR] and 95% confidence interval [95% CI]) through logical regression between the oral health categories (latent classes) and OHRoL in older adults, adjusted with the other variables included in the study: age, sex, marital status, living arrangements (lives alone), educational level, paid work status, comorbidity, cognitive deterioration, depression and use of medical and dental services in the previous 12 months.ResultsThe mean (SD) GOHAI score for the 228 older adults to 46.5 (8.7), number of classes to characterize oral health through LCA was three (entropy 0.805). The GOHAI mean for Class 3 (57.0%), acceptable oral health was 50.1 (7.1); totally edentulous (9.6%), 47.9 (8.4); for Class 2 (16.7%), regular oral health, 43.8 (9.3); and for Class 1 (16.7%), poor oral health, 42.2 (9.7). Significant differences were observed among means (p < .001). Using Class 3 an as a reference, the strength of association between the GOHAI scores and low OHRQoL (GOHAI 25th percentile = 24.0) was OR = 0.7, 95% CI = 0.2–3.3 for totally edentulous; OR = 3.0, 95% CI = 1.2–7.6 for Class 2 and OR = 5.0, 95% CI = 2.1–12.1 for Class 1.ConclusionPoor oral health was associated with a negative impact on the OHRQoL of community-dwelling older adults.Clinical relevanceIt is essential to design and implement oral health care policies specifically targeted at improving the quality of life in this older adult population.

The purpose of the current study was to assess the oral health related quality of life (OHRQoL), general health related quality of life (HRQoL), clinical oral and denture status, as well as their interrelation, within a hospitalized general population. The Romanian versions of the Oral Health Impact Profile-49 (OHIP-49Ro), SF-36 questionnaires, together with an additional set of oral health assessment questions, were administered under the interview format to 170 patients, hospitalized in the Second Medical Clinic of Internal Medicine, Cluj-Napoca, Romania. The patients also underwent clinical examination, based on which the DMFT was calculated. Denture status, was as well, registered, together with the denture material. Each patient provided informed consent, prior to any examination. Questionnaire scores were calculated and used for the univariate descriptive statistics, reflecting oral health, OHRQoL and HRQoL sample tendencies. Successively, multiple regression analysis was applied, with the purpose of investigating the relationship between: the clinical oral health status, OHRQoL and HRQoL. In the first model, OHRQoL, while in the second model the dependent variable was represented by the HRQoL, each having a set of established predictors. Additionally, for denture wearing patients, OHRQoL variations in respect to the denture material were assessed, using one-way ANOVA. The mean OHIP-49Ro overall score was 31.90. The mean SF-36 subscales score was 60.66. The mean DMFT score was 18.47. For both regression analyses, all the regression models were significant. For the first model, the predictors accounted for 48.5% of variance in OHRQoL. For the second model, the highest percent of variance, explained by the predictors, was registered for the Mental Health subscale (22.8%). DMFT, as a clinical measure, was a statistically significant predictor rather for the perception in general health. However, OHRQoL was a good predictor for HRQoL, as an integrated part of it. Moreover, the one-way ANOVA indicated statistically significant differences in OHRQoL perception, in respect to the denture material F(2, 82) = 3.253, p = 0.044. The current study indicated complex relations between the patients� clinical status, the OHRQoL and HRQoL. The clinical determinants presented direct impact on both OHRQoL and HRQoL. More balanced HRQoL scores suggested that patients focused more on the perception of general health outcomes.

