|Year : 2015 | Volume
| Issue : 3 | Page : 269-273
Association of oral health-related quality of life and nutritional status among elderly population of Satara district, Western Maharashtra, India
Parth Patel1, KM Shivakumar1, Snehal Patil1, KV Suresh2, Vidya Kadashetti3
1 Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
2 Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
3 Department of Oral Pathology, Microbiology and Forensic Odontology, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
|Date of Web Publication||14-Sep-2015|
K M Shivakumar
Department of Public Health Dentistry, School of Dental Sciences, Krishna Institute of Medical Sciences University, Karad - 415 110, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: The major proportion of the population suffering from nutritional deficiency and continues to grow worldwide, especially in developing countries like India, and it is the most common cause of morbidity and mortality. Aim: To evaluate the oral health-related quality of life (OHRQOL) and nutrition status and association between nutritional status, and OHRQOL in the elderly. Materials and Methods: A cross-sectional study was conducted among the elderly of Karad city. The elderly were subjected to type 3 oral examination. Data regarding the nutritional status and OHRQOL were obtained using Geriatric Oral Health Assessment Index (GOHAI) and mini nutritional assessment (MNA) index. Descriptive statistics was used to analyze data using SPSS version 21. Results: The sample included 200 elderly, of which 59% consisted of males, and 41% are females. The majority of study subjects (46%) were between age group 61 and 70 years. Among the assessed subjects, nearly 95% of them had total scores of GOHAI between 12 and 57 which require "needed dental care." As per MNA, 3.5% had adequate nutrition, 60% were at risk of malnutrition, and remaining 36.5% of subjects were malnourished. There was a significant correlation between GOHAI and MNA scores. Conclusion: Nutritional status was associated with the poor OHRQOL among the elderly. A strong association was found between mean GOHAI and MNA scores and nutrition status and OHRQOL.
Keywords: Elderly, geriatric assessment, nutritional status, oral health, quality of life
|How to cite this article:|
Patel P, Shivakumar K M, Patil S, Suresh K V, Kadashetti V. Association of oral health-related quality of life and nutritional status among elderly population of Satara district, Western Maharashtra, India. J Indian Assoc Public Health Dent 2015;13:269-73
|How to cite this URL:|
Patel P, Shivakumar K M, Patil S, Suresh K V, Kadashetti V. Association of oral health-related quality of life and nutritional status among elderly population of Satara district, Western Maharashtra, India. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2019 Jul 23];13:269-73. Available from: http://www.jiaphd.org/text.asp?2015/13/3/269/165261
| Introduction|| |
In almost every country, the proportion of people aged over 60 years is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates.  India has around 100 million elderly at present, and the number is expected to increase to 323 million, constituting 20% of the total population, by 2050.  The boundary of old age cannot be defined exactly because it does not have the same meaning in all societies. Government of India adopted "National policy on older person" in January 1999. The policy defines "senior citizen" or "elderly" as a person who is age of 60 years or above. 
Many of the older adults face special health challenges like degenerative, physical, mental, and cognitive diseases and are at constant risk of noncommunicable cerebral and cardiovascular diseases and communicable diseases.  Globally, poor oral health among older people has particularly been seen in a high level of tooth loss, dental caries experience, high prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer. The negative impact of poor oral conditions on daily life is particularly signiﬁcant among edentulous people. Extensive tooth loss reduces chewing performance and affects food choice; leading to malnourishment. 
Malnutrition in the elderly has an evident impact on their general health and quality of life. Studies  report that oral health has an impact on food choice and on the intake of key nutrients, causing various nutritional problems.  Other studies indicate that edentulous patients with no, or only one, prosthesis (upper or lower) experience more difficulty in chewing solid food, placing them at a greater risk of malnutrition. Inadequate dental status and folate intake in the elderly have been reported to be independent predictors of mortality at 6 years, at least in women. 
The Geriatric Oral Health Assessment Index (GOHAI) measures patient-reported oral functional problems. The measure, based on a patient-centered definition of oral health for older adults, includes items regarding freedom from pain and infection, and the patient's ability to continue in his or her desired social roles. This patient-centered definition of health diverges from disease-centered epidemiological measures of health (presence or absence of disease) traditionally used in dentistry.  GOHAI pays special attention to problems related to food ingestion, which are addressed by one item in all four dimensions of the index: "Trouble biting or chewing food" (functional limitation), "discomfort when eating" (pain and discomfort), "uncomfortable eating in front of people" (psychological impacts), and "limit kinds or amounts of food" (behavioral impacts). 
The oral cavity is closely related to nutrition because it is the entrance to the digestive tract. There are relatively very few studies on oral health and nutritional status. Therefore, an attempt was made to assess the relationship between nutritional status and oral health-related quality of life (OHRQOL) among elderly of Satara district of Maharashtra state, India.
| Materials and methods|| |
A cross-sectional study was conducted from February 2014 to June 2014 among the institutionalized elderly of Satara district, India. Satara is a district situated in western part of Maharashtra with a population of 3,003,741 and literacy rate of 82.87 with most of the people belonging to middle socioeconomic status.  Ethical approval was obtained from the Institutional Ethics Committee prior to the start of the study. List of the old age homes was procured form the district office, and the old age homes were visited for conducting the study. Permissions were obtained from the concerned authorities, and informed consent was obtained from the elderly participants. Inclusion criteria were the subjects more than 60 years old and did not have any medical conditions contraindicating the oral examination. A pilot study was conducted among 30 individuals, and sample size was derived at probability of 90% and error of 5%. The final sample size was calculated to 200.
