EdenteV2, Istex, Corpus, bibRecord, 001793

Associations between xerostomia and health status indicators in the elderly

Identifieur interne : 001793 ( Istex/Corpus ); précédent : 001792; suivant : 001794

Associations between xerostomia and health status indicators in the elderly

Auteurs : David W. Matear ; D. Locker ; M. Stephens ; H P Lawrence

Source :

Perspectives in public health [ 1466-4240 ] ; 2006-03.

RBID : ISTEX:30F9D3AE2F8C125AD2671D729162F7C2B9561C53

English descriptors

KwdEn :
- Apartment building, Baycrest, Baycrest centre, Chronic care hospital, Community dent, Dent, Dent assoc, Dental care facility, Dental charts, Dentate, Dentate status, Dependent variables, Depressive symptoms, Drink water, Elderly individuals, Elderly people, Elderly population, Elderly research, General health, General health change, General health status, Gohai, Health assessment index, Health jrsh, Health march, Health problems, Health services research unit, Health status indicators, High xerostomia group, Higher levels, Independent effect, Independent variables, Index score, Jrsh, Life measures, Life satisfaction, Life scales, Life stress, Likert format, Logistic regression analysis, Longitudinal study, Marital status income, Medical conditions, Medication, Negative impact, Odds ratio, Odds ratios, Older adults, Oral function, Oral health, Oral health change, Oral health impact profile, Oral health measures, Oral health satisfaction, Oral health status, Oral pathol, Oral quality, Oral surg, Other aspects, Other studies, Personal interview, Reference period, Response codes, Royal society, Salivary, Salivary flow, Salivary flow rate, Salivary gland hypofunction, Several health scales, Significant effect, Significant impact, Significant relationships, Single item, Stress scale, Xerostomia, Xerostomia groups, Xerostomia index, Xerostomia index score, Xerostomia inventory, Xerostomia scale, Xerostomia score.
Teeft :
- Apartment building, Baycrest, Baycrest centre, Chronic care hospital, Community dent, Dent, Dent assoc, Dental care facility, Dental charts, Dentate, Dentate status, Dependent variables, Depressive symptoms, Drink water, Elderly individuals, Elderly people, Elderly population, Elderly research, General health, General health change, General health status, Gohai, Health assessment index, Health jrsh, Health march, Health problems, Health services research unit, Health status indicators, High xerostomia group, Higher levels, Independent effect, Independent variables, Index score, Jrsh, Life measures, Life satisfaction, Life scales, Life stress, Likert format, Logistic regression analysis, Longitudinal study, Marital status income, Medical conditions, Medication, Negative impact, Odds ratio, Odds ratios, Older adults, Oral function, Oral health, Oral health change, Oral health impact profile, Oral health measures, Oral health satisfaction, Oral health status, Oral pathol, Oral quality, Oral surg, Other aspects, Other studies, Personal interview, Reference period, Response codes, Royal society, Salivary, Salivary flow, Salivary flow rate, Salivary gland hypofunction, Several health scales, Significant effect, Significant impact, Significant relationships, Single item, Stress scale, Xerostomia, Xerostomia groups, Xerostomia index, Xerostomia index score, Xerostomia inventory, Xerostomia scale, Xerostomia score.

Abstract

Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence. Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.

Url:

https://api.istex.fr/document/30F9D3AE2F8C125AD2671D729162F7C2B9561C53/fulltext/pdf