BackgroundOlder adults present a variety of oral diseases and conditions, in addition to co-morbidities and limited access to dental care, which significantly impact their oral health-related quality of life (OHRQoL). There are many instruments published to measure OHRQoL. However, it is challenging for clinicians and researchers to choose the best instrument for a given purpose.PurposeTo identify OHRQoL instruments available for older adults and summarize the evidence on the conceptual and measurement model, psychometric properties, interpretability, and administration issues of OHRQoL instruments available for older adults through a systematic review.MethodsA systematic search was conducted in MEDLINE, EMBASE, LILACS, and CENTRAL up to February 2023. Articles reporting information on the concept model measurement, psychometric properties, and administration issues of an instrument measuring OHRQoL in older adults were included. Two researchers independently evaluated each instrument using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The overall score and seven attribute-specific scores were calculated (range 0–100): Conceptual and measurement model, Reliability, Validity, Responsiveness, Interpretability, Burden, and Alternative forms.ResultsWe identified 14 instruments evaluated in 97 articles. The overall score varied between 73.7 and 8.9, with only six questionnaires over the threshold score 50.0. EORTC QLQ OH-15 (cancer-specific questionnaire) achieved the highest score (73.7), followed by OHIP (generic OHRQoL questionnaire) (66.9), GOHAI (generic OHRQoL questionnaire) (65.5), and OHIDL (generic OHRQoL questionnaire) (65.2). Overall, the Conceptual and measurement model and Validity showed the best performance, while Responsiveness and Interpretability showed the worst. Insufficient information was presented for an overall evaluation of DSQ and OHAI.ConclusionThe evidence supports using EORTC QLQ-OH15 as a specific instrument to assess OHRQoL in cancer patients and the OHIP-49, GOHAI, or OHIDL as generic instruments to assess OHRQoL either for cross-sectional or longitudinal studies in older adults.

Introduction: this study evaluated the Comprehensive Oral Health Program (GES-60) and its association with oral health indicators and Oral Health-Related Quality of Life (OHRQoL) in older adults in Ovalle, Chile. Methods: a non-concurrent cohort study was conducted comparing users and non-users of the GES-60 program, who were surveyed and clinically examined for periodontal status, oral hygiene habits, smoking, type 2 diabetes mellitus, and OHRQoL assessed using the OHIP-7Sp scale. Results: a total of 238 older adults were examined (102 users and 136 non-users). Access to the program did not differ by sex (Chi-square test; p = 0.935). Awareness of the benefit was low (18.5 %). Users and non-users brushed with fluoride toothpaste twice or more a day (83.6 %). More than 50 % of the sample was diagnosed with periodontitis and perceived to have good OHRQoL. Among participants with type 2 diabetes mellitus, 79.8 % brushed twice or more daily (p &lt; 0.0001) and 75 % used fluoride toothpaste at the same frequency (p &lt; 0.0001). No association was found between OHRQoL and the use of GES-60 (Fisher's exact test; p=0.142). Conclusions: most older adults demonstrated adequate oral hygiene habits and good self-perceptions of OHRQoL. The high prevalence of periodontitis suggests possible gaps in periodontal disease awareness. These findings highlight the need to strengthen educational components to help users better understand the OHIP-7Sp survey.

Background: Patient-centered care requires medical personnel to address not only physical illnesses but also the psychosocial well-being of patients. older adultsOlder adults often have medically complex conditions, including one or more chronic diseases, requiring the use of multiple medications (polypharmacy). Polypharmacy is a common problem among older adults, with a reported prevalence of 30% to 80%. Many prescribed medications can lead to xerostomia and hyposalivation, which negatively impact the quality of life , including Oral Health-Related Quality of Life (OHRQoL). This systematic review aims to determine the impact of polypharmacy on OHRQoL in older adults and explore strategies to optimize OHRQoL in this population. Method: The dataset of articles concerning polypharmacy and OHRQoL in older adults was compiled from Google Scholar, PubMed, Semantic, and OpenAlex. The search encompassed publication from 2019 to 2024. Five articles were selected for in-depth analyses, and variations in methodologies used by the researchers in these selected studies were identified and considered. Results: Patients with polypharmacy hyposalivation exhibited significantly higher scores of the Summated Xerostomia Inventory questionnaire (SXI-PL) (8.60 ± 2.56) and the Oral Health Impact Profile-14 (OHIP-14sp) (16.0 ± 15.8). A statistically significant association was found between hyposalivation and both SXI-PL and OHIP-14sp scores (p &lt; 0.05). Elderly individuals on continuous medication demonstrated increased odds of self-reported xerostomia (OR: 2.3; 95% CI: 1.19-4.67; P = 0.009). Conclusion: This study demonstrates an association between polypharmacy and decreased oral health-related quality of life (OHRQoL) in older adults.

