Quality of Life as an Indicator of Oral Health in Older People

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Quality of Life as an Indicator of Oral Health in Older People
2007
Michael I. MacEntee, LDS(I), Dip Prosth, FRCD(C), PhD
Journal of the American Dental Association

ABSTRACT

Background. Quality of life is dynamic, fluctuating and resilent; it has both positive and negative attributes and is influenced by personal and social expectations. However, it is difficult to measure the experience in a way that is clinically relevant and useful.

Methods. The author examined the literature relating to the assessment and measurement of quality of life as influenced by oral health.

Results. It is difficult to interpret the clinical relevance of measurements from questionnaires or structured interviews that use predetermined response options to indicate health-related quality of life. In contrast, open-ended interviews and focus groups have helped to clarify the mouthÌs effect on the quality of life of older people. They also have helped to construct a new model of oral health that is consistent with current concepts of aging and disability.

Clinical Implications. The new model of oral health offers the possibility of developing interviews and questionnaires using language that has the scope and sensitivity needed to reveal the positive strategies that older people use to manage their oral health and quality of life.

Key Words: Research; aging; oral health; outcome assessment; quality of care


Abbreviations: WHO: World Health Organization


The biomedical model of disease dominates our professional education to direct how we examine, measure and interpret oral health, and it focuses our attention on the physical structures and processes associated with the mouth. However, some clinicians and researchers are uneasy with this narrow focus, partly because it can exaggerate the need for treatment. For example, researchers1,2 exaggerated by between 30 and 90 percent estimates of the need and time required to treat oral healthÒrelated problems among frail elderly people in residential care when they ignored patientsÌ propensity to benefit from treatment.

In addition, the biomedical model provides a limited explanation of what causes or promotes disease. For example, the theory regarding the cause of periodontal disease has moved from germ theory to molecular and genetic biology, and from a nonspecific to a specific plaque hypothesis. However, it is more likely that the causeÛin contrast to the pathogenesis of this and many other chronic diseases of the mouthÛwill surface at the population and societal level within the realms of economics, sociocultural structure and behavior.1

The promotion of oral health might benefit more from knowing why people choose to neglect their oral hygiene, or binge on sweet snacks, than it does from an explanation of how DNA polymorphisms influence susceptibility to periodontal disease. Similarly, reconsideration of what constitutes a minimal threshold of physical functionÛprompted by an increased awareness of the propensity to seek and tolerate treatment, as well as to benefit from itÛhas led dental professionals to promote the "shortened dental arch" as a healthy alternative to prosthodontic replacement of missing molars, at least among older people.2Ò6

The propensity for treatment is influenced by the physical, psychological and social context in which treatment is considered, along with a personÌs desire for treatment and ability to benefit from it.7 Several practical observations support this concept. We find, for example, that elderly people maintain, for as long as possible, patterns of oral care established early in life.8 They seek treatment for problems they believe to be serious and are likely to be treated successfully9; moreover, they are more accepting of treatment that they believe will benefit their self-image and social interaction than they are of treatment that enhances their physical function.10,11 This leads us to consider quality of life as an experience that warrants our attention when assessing treatment needs and outcomes, as well as a motivator of behavioral change to enhance the oral health of older adults.

© 2007 American Dental Association

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