DOI: 10.1177/1466424006063183

Links to Exploration step

ISTEX:30F9D3AE2F8C125AD2671D729162F7C2B9561C53

Le document en format XML

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<front><div type="abstract" xml:lang="en">Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence. Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.</div>
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<abstract>Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence. Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.</abstract>
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<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
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<author xml:id="author-0001"><persName><forename type="first">D</forename>
<surname>Locker</surname>
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<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
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<author xml:id="author-0002"><persName><forename type="first">M</forename>
<surname>Stephens</surname>
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<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
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<author xml:id="author-0003"><persName><forename type="first">H P</forename>
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<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
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<abstract xml:lang="en"><p>Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence. Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.</p>
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<title-group><article-title>Associations between xerostomia and health status indicators in the elderly</article-title>
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         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Matear</surname>
<given-names>David W</given-names>
</name>
<aff>Faculty of Dentistry, University of Toronto, Canada</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Locker</surname>
<given-names>D</given-names>
</name>
<aff>Faculty of Dentistry, University of Toronto, Canada</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Stephens</surname>
<given-names>M</given-names>
</name>
<aff>Faculty of Dentistry, University of Toronto, Canada</aff>
</contrib>
</contrib-group>                 
         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lawrence</surname>
<given-names>H P</given-names>
</name>
<aff>Faculty of Dentistry, University of Toronto, Canada </aff>
</contrib>
</contrib-group>             
         <pub-date pub-type="ppub"><month>03</month>
<year>2006</year>
</pub-date>
<volume>126</volume>
<issue>2</issue>
<fpage>79</fpage>
<lpage>85</lpage>
<abstract>             
            <p>                 
               <bold>Aims:</bold>
 This study investigated the associations between xerostomia (dry                 mouth) (low, moderate and high) with other categorical variables (e.g. demographic                 and health status indicators). This paper aims to report on the severity of                 xerostomia in the elderly population and investigate the relationship with other                 aspects of perceived health.</p>             
            <p>                 
               <bold>Method:</bold>
 Data were obtained from a cross-sectional survey of 225 elderly                 people from a large multilevel geriatric care centre. The centre consists of three                 levels of care: an apartment building in which residents live more or less                 independently, a home for the aged, and a chronic care hospital. Participants in the                 study were recruited when they attended the dental care facility. Data were                 collected by means of a personal interview conducted either at the dental care                 facility or the participant’s residence.</p>             
            <p>                 
               <bold>Results:</bold>
 The mean age was 83 years. Most were females (72%) and almost all                 (99%) reported one or more chronic medical conditions; 88% had physical                 disabilities. Xerostomia was recorded on a seven-point scale. Scores were                 categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4%                 respectively. Bivariate analysis showed no association between dry mouth and sex,                 age, general health change or life satisfaction. However, when the high xerostomia                 group was separated out and odds ratios calculated they were 2.3 to 4.9 times more                 likely to experience a negative impact on health than the low group. Xerostomia did                 not have a significant impact on chewing capacity, morale or stress, although it                 contributed to the variability of the oral health-related quality of life measures.                 It was the only variable with a significant effect (OR 2.55) for the Oral Health                 Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral                 Health Assessment Index. Selfreported xerostomia in the elderly population can be                 categorised into a severity scale. Those suffering most from xerostomia are more                 likely to experience a negative impact on general health.</p>             
            <p>                 
               <bold>Conclusion:</bold>
 The key finding in this study is that xerostomia has a                 significant and negative impact on the quality of life of elderly individuals,                 though oral function may be less affected.</p>         
         </abstract>
<kwd-group>             
            <kwd>Elderly population</kwd>             
            <kwd>xerostomia</kwd>         