This study was conducted to investigate the degree of dry mouth and oral health-related quality of life and to identify factors contributing to oral health-related quality of life for community-dwelling elders. A descriptive correlational study design was used. Participants were 156 older adults from two senior welfare centers. Data were collected on February 21, 22 and 29, 30, 2009 using structured questionnaires. Enter type multiple regression analysis was used to identify factors influencing oral health-related quality of life according to general and oral health characteristics. There were significant differences in oral health-related quality of life according to living arrangement, insurance, smoking, number of natural teeth, and denture type. The oral health-related quality of life had significant correlations with the number of chronic disease, number of medications, and dry mouth. Factors influencing oral health-related quality of life for community-dwelling older adults were dry mouth, number of chronic disease, and medical aid, which explained about 47.9% of total variance. These results indicate that in order to promote oral health-related quality of life for older adults, prevention or management of chronic diseases as well as oral health and dry mouth are needed for this population, and especially economically poor elders.

BackgroundIt is increasingly recognized that the impact of disease on quality of life should be taken into account when assessing health status. It is likely that tooth loss, in most cases being a consequence of oral diseases, affects Oral Health-Related Quality of Life (OHRQoL). The aim of the present study is to systematically review the literature and to analyse the relationship between the number and location of missing teeth and oral health-related quality of life (OHRQoL). It was hypothesized that tooth loss is associated with an impairment of OHRQoL. Secondly, it was hypothesized that location and distribution of remaining teeth play an important role in this.MethodsRelevant databases were searched for papers in English, published from 1990 to July 2009 following a broad search strategy. Relevant papers were selected by two independent readers using predefined exclusion criteria, firstly on the basis of abstracts, secondly by assessing full-text papers. Selected studies were grouped on the basis of OHRQoL instruments used and assessed for feasibility for quantitative synthesis. Comparable outcomes were subjected to meta-analysis; remaining outcomes were subjected to a qualitative synthesis only.ResultsFrom a total of 924 references, 35 were eligible for synthesis (inter-reader agreement abstracts κ = 0.84 ± 0.03; full-texts: κ = 0.68 ± 0.06). Meta-analysis was feasible for 10 studies reporting on 13 different samples, resulting in 6 separate analyses. All studies showed that tooth loss is associated with unfavourable OHRQoL scores, independent of study location and OHRQoL instrument used. Qualitative synthesis showed that all 9 studies investigating a possible relationship between number of occluding pairs of teeth present and OHRQoL reported significant positive correlations. Five studies presented separate data regarding OHRQoL and location of tooth loss (anterior tooth loss vs. posterior tooth loss). Four of these reported highest impact for anterior tooth loss; one study indicated a similar impact for both locations of tooth loss.ConclusionsThis study provides fairly strong evidence that tooth loss is associated with impairment of OHRQoL and location and distribution of tooth loss affect the severity of the impairment. This association seems to be independent from the OHRQoL instrument used and context of the included samples.

Integration of oral health-related quality of life instruments

Background: Oral disease prevalence is rising globally in a major way, with a heavier impact and concern on developing countries like India. Also, limited data in literature has previously assessed oral health-related quality of life (OHRQoL) in older adults in Indian settings.Aims: The present study aimed to evaluate OHRQoL in older adults seeking dental care in Indian settings.Methods: In 140 subjects, an oral examination to detect any oral condition was done followed by filling out a questionnaire for OHRQoL assessment using the Geriatric Oral Health Assessment Index 12 (GOHAI-12). The treatment needs of each study subject were governed by prosthetic and dental status individually. Statistical evaluation of the data collected was done to formulate the results.Results: Concerning age, a significant impact was seen, where increasing age was associated with poor quality of life (p=0.025). For gender, older females had poor OHRQoL with p-values of <0.001, 0.01, 0.04, and <0.001 respectively for behaviour, psychological, pain and discomfort, and functional limitation. Also, edentulous patients had poorer OHRQoL compared to subjects with >20 teethConclusion: The present study concludes that oral diseases can significantly affect the OHRQoL, with higher female and edentulous state preponderance. Early diagnosis and management can aid in improving QoL in older adults.

