Impact of oral health on quality of life among the elderly population of Joaçaba, Santa Catarina, Brazil Impacto da condição bucal na qualidade de vida dos idosos de Joaçaba, Santa Catarina, Brasil

The objective of this study was to investigate the impact of oral health conditions on the quality of life of elderly people in Joaçaba SC, in Southern Brazil. A survey based on systematic sampling of clusters was carried out with 183 elderly people that belong to old age groups. The survey was conducted in order to assess the oral conditions of the participants (use of and need for prosthesis) based on the criteria from the World Health Organization publication “Oral Health Surveys, Basic Methods”, 4 edition. The oral health impact profile (OHIP) was used to evaluate the impact of oral condition in the quality of life. ABIPEME (Brazilian Association of Market Research Institutes) criterion was used, together with the level of education and the number of people in the household to determine social inequalities. The participants were mostly women (82%) and the OHIP mean was 10.35. No correlation was observed between the OHIP level and formal education or between OHIP and number of residents per household. There was a correlation of 0.240 (p = 0.001) between ABIPEME and OHIP. The OHIP mean for those not using maxillary prosthesis was 12.48 and the mean for those using it was 9.81 (p = 0.399). The mean OHIP for those in need of maxillary prosthesis for those who did not need it was 13.00 and 8.88, respectively (p = 0.014). The same trend was found for the use and need for mandibular prosthesis. The conclusion was that the need for maxillary and mandibular prosthesis impacted the quality of life among the elderly population of Joaçaba. DESCRIPTORS: Quality of life; Oral health; Geriatrics; Health surveys. RESUMO: O objetivo do presente estudo foi investigar o impacto da condição bucal na qualidade de vida dos idosos do município de Joaçaba SC. Foi estudada a população de idosos que participa dos grupos da terceira idade a partir de amostra sistemática por conglomerados de 183 idosos. Foi realizado um levantamento epidemiológico utilizando os critérios de diagnóstico da OMS (Organização Mundial da Saúde) (1997) para verificar a condição bucal dos participantes (uso e necessidades de prótese). Foi aplicado o OHIP (Oral Health Impact Profile) para verificar o impacto da condição bucal na qualidade de vida. Para verificar a desigualdade social, foram utilizados critério ABIPEME (Associação Brasileira dos Institutos de Pesquisa de Mercado), grau de escolaridade e número de pessoas que moram no domicílio. A maioria dos participantes era do sexo feminino (82%), e a média do OHIP foi de 10,35. Não se observou correlação entre OHIP e grau de escolaridade e OHIP e número de moradores por domicílio. Verificou-se correlação de 0,240 (p = 0,001) entre OHIP e ABIPEME. A média do OHIP para as pessoas que não usavam prótese superior foi de 12,48 e, para os que usavam, 9,81 (p = 0,399). O OHIP médio para os que necessitavam de prótese superior foi de 13,00 e 8,88 para os que não necessitavam (p = 0,014). Foi verificada a mesma tendência para uso e necessidades de próteses inferior. Concluiu-se que a necessidade de prótese total, tanto superior quanto inferior, mostrou relação com o impacto na qualidade de vida. DESCRITORES: Qualidade de vida; Saúde bucal; Geriatria; Levantamentos epidemiológicos. Public Health Biazevic MGH, Michel Crosato E, Iagher F, Pooter CE, Correa SL, Grasel CE. Impact of oral health on quality of life among the elderly population of Joaçaba, Santa Catarina, Brazil. Braz Oral Res 2004;18(1):85-91. 86 this sense, Locker (1997) explains that the term “health” may be defined as the “subjective experience of a person in relation to his functional, social and psychological well-being”. Consequently, it refers to the individual experience, and its consequences in everyday life. Therefore, it constitutes a sociological and psychological concept, which may be applied to individuals and populations. The greatest limitation of traditional epidemiological indicators is their inability to reflect the “capacity of an individual to perform tasks and activities”. Self-perceived measures convey more information about the way a certain disease is affecting the individual’s daily routine and the population in general than the measurements collected from a clinical environment. Clinical indicators are important for the assessment of oral health and treatment needs; nevertheless, their limitations must be considered. The combined clinical and subjective indicators define a multi-dimensional assessment of the oral health condition. Locker (1998) explains that the quality of life indicators related to oral health were defined as the measurements of how much dental problems and oral disorders interfere in the normal functioning of an individual’s life. Since the indicators were meant to supply information related to societies, they are inadequate to evaluate individual well-being. Each population, depending on their life styles, socio-economic status and access to health services, has distinctive experiences about their health condition. Therefore, the purpose of this study was to assess the impact of oral health on the quality of life of the elderly population in the city of Joaçaba, SC, Southern Brazil. MATERIAL AND METHODS The assessment was carried out in Joaçaba, a city in the western region of the State of Santa Catarina, in Southern Brazil. The Oral Health Impact Profile (OHIP) was used as the instrument to assess the quality of life associated with oral health conditions and was applied through personal interviews; the standard clinical exam for the observation of the use and need of prosthesis was carried out according to the criteria established in the 4 edition of the World Health Organization Manual; the socio-economic breakdown was determined according to the criteria of the Brazilian Association of Market Research Institutes – ABIPEME, level of education and number of residents per household. The information related to the use of health services and of preventive methods was obtained through specific direct questions concerning every health professional visited during the 12 months prior to the questioning, and about every method of oral hygiene used by the participant in the 14 days prior to the interview. A representative random systematic sampling of clusters from 183 elderly people aged 65 and over was selected from the old age groups of Joaçaba, SC. Previous to the commencement of the research, workshops with the participants were conducted in order to discuss the method of performance of the interviews. A pilot test was done to calibrate the 5 surveyors in relation to the observation of the clinical condition examined, and the (kappa) agreement test was used for these measurements until an adequate value was obtained. For the analysis of the results, the Spearman correlation test was used to verify correlations between OHIP items and use of and need for both maxillary and mandibular prosthesis, OHIP and ABIPEME criteria, OHIP and level of education, and also OHIP and number of residents per household; the Mann-Whitney association test was used to verify the association between the use of and need for maxillary and mandibular prosthesis and ABIPEME criteria and also between the use of and need for maxillary and mandibular prosthesis and the OHIP average. A 5% significance level was adopted. RESULTS The kappa agreement test result was adequate for the purposes of the study ( > 0.8). The population studied was composed mainly of female individuals (82%), with average socioeconomic level of 30.98 (maximum possible: 66), and OHIP average of 10.35 (maximum possible: 56). Half of the participants (50%) are in the C socio-economic class according to the ABIPEME classification methods, followed by the participants from classes D (28.6%), E (7.7%), B (5.6%) and A (1.5%). Table 1 shows the distribution of the answers to each impact measured by the OHIP. It was noticed that the participants showed low impact of oral problems since the average of each impact measured ranged from 0.16 to 1.51. Table 1 further shows the frequency distribution of the answers to the items measured by the instrument. Most participants experienced several impacts affecting their daily life: speech (33.4%), alterations in flavor of foods (38.3%), pain (46.5%), food intake discomfort (40.4%), uneasiness (42.1%), stress (44.8%),