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<meta-value> March 2006 Vol 126 No 2 Copyright © 2006 The Journal of The Royal Society for             the Promotion of Health JRSH ISSN 1466-4240 DOI: 10.1177/1466424006063183 JRSH             2006;126(2):79-85 Dry mouth and health status indicators in the elderly RESEARCH 79             Authors David W Matear, BDS, BMSc, DDPHRCS (Eng), MSc, MCMI, MHSM, FRSH, Assistant Dean,             Clinical Affairs, Faculty of Dentistry, University of Toronto, Toronto, Ontario M5G 1G6,             Canada Email: david.matear@ utoronto.ca D Locker, Community Dental Health Services             Research Unit, Faculty of Dentistry, University of Toronto, as above M Stephens,             Community Dental Health Services Research Unit, Faculty of Dentistry, University of             Toronto, as above H P Lawrence, Community Dental Health Services Research Unit, Faculty             of Dentistry, University of Toronto, as above Corresponding author: David W Matear, as             above Received 21 July 2004, revised and accepted 6 December 2004 Key words Elderly             population; xerostomia Associations between xerostomia and health status indicators in             the elderly Abstract Aims: This study investigated the associations between xerostomia             (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic             and health status indicators). This paper aims to report on the severity of xerostomia             in the elderly population and investigate the relationship with other aspects of             perceived health. Method: Data were obtained from a cross-sectional survey of 225             elderly people from a large multilevel geriatric care centre. The centre consists of             three levels of care: an apartment building in which residents live more or less             independently, a home for the aged, and a chronic care hospital. Participants in the             study were recruited when they attended the dental care facility. Data were collected by             means of a personal interview conducted either at the dental care facility or the             participant's residence. Results: The mean age was 83 years. Most were females (72%) and             almost all (99%) reported one or more chronic medical conditions; 88% had physical             disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as             low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively.             Bivariate analysis showed no association between dry mouth and sex, age, general health             change or life satisfaction. However, when the high xerostomia group was separated out             and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a             negative impact on health than the low group. Xerostomia did not have a significant             impact on chewing capacity, morale or stress, although it contributed to the variability             of the oral health-related quality of life measures. It was the only variable with a             significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a             higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Self- reported             xerostomia in the elderly population can be categorised into a severity scale. Those             suffering most from xerostomia are more likely to experience a negative impact on             general health. Conclusion: The key finding in this study is that xerostomia has a             significant and negative impact on the quality of life of elderly individuals, though             oral function may be less affected. INTRODUCTION Xerostomia (dry mouth) is a frequent             complaint in the elderly population. Prevalence has been estimated to range from 10% to             38%14 though the most frequently reported figure is 20%5 and is more common in older             adults than in other age groups.6 Dry mouth can occur due to severe reduction in             salivary flow7 or even when there is apparently normal salivary gland function.7, 8             Salivary gland hypofunction (SGH) can be objectively measured using sialometry.9             However, the condition of xerostomia, which comprises a set of symptoms that impact on             the individual, can only be assessed through questioning patients.10 The most frequent             cause of dry mouth is medication,11 which can mimic or antagonise regulatory aspects of             salivation and affect flow rate and composition.12 Dry mouth can be caused by several             diseases, conditions and treatments.11 Among these are head and neck radiotherapy,             diseases of the salivary glands, autoimmune diseases (for example, Sjögrens syndrome),             and psychosocial depression. Symptoms of dry mouth may include: burning or itching of             the oral mucosa and tongue, difficulties JRSH The Journal of The Royal Society for the             Promotion of Health March 2006 Vol 126 No 2 80 RESEARCH Dry mouth and health status             indicators in the elderly with speech and swallowing, difficulty eating13, 14 and taste             impairment.15 Difficulty wearing dentures and malnutrition have also been cited as             problems.11 The method of assessing the presence of dry mouth subjectively has varied,             including patient-reported changes in symptoms,16, 17 a single-item questionnaire,18 a             broader approach using a series of items indicative of the symptoms experienced19 and             the Xerostomia Inventory.20, 21 Whatever method is employed the importance may lie in             the effect that xerostomia has on the individual, that is the interaction between health             and the symptoms associated with dry mouth. This may be measured on quality of life             scales, including measures of general health and oral health, such as the Oral Health             Impact Profile (OHIP) and the Geriatric Oral Health Assessment Index (GOHAI). Functional             indices, for example the Chewing Index, may be used to attempt to investigate any             masticatory link. Indices of psychological well-being, such as perceived stress and             morale, can also be used and compared to the perceived seriousness of dry mouth. This             paper aims to report on the severity of xerostomia in the elderly population and             investigate the relationship with other aspects of perceived health. It is hypothesised             that xerostomia would be associated with, and therefore may impact on, other aspects of             general health. METHODS Study procedures The