BackgroundPoor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan.MethodsA cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL.ResultsA total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men.ConclusionsThe relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women’s oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

ObjectivesTo investigate the correlation between the four dimensions of Oral Health-Related Quality of Life (OHRQoL) and Health-Related Quality of Life (HRQoL) constructs in a dental patient population.MethodsA cross-sectional study carried out at HealthPartners, Minnesota, USA. This study is a secondary data analysis of available adult dental patients’ data. The instruments used to assess the OHRQoL and HRQoL constructs were the Oral Health Impact Profile–version with 49 items (OHIP-49) and Patient-Reported Outcome Measures Information System (PROMIS) measures v.1.1 Global Health instruments Patient Reported Outcome Measures (PROMs), respectively. We used Structural Equation Modeling to determine the correlation between OHRQoL and HRQoL.ResultsTwo thousand and seventy-six dental patients participated in the study. OHRQoL and HRQoL scores correlated with 0.56 (95%CI:0.52–0.60). The OHRQoL and Physical Health dimension of HRQoL correlated with 0.55 (95%CI:0.51–0.59). The OHRQoL and Mental Health dimension of HRQoL correlated with 0.51 (95%CI:0.47–0.55). When adjusted for age, gender, and depression, the correlation coefficients changed only slightly and resulted in 0.52 between OHRQoL and HRQoL Physical Health, and 0.47 between OHRQoL and HRQoL Mental Health. Model fit statistics for all analyses were adequate and indicated a good fit.ConclusionsOHRQoL and HRQoL overlap greatly. For dental practitioners, the OHRQoL score is informative for their patients’ general health status and vice versa. Study results indicate that effective therapeutic interventions by dentists improve patients’ OHRQoL as well as HRQoL.

The impact of treatments on completely edentulous individuals on masticatory performance (MP), oral health-related quality of life (OHRQoL), nutritional status (NS) and socio-economic profile (SP) is unclear in the literature. To compare the MP, OHRQoL, NS and SP of totally edentulous elderly users of bimaxillary complete dentures (CD) and users of lower implant-supported fixed complete dentures (IFCD). Forty participants were allocated into groups according to rehabilitation treatment (n = 20): bimaxillary CD (G1) and lower IFCD, and upper CD (G2). The evaluation of MP used almonds by the method of sieves. Four questionnaires (Geriatric Oral Health Assessment Index-GOHAI and Oral Health Impact Profile Edent-OHIP-Edent, Brazilian Economic Classification Criteria-ABEP and Mini Nutritional Assessment-MNA) were applied to assess the OHRQoL, SP and NS of the elderly, respectively. After evaluating the statistical assumptions, the Mann-Whitney (α = .05) test was applied to compare the groups regarding MP, OHRQoL, NS and SP. Spearman's correlation (α = .05) was performed to verify the correlation between the MP, the OHRQoL and the NS of the participants. G2 showed better MP (p < .05) in all masticatory cycles, OHRQoL (p < .05) and NS than the G1. However, the participants' self-perception of oral health did not differ between groups (p < .05). A moderate negative correlation was found between MP and OHRQoL for 40 masticatory cycles (r2 = -0.513; p = .001). Individuals rehabilitated with IFCD had a higher average monthly family income and achieved superior behaviour in MP and OHRQoL, in addition to lower risks of malnutrition when compared to individuals using bimaxillary CD.