WHO oral health assessment form (1997)  was used to record oral health status. Emergency treatment was referred to dental hospital. Variables assessed were demographic variables, OHRQOL, and nutritional status of the elderly. GOHAI has 12-item questionnaires to assess three dimensions: (1) Physical function including eating, speech, and swallowing; (2) psychosocial function including worry or concern about oral health, dissatisfaction with appearance, self-consciousness about oral health, and avoidance of social contacts because of oral problems; (3) pain or discomfort including the use of medication to relieve pain or discomfort from the mouth. Responses were - always, often, sometimes, seldom, or never experienced problems in the previous 3 months and were coded as "never = 0" and "always 5." ,
Because the scale score is the sum of these values, a low value indicates an oral health problem. An overall GOHAI score ranging from 12 to 60 was calculated for each person, with a higher score indicating better oral health. Individuals with a GOHAI score of 12-57 were identiﬁed as "needing dental care," and those with a score of more than 57 were identiﬁed as "not needing dental care." ,
Mini nutritional assessment (MNA) index: 11-item questionnaires that assessed the malnutrition risk among elderly. The MNA score (maximum score = 30 points) distinguishes between three categories of elderly patients: Those with adequate nutrition (score 24), those at risk of malnutrition (score of 17-23.5), and those who are actually malnourished (score <17). 
The recorded data were transferred to computer in MS Excel Work Sheet. The data were subjected to Statistical Analysis by SPSS version 21 (SPSS Inc., Chicago, IL, USA). Descriptive and Inferential statistics were used to analyze the data. P value was set at < 0.05.
| Results|| |
A total of 200 institutionalized elderly were included in the study, of which 59% were males and 41% were females. The majority of study subjects (46%) were between age group 61 and 70 years. Only 79 (39.5%) of subjects had completed secondary education. The majority of the (87.0%) subjects were in unskilled, and 26 (13.0%) of subjects were in skilled occupation [Table 1].
|Table 1: Distribution of participants according to the demographic variables |
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About 85.0% of subjects sometimes had difficulty in eating food because of the problems with teeth or dentures. Approximately, 85.0% of subjects had trouble biting or chewing any kinds or food such as firm meat or apples, 95.0% of subjects were able to swallow comfortably, and 85.5% of subjects never had problems in speaking. Nearly, 95% of them had total scores of GOHAI between 12 and 57 require "needed dental care" [Table 2]. MNA showed, 3.5% had adequate nutrition, 60% were at risk of malnutrition and remaining 36.5% of subjects were malnourished [Table 3] and [Table 4]. Pearson correlation results showed that there was a significant correlation between GOHAI and MNA scores (P < 0.001, r = 0.36).
|Table 4: Distribution of participants according to the various GOHAI and MNA categories |
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| Discussion|| |
A multitude of physical, social, psychological, and biological factors contribute to a person's nutritional health status.  Almost all these factors are particularly pertinent among older adults. Factors such as poverty, social isolation, poorer mental health, loneliness, and losses of different kinds can affect general health and oral health of the person. Older adults are more likely to experience events such as bereavements or physical disability that affect emotional well-being and can result in nutritional health.
In this study of an elderly population, the elderly with a poor perception of their oral health state had a lower MNA score. In fact, more than 80% of the individuals' classiﬁed by MNA results as malnourished required dental care according to their GOHAI score. OHRQOL tools for the elderly that take account of the functional, social, and psychological repercussions of their oral health are valuable. Only Daly et al. have evaluated the OHRQOL as part of an analysis of oral health status and malnutrition risk.  These elderly people who needed a complete prosthesis did not have one, suggesting that prosthetic rehabilitation may have played an important role in the prevention of malnutrition risk among the remaining older adults. 
The MNA results were signiﬁcantly associated with GOHAI score. All the subjects in our study were institutionalized elderly. These results are similar to the those observed by Kshetrimayum et al. in the study conducted among institutionalized elderly of Mysore City (South India).  A high prevalence of the different mastication-related problems was detected (limits on types or amounts of food, difficulties with biting or chewing food, discomfort when swallowing or eating, and feeling uncomfortable eating in front of people) which is supportive of reports by other authors. 
Sheiham et al. reported that a restriction in food because of mastication difficulties only very occasionally produced a deﬁcit in key nutrients (except Vitamin C) detectable by biochemical analysis that could cause a clinical nutritional disease. Hence, these results should always be interpreted in terms of malnutrition risk rather than actual malnutrition.  Besides the large number of reported mastication-related problems in this elderly population, the present results show the strong association of an OHRQOL measure with malnutrition in individuals with oral health concerns, although the actual diagnosis of malnutrition requires a more complex study of the patient. Daly et al. found a significant relationship between low body weight and the number of remaining teeth using the MNA. 
El Osta et al. evaluated OHRQOL using the GOHAI and MNA. The mean GOHAI score was 52.1 ± 7.2, with 70.7% of the sample needing oral health care and the mean MNA score was 24.0 ± 3.31; 3.5% of the elderly were malnourished; 31.5% were at risk of malnutrition; 65.0% were considered adequately nourished.  Similar findings were recorded in our study.
| Limitations|| |
Due to the nature of the study, the causal relation between the quality of life and nutritional status cannot be assessed. Similarly, larger sample size may be required for further in-depth studies on the relationship between quality of life and nutritional status.
OHRQOL assessment is associated with MNA estimated malnutrition risk. These tools, designed to detect the outcomes of oral-facial disorders, in general, may also serve to identify individuals at risk of malnutrition caused by oral problems. More such surveys need to be carried out in other large cities of the country in order to build comprehensive database for future policy decisions on OHRQOL and nutritional status.
| Conclusion|| |
The OHRQOL can provide the basis for oral health-care program and nutritional status in elderly. The results of the present study showed that Nutritional status was associated with the poor OHRQOL, and the strong association was found between mean GOHAI and MNA scores and nutrition status and OHRQOL.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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