data were collected as part of the Baycrest             Oral Health Survey, a study designed to assess the oral health and oral health-related             quality of life of residents of the Baycrest Centre for Geriatric Care. The Baycrest             Centre is a large multilevel care setting for elderly people located in the City of             Toronto, Ontario, Canada. It consists of three levels of care: an apartment building in             which residents live more or less independently but with some support; a home for the             aged; and a chronic care hospital. Residents of the last two settings were significantly             more physically and cognitively impaired than residents of the apartment building. The             Centre has an in- house dental care facility that provides dental services to residents             of the Centre and to some residents of other institutional settings. The facility also             provides dental care to individuals living in the community through its out-reach             programme. Participants in the study were recruited when they attended the dental care             facility either for their annual dental examination or when requesting treatment. In             order to ensure that only those individuals able to give informed consent were             approached, dental clinic staff reviewed patients' medical and dental charts and             excluded those with cognitive impairment. In addition, for some residents of the home             for the aged and the chronic care hospital, cognitive competency was confirmed through             consultation with nursing staff. Eligible individuals who agreed to participate were             required to sign a consent form before being interviewed. Data were collected by means             of a personal interview conducted either at the dental care facility or the             participant's residence. The questionnaire was concerned with self-perceived oral and             general health and well-being. For dentate participants, clinical data such as the             number of missing teeth were abstracted from the dental charts. The recruitment process,             procedures for ensuring and obtaining informed consent and the data collection methods             were approved by the University of Toronto Human Subjects Certification Committee and             the Baycrest Centre's research ethics committee. Measures Self-perceived oral health             Measures included: three single-item ratings of oral health status, oral health             satisfaction, and oral health change; a six-item index of chewing capacity; 22 a             seven-item xerostomia index; questions on edentulism and denture wearing; and two oral             health-related quality of life measures  the GOHAI23 and the OHIP-14.24 The single             items for oral health used a Likert format with an 'excellent' to 'poor' five- point             range for status, 'very satisfied' to 'very dissatisfied' four-point range for             satisfaction, and 'worsened a lot' to 'improved a lot' five-point range for change. The             reference period for oral health change was two years. Scores for chewing and xerostomia             were calculated by counting the 'yes' responses. The xerostomia index is presented in             Table 1. For comparison purposes, the GOHAI and the OHIP-14 used the same reference             period (one year) and the same six-point Likert format with responses ranging from             'never'(1) to 'all the time'(6). Scores were calculated by summing the response codes;             consequently the GOHAI score range was 12 to 72 and the OHIP-14 range was 14 to 84, with             higher scores indicating poorer oral health- related quality of life. Self-perceived             general health Measures included: two single-item ratings of general health status and             change; a ten- item index of problems with activities of daily living (ADL); a check             list of 17 diagnoses of health problems such as arthritis, heart disease and problems             with hearing; and a question regarding the number of prescribed medications used. A             six-point Likert format ranging from 'excellent' to 'very poor' was used for general             health status; for change, which had a reference period of a year, there were five             points ranging from 'worsened a lot' to Xerostomia index items Answer 'Yes' or 'No' to             the following: In the last four weeks have you. . . . . . had a dry mouth or tongue             during the daytime? . . . needed to drink water in the daytime because of a dry mouth? .             . . had difficulty talking due to a dry mouth? . . . needed to drink water with meals             because your mouth is dry? . . . experienced difficulty in chewing due to a dry mouth? .             . . had problems swallowing food because your mouth is dry? . . . needed to chew gum             daily to relieve oral dryness? Table 1 March 2006 Vol 126 No 2 The Journal of The Royal             Society for the Promotion of Health JRSH Dry mouth and health status indicators in the             elderly RESEARCH 81 'improved a lot'. Scores for ADL and health problems were calculated             by counting the 'yes' responses. Psychological well-being Measures included: two             single-item ratings of life stress and life satisfaction; the 23- item Perceived Stress             Questionnaire;25 and a six-item morale scale.26 All four measures used a Likert response             format. The single item for stress in the 'past two years' had a five-point range of             'not at all stressful' to 'extremely stressful'. The satisfaction question, worded as             "Thinking about your life overall, how do you feel taking everything into account?" used             responses ranging from 'delighted' (1) to 'terrible' (7). Response codes ranged from             'never' (1) to 'all the time' (5) for the Perceived Stress scale, and 'strongly agree'             (1) to 'strongly disagree' (4) for morale. For both scales, scores were calculated by             summing the response codes; consequently the Perceived Stress