Periodontal Status and Oral Health-Related Quality of Life among Elderly attending Kantipur Dental College, Kathmandu, Nepal

Background: In elderly, poor oral health in the form of tooth loss, dental caries, periodontal disease and oral cancer affects physical and psychological aspect of life. Health is not only absence of disease but also psychological and social well-being. Thus, the assessment of disease by clinical examination as well as measurement of psychosocial impacts associated with disease are equally important. Aim: To find the association between periodontal status and oral health-related quality of life among elderly attending Kantipur Dental College. Materials and Methods: A cross-sectional study was carried out among 184 elderly patients attending Kantipur Dental College by convenient sampling method. Oral health-related quality of life was assessed by GOHAI. Periodontal status was assessed by using CPI modified and Loss of attachment. Data was analysed with SPSS version 20. Results: Among 184 total participants (74 men, 110 women), the mean GOHAI score was 46.59+8.70. Of the total, 13% had high GOHAI score whereas 27% had moderate and 60% had low GOHAI score. Periodontal status of elderly population was found to be significantly associated with oral health-related quality of life (p<0.05). Conclusion: The findings of this study suggest a need to improve oral health care and knowledge for elderly group through preventive and curative public health measures.


INTRODUCTION
Nepal Senior Citizens Act 2006 defines elderly as the individuals over the age of 60 years. 1 Globally, there has been an increase in life expectancy due to declining mortality, advances in medicine and public health interventions. 2 The elderly population percentage in Nepal has increased from 6.5% (1.5 million) in 2001 to 8.13% (2.1million) in 2011. 3,4 Poor oral health among older people is manifested as tooth loss, dental caries, periodontal diseases and oral cancer. 5  aspect of life as well as their appearance, speech, chewing ability, taste of food and socialisation. 6 The traditional methods of oral health assessment are limited to recording of the clinical and oral indices and determining presence or absence of disease. But this does not make subjective measurements i.e. self-perception of oral health. 7 Current concept of health suggests health as not only absence of disease but also physical, psychological and social well-being. 8 Though there are many instruments to measure Oral Health-Related Quality of Life (OHRQoL), the most preferred are Oral Health Impact Profile (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI) as they are short and do not pose significant burden to the respondents. However, GOHAI is the more sensitive measure of the two. 9 According to the highest CPI-Pocket score (Figure 2), 117 (63.6%) participants had a score of 0 (absence of condition), 28 (15.2%) participants had a score of 1 (pocket 4-5 mm), 3 (1.6%) participants had a score of 2 (pocket 6 mm or more), 4 (2.2%) participants were excluded and 32 (17.4%) participants had score X (tooth not present).
The mean GOHAI scores showed a decrease with an increase in LOA scores and this difference was found to be statistically significant ( Table 2). In the present study, participants with no formal education showed lower mean GOHAI scores indicating poorer OHRQoL as compared to participants with any form of formal education and this difference was found to be statistically significant. This is in accordance with studies carried out by Atchison and Dolan, 11 Rekhi A et al., 12  Age category was not significantly associated with GOHAI scores. This is in accordance to studies done by Alcarde et al., 14 and Ibeke et al. 17 which did not find any significant association between age category and GOHAI scores. In contrast, the studies done by Raja et al., 15 and Rekhi et al. 12 showed that there was a decline in mean GOHAI scores with increasing age. Non-association of age category with GOHAI scores seen in this study could be because of non-uniform distribution of study participants in various age groups.
There was no significant association between gender and GOHAI scores. This is in agreement with a study done by Ibeke et al. 17 which showed that gender did not have a significant relation with GOHAI. In contrast, the studies done by Rekhi et al., 12 and Atieh 16 found that women showed lower mean GOHAI scores as compared with men. This could be because the majority of participants in this study were female.
Relationship between GOHAI scores and CPI scores showed that with an increase in CPI score, a significant decrease in mean GOHAI score was observed. Contradictory results were seen in a study carried out by Wong et al. 18 who found no significant association between the two variables.
There was a significant association between GOHAI scores