score range was 23 to 115             and the morale 6 to 24. Note that high scores on the morale scale, in contrast to the             stress scale, represent positive psychological well- being. Data analysis As xerostomia             was the focus of this paper, more than one variable was used in the analyses. In             addition to the index score, which had a range from 0 to 7, a categorical variable was             created: low xerostomia (score 01), moderate (23) and high (47). Due to the skewed             distribution of the index score, a binary variable (0 = less than 4; and 1 = 4 or             higher) was used for the regression analyses. Associations between xerostomia (low,             moderate, high) and other categorical variables (i.e. demographic and health status             indicators, as described in the previous section) were examined through             cross-tabulations, using the chi-square statistic. Then the moderate and high groups             were compared separately to the low group and odds ratios calculated. A non-parametric             test, the Kruskal-Wallis, was used to explore the relationship between the dry mouth             groups and several discrete variables, which did not have normal distributions (e.g.             chewing index, GOHAI). Non-parametric tests were also used in additional bivariate             analyses involving the xerostomia score. Specifically, the strength, significance and             direction of the relationship between xerostomia and other discrete variables (e.g.             quality of life scales) were explored using Spearman rank correlations, and comparison             of xerostomia scores according to a grouping variable (e.g. arthritis, yes/no) was made             using the MannWhitney U-test. Linear regression proved inappropriate for multivariate             analyses as transformations of discrete variables with skewed distributions were not             successful. Thus logistic regression was used to examine the independent effect of dry             mouth on chewing, oral health-related quality of life and psychological well-being,             while controlling for dentate status, general health status, and certain demographic             categories. For the dependent variables, chewing, OHIP-14, GOHAI, Perceived Stress, and             morale, median splits in the scores were used to create binary variables. Additional             dependent variables, the two ordinal indicators of well-being, were dichotomised as             follows: life satisfaction, 1 = 'mostly dissatisfied, unhappy or terrible', 0 = other             categories; stress in past two years, 1 = 'moderately, very or extremely stressful', 0 =             'not at all or a little stressful'. For the independent variables, the categories coded             as 1 were: male, 75 years or older, not currently married, income satisfying needs 'not             very well or totally inadequate', general health 'fair, poor or very poor', and dental             status 'edentulous'. RESULTS Study participants Non-participation rates were high,             largely because of the number of individuals unable to give informed consent. Among             those eligible, the response rate was 71%. The 225 participants were predominantly             female (72%), not currently married (74%) and elderly (mean age 83 years). While ages             ranged from 52 to 100, 87% were aged 75 or over and 56% were 85 years or over. Close to             half (49%) lived in the Baycrest apartment building, 27% resided in the chronic care             sections of Baycrest or a similar facility, and 24% were community- dwelling. Of those             living in the Baycrest apartments or in the community, 71% lived alone. The majority of             participants (76%) reported that their income and assets currently satisfy their needs             either 'adequately' or 'very well', and 77% had dental care insurance. General health             Almost all participants (99%) reported one or more chronic medical conditions, and 93%             reported use of one or more prescribed medications (mean number 4.3). The mean number of             medical conditions was 4.5, and the most prevalent were arthritis (62%) and eye problems             such as glaucoma or cataracts (53%). A high proportion of the participants (88%) had             some degree of physical disability as measured by the ADL scale (mean score = 4.3).             Ratings of general health were 'excellent/very good' 17.5%, 'good' 32.7%, and             'fair/poor/very poor' 49.8%. Close to half (45%) reported that their general health had             'worsened' over the last year; only 6% reported that it had 'improved', and for 49%             there was no change. Psychological well-being The mean scores for the Perceived Stress             and morale scales were 50.4 (SD 12.44) and 16.09 (SD 2.42), respectively. Although half             of the participants (50.9%) reported 'not at all' or 'a little' on the single item for             stress, 31.1% were in the 'moderate' category and 17.9% in the 'very' or 'extremely             stressful' categories. When responses regarding 'life overall' were grouped according to             'satisfied', 'equally satisfied/dissatisfied' and 'dissatisfied', the respective             proportions were 67.6%, 21.7% and 10.6%. Oral health The majority of the participants             (69%) were dentate, and, of these, 71% wore a partial denture and 22% had one or more             fixed bridges. The mean number of missing teeth was 21.1 for the whole sample and 16.2             for the dentate group. Overall self- ratings of oral health were 'excellent/very good'             28.6%, 'good' 38.8% and 'fair/poor' 32.6%. The majority (80%) were either satisfied or             very satisfied with their oral health status. While 28% reported deterioration in oral             health over the previous two years, for a small number (9.8%) it had improved. According             to the chewing index scores (mean 1.37, SD 1.40), 60% were unable to chew or bite one or             more of the six foods in the measure. For the oral health-related quality of life             measures, the mean scores were 19.99 (SD 8.37) for the OHIP-14 and 22.45 (SD 8.58) for             the GOHAI. The measures differed in terms of the proportion of participants who reported             no impact; close to a third JRSH The Journal of The Royal Society for the Promotion of             Health March 2006 Vol 126 No 2 82 RESEARCH Dry mouth and health status indicators in the             elderly (30.4%) responded 'never' to every item on the OHIP-14, while only 8.4% did so             for the GOHAI.27 Xerostomia For the xerostomia scale, the mean was 1.83 (SD 1.88),             median 2.0, and the scores ranged from 0 to 7. When scores were categorised as low,             moderate, and high, the proportions were 49.3%, 30.3% and 20.4%, respectively. Bivariate             analyses using this group variable demonstrated significant relationships between dry             mouth and oral health status, oral health satisfaction, oral health change, missing             teeth, general health status and psychological stress (Table 2). No association was             found between dry mouth and sex, age, general health change or life satisfaction. When             the high xerostomia group was compared separately to the low group and odds ratios             calculated, the results show that the high group was 2.3 to 4.9 times more likely to             experience negative impact on health (Table 3). When the moderate xerostomia group was             compared to the low one, only missing teeth (OR 2.10, p = 0.019) and general health             status (OR 3.35, p<0.001) were significant. Further analyses showing significant             associations between the xerostomia groups and several health scales are presented in             Table 4. Statistically significant differences were found for all health status             indicators, suggesting that subjects in the highest xerostomia category suffer more             impacts than those in the lowest category. Spearman rank correlation coefficients using             the xerostomia index score showed that relationships with the seven health measures,             while significant (p<0.01), were relatively weak in strength. Correlations ranged             from 0.31 to 0.33 for Perceived Stress, GOHAI, number of medications, and number of             medical conditions; they were 0.27 for OHIP-14 and morale and 0.20 for chewing. As             expected, the direction of the correlation with morale was negative. Chewing, the two             oral health-related quality of life measures (GOHAI, OHIP- 14) and four indicators of             psychological well-being (Perceived Stress, morale, life stress item and life             satisfaction item) were used as dependent variables in logistic regression analyses.             These analyses explored the independent effect of xerostomia, while controlling for age,             sex, marital status, income adequacy, and general health status; dentate status was also             included as a covariate variable when the dependent variable was one of the three oral             health measures. When other independent variables were included, xerostomia did not have             a significant impact on chewing capacity, morale, or stress (as measured by the single             item). In contrast, the regression results in Table 5 show that xerostomia contributed             to the variability of the two oral health- related quality of life measures. For the             OHIP-14, it was the only variable with a significant effect (OR 2.55). For the GOHAI,             although general health status was an additional predictor (OR 2.02), the odds ratio for             dry mouth was higher, 2.72. When controlling for other variables, xerostomia had a             significant impact on only one indicator of psychological well-being, the Perceived             Stress scale (Table 6). In this regression, general health status (OR 2.76) and income             (OR 2.79) were also significant, but their odds ratios were lower than that of             xerostomia, 3.01. The relationship between dry mouth and self-rated general health was             explored further by examining relationships with specific medical conditions. Using the             MannWhitney U-test with the xerostomia index score as the dependent variable, eight of             the 17 conditions showed significant Percentage of xerostomia group reporting health             impact Xerostomia Health impact Low Moderate High Significance* Oral health: fair to             poor 24.5 33.8 50.0 0.070 Oral health: dissatisfied 11.4 21.2 38.6 0.001 Oral health:             worsened 23.4 23.5 43.5 0.025 Missing teeth >21 40.7 59.1 65.2 0.007 General             health 'fair' to 'very poor' 36.4 65.7 58.7 <0.001 Stress in the past two years             'moderate' to 'extreme' 12.4 21.9 25.6 0.017 *Chi-square test Table 2 Relationship of             the degree of xerostomia to other health impacts Health impact OR High vs low xerostomia             Significance Oral health: fair to poor 3.11 0.002 Oral health: dissatisfied 4.88             <0.001 Oral health: worsened 2.52 0.012 Missing teeth >21 2.73 0.005             General health 'fair' to 'very poor' 2.49 0.010 Life stress 'moderate' to 'extreme' 2.25             0.028 Table 3 March 2006 Vol 126 No 2 The Journal of The Royal Society for the Promotion             of Health JRSH Dry mouth and health status indicators in the elderly RESEARCH 83             relationships, with p values ranging from <0.001 to 0.049. These conditions, in             order of significance, included: breathing problems, eye problems such as glaucoma or             cataracts, neurological, stomach/digestive, emotional problems such as depression,             bladder/kidney, arthritis, and thyroid. DISCUSSION The xerostomia index used was part of             an overall questionnaire, which took approximately 3045 minutes to administer. This             necessitated the xerostomia part of the questionnaire to be short and concise. The             seven-question scale provided a severity measure of the effects of xerostomia in the             patients surveyed, over the previous four-week period, and took into account the             activities of daily living potentially affected by dry mouth and actions which could be             taken by the patient to ameliorate the symptoms. The questions within this xerostomia             scale are similar to those used in other studies, for example, the Xerostomia             Inventory20 and that developed by Fox et al.10 The main difference is that in this study             a simple 'yes' or 'no' response is recorded, as in the Fox study,10 rather than using a             Likert scale to measure the frequency with which the patient may have felt symptoms or             acted upon them. These types of scales have been used to measure a change in subjective             dry mouth over time and, therefore, required to be more detailed Association between             xerostomia groups and several health scales Low Moderate High Significance* Chewing 1.08             1.53 1.83 0.003 GOHAI 20.05 23.24 27.07 <0.001 OHIP-14 18.21 20.69 23.31             <0.001 Perceived Stress 47.57 50.36 57.09 <0.001 Morale 16.59 15.70 15.44             0.011 Medical conditions 3.86 5.00 5.39 <0.001 Prescribed medications 3.48 4.82             5.84 <0.001 *KruskalWallis test for mean ranks Table 4 Logistic regression             analysis: predictors of oral health-related quality of life Dependent variable: OHIP-14             0 = 1416; 1 = 1759 Independent variables: SE p OR Xerostomia score 0 = 03; 1 = 47             0.936 0.376 0.013 2.55 General health 0 = other; 1 = 'fair'/'poor'/'very poor' 0.321             0.286 ns 1.38 Dentate status 0 = dentate; 1 = edentulous 0.092 0.320 ns 0.91 Age 0 =             <75; 1 = 75 or more 0.105 0.422 ns 1.11 Sex 0 = female; 1 = male 0.180 0.330 ns             1.20 Marital status 0 = married; 1 = not married 0.039 0.341 ns 1.04 Income 0 =             adequate; 1 = inadequate 0.468 0.346 ns 1.60 Dependent variable: GOHAI 0 = 1219; 1 =             2051 Independent variables: SE p OR Xerostomia score 0 = 03; 1 = 47 1.001 0.387 0.010             2.72 General health 0 = other; 1 = 'fair'/'poor'/'very poor' 0.705 0.290 0.015 2.02             Dentate status 0 = dentate; 1 = edentulous 0.234 0.325 ns 0.79 Age 0 = <75; 1 =             75 or more 0.309 0.428 ns 1.36 Sex 0 = female; 1 = male 0.014 0.335 ns 1.01 Marital             status 0 = married; 1 = not married 0.111 0.346 ns 1.12 Income 0 = adequate; 1 =             inadequate 0.402 0.350 ns 1.49 ns = not significant Table 5 JRSH The Journal of The             Royal Society for the Promotion of Health March 2006 Vol 126 No 2 84 RESEARCH Dry mouth             and health status indicators in the elderly in their content and the responses elicited             from the patients. Salivary flow could have been measured, which may have been useful in             comparing the actual flow rates and the perceived degree of xerostomia. Flow rates have             been found to have poor correlation with xerostomia5 and a measure of the patients'             subjective assessment of the symptoms of xerostomia was the objective in this study.             This could then be compared with the subjective views of other areas of health. The             seven-item cumulative scale was collapsed into low, medium and high categories. When the             degree of xerostomia was compared to other perceptions of health, there were             statistically significant findings. Oral health related significantly through an odds             ratio of 4.88 for those subjects who considered that they were dissatisfied with their             oral health, and 3.07 for those subjects who considered their oral health to be fair or             poor, when comparing high versus low levels of xerostomia. Those with high perceived             xerostomia also showed a statistically significant difference and odds ratios over 2             when compared to those with a low level of xerostomia, for >21 missing teeth,             worsening oral health, poor general health and higher levels of life stress. This may be             partly explained by the relationship between depression and xerostomia28, 29 and that             those who have poorer health may be treated with higher numbers of drugs. Polypharmacy             has been related to xerostomia.30 This study's results also corroborates the findings of             Russell and Reisine,31 who concluded that those patients who had the most physical             disease symptoms were at a greater risk of having reduced salivary flow, and Screebny             and Valdini,14 who related xerostomia to those patients with serious systemic conditions             and diseases. The relationship with fewer teeth for those suffering from xerostomia was             also a statistically significant related finding in other studies when salivary flow             rate was a variable32 and xerostomia was self-reported.33 As higher levels of xerostomia             were perceived, higher group mean impact scores were recorded in the GOHAI, OHIP- 14,             Perceived Stress scales, chewing ability, medical conditions and prescribed medications             (Table 4). This would corroborate the findings of Loesche et al.34 who associated good             oral and good general health. The negative impact of dry mouth may be correlated to the             impact of Sjögrens syndrome, which has been found to significantly impair health and             well-being, using self-reported measures.35 The logistic regression analysis, using the             OHIP-14 and GOHAI, indicates the strength of association of xerostomia and perception of             general health as being the only two statistically significant variables in determining             oral health-related quality of life. This also holds true for predicting psychological             well-being of subjects, but includes income as an additional variable. CONCLUSIONS             Degrees of xerostomia can be effectively measured by utilising self-reporting methods in             the institutionalised elderly population. In addition, trends can be identified as the             self-reported severity of xerostomia increases. Moreover, the impact of xerostomia can             be measured through quality of life indices, such as the OHIP-14 and GOHAI. The key             finding in this study is that xerostomia has a significant and negative impact on the             quality of life of elderly individuals, although oral function may be less affected.             Logistic regression analysis: predictors of psychological well-being Dependent variable:             perceived stress score 0 = 2349; 1 = 5094 Independent variables: SE p OR Xerostomia             score 0 = 03; 1= 47 1.102 0.402 0.006 3.01 General health 0 = other; 1 =             'fair'/'poor'/'very poor' 1.016 0.307 0.001 2.76 Age 0 = <75; 1 = 75 or more             0.799 0.466 ns 0.45 Sex 0 = female; 1 = male 0.015 0.350 ns 0.99 Marital status 0 =             married; 1 = not married 0.076 0.360 ns 0.93 Income 0 = adequate; 1 = inadequate 1.027             0.385 0.008 2.79 ns = not significant Table 6 References 1 O'Grady NP. Incidence of dry             mouth complaint in Cork dental hospital patient population. Stoma (Lisb)             1990;2(17):556, 58 2 Osterberg T, Birkhed D, Johansson C, Svanborg A. Longitudinal             study of stimulated whole saliva in an elderly population. Scand J Dent Res             1992;100(6):3405 3 Thomson WM, Brown RH, Williams SM. 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<mods version="3.6"><titleInfo lang="en"><title>Associations between xerostomia and health status indicators in the elderly</title>
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<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Associations between xerostomia and health status indicators in the elderly</title>
</titleInfo>
<name type="personal"><namePart type="given">David W</namePart>
<namePart type="family">Matear</namePart>
<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
</name>
<name type="personal"><namePart type="given">D</namePart>
<namePart type="family">Locker</namePart>
<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
</name>
<name type="personal"><namePart type="given">M</namePart>
<namePart type="family">Stephens</namePart>
<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
</name>
<name type="personal"><namePart type="given">H P</namePart>
<namePart type="family">Lawrence</namePart>
<affiliation>Faculty of Dentistry, University of Toronto, Canada</affiliation>
</name>
<typeOfResource>text</typeOfResource>
<genre type="research-article" displayLabel="research-article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre>
<originInfo><publisher>Sage Publications</publisher>
<place><placeTerm type="text">Sage CA: Thousand Oaks, CA</placeTerm>
</place>
<dateIssued encoding="w3cdtf">2006-03</dateIssued>
<copyrightDate encoding="w3cdtf">2006</copyrightDate>
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<language><languageTerm type="code" authority="iso639-2b">eng</languageTerm>
<languageTerm type="code" authority="rfc3066">en</languageTerm>
</language>
<abstract lang="en">Aims: This study investigated the associations between xerostomia (dry mouth) (low, moderate and high) with other categorical variables (e.g. demographic and health status indicators). This paper aims to report on the severity of xerostomia in the elderly population and investigate the relationship with other aspects of perceived health. Method: Data were obtained from a cross-sectional survey of 225 elderly people from a large multilevel geriatric care centre. The centre consists of three levels of care: an apartment building in which residents live more or less independently, a home for the aged, and a chronic care hospital. Participants in the study were recruited when they attended the dental care facility. Data were collected by means of a personal interview conducted either at the dental care facility or the participant’s residence. Results: The mean age was 83 years. Most were females (72%) and almost all (99%) reported one or more chronic medical conditions; 88% had physical disabilities. Xerostomia was recorded on a seven-point scale. Scores were categorised as low, medium or high and the proportions were 49.3%, 30.3% and 20.4% respectively. Bivariate analysis showed no association between dry mouth and sex, age, general health change or life satisfaction. However, when the high xerostomia group was separated out and odds ratios calculated they were 2.3 to 4.9 times more likely to experience a negative impact on health than the low group. Xerostomia did not have a significant impact on chewing capacity, morale or stress, although it contributed to the variability of the oral health-related quality of life measures. It was the only variable with a significant effect (OR 2.55) for the Oral Health Impact Profile-14 and displayed a higher odds ratio (2.76) for the Geriatric Oral Health Assessment Index. Selfreported xerostomia in the elderly population can be categorised into a severity scale. Those suffering most from xerostomia are more likely to experience a negative impact on general health. Conclusion: The key finding in this study is that xerostomia has a significant and negative impact on the quality of life of elderly individuals, though oral function may be less affected.</abstract>
<subject><genre>keywords</genre>
<topic>Elderly population</topic>
<topic>xerostomia</topic>
</subject>
<relatedItem type="host"><titleInfo><title>Perspectives in public health</title>
</titleInfo>
<genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre>
<identifier type="ISSN">1466-4240</identifier>
<identifier type="eISSN">1757-9147</identifier>
<identifier type="PublisherID">RSH</identifier>
<identifier type="PublisherID-hwp">sprsh</identifier>
<part><date>2006</date>
<detail type="volume"><caption>vol.</caption>
<number>126</number>
</detail>
<detail type="issue"><caption>no.</caption>
<number>2</number>
</detail>
<extent unit="pages"><start>79</start>
<end>85</end>
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<identifier type="DOI">10.1177/1466424006063183</identifier>
<identifier type="ArticleID">10.1177_1466424006063183</identifier>
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Associations between xerostomia and health status indicators in the elderly

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