|Year : 2020 | Volume
| Issue : 2 | Page : 168-172
Oral health status and self-perceived oral health satisfaction among residents in the largest care home in east coast Malaysia and its associated factors: A cross-sectional study
Farah N Mohd1, Abdul H Said2, Muhammad Z Yusof3, Nor I Ismail4, Nor M Musa4
1 Special Care Dentistry Unit, Kulliyyah of Dentistry, Kuantan, Malaysia
2 Department of Family Medicine, Kulliyyah of Medicine, Kuantan, Malaysia
3 Department of Community Medicine, Kuliyyah of Medicine, Kuantan, Malaysia
4 Kulliyyah of Dentistry, International Islamic University Malaysia (IIUM), Kuantan, Malaysia
|Date of Submission||23-Sep-2019|
|Date of Acceptance||12-Nov-2019|
|Date of Web Publication||28-Mar-2020|
Dr. Abdul H Said
Department of Family Medicine, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan.
Source of Support: None, Conflict of Interest: None
Aim: To Assess the oral health status among residents living in care home and to determine its association with their self-perceived oral health satisfaction. Materials and Methods: A cross-sectional study was conducted from July to August 2018 among 75 residents of Rumah Ehsan, Terengganu (the largest care home in east coast Malaysia). The oral health status of the residents was examined by one dental specialist based on two domains: the number of decayed, missing, and filled teeth (DMF-T) and the edentulous state. Their sociodemographic profile and self-perceived oral health status were collected through interviews. Multiple logistic regressions were used to determine factors associated with oral health satisfaction. Results: Unsurprisingly, majority of residents had high DMF-T score with median DMF-T score of 29.0 (interquartile range [IQR] = 12). On the contrary, majority of them (64%) perceived that they had good oral health status and 68% were satisfied with their current oral health status. There was no significant association between the actual oral health status and their perceived satisfaction. However, older age, Malay, and those eating dependently were less likely satisfied with their oral health status. Meanwhile, those who were dependent to the staff to brush their teeth were more likely satisfied with their oral health status. Conclusion: There was a discrepancy between actual and self-perceived oral health status among residents in care home. Hence, every effort is necessary to improve the awareness and knowledge among them in order to improve the oral health.
Keywords: Care Home Residents, Oral Health Status, Self-perceived Satisfaction
|How to cite this article:|
Mohd FN, Said AH, Yusof MZ, Ismail NI, Musa NM. Oral health status and self-perceived oral health satisfaction among residents in the largest care home in east coast Malaysia and its associated factors: A cross-sectional study. J Int Oral Health 2020;12:168-72
|How to cite this URL:|
Mohd FN, Said AH, Yusof MZ, Ismail NI, Musa NM. Oral health status and self-perceived oral health satisfaction among residents in the largest care home in east coast Malaysia and its associated factors: A cross-sectional study. J Int Oral Health [serial online] 2020 [cited 2020 May 28];12:168-72. Available from: http://www.jioh.org/text.asp?2020/12/2/168/281492
| Introduction|| |
Most studies reported that the oral health status among people living in care homes was poor.,,, In Malaysia, a study in a care home in Kelantan state reported that most of the residents had poor oral hygiene (69.6%) and majority of them were edentulous. This finding was supported by another local study conducted in Kedah state. A local study also reported that the number of decayed, missing, and filled teeth (DMF-T) among care home residents was high. It was also found that there were increased treatment needs for caries and periodontal diseases with increasing age especially at the age where people may end up living in residents care home., Meanwhile, another study found that people in care homes had higher unmet dental need, fewer teeth, and poorly fitting dentures. In addition, a few studies found that the risk factors for the poor oral health were increasing age and limited access to dental care., Other factor found was inability to perform daily oral self-care because of physical disability or nonambulatory.,
Although many studies have shown that the oral health status among residents in care homes was poor, little was known about their self-perceived oral health status and satisfaction. This is in particularly important as their self-perceived oral health status may determine their oral health care seeking behavior. Misperception of self-oral health may lead to poor oral care, which subsequently may cause reduced oral health-related quality of life. Hence, it is crucial to know their self-perceived oral health status and satisfaction in order to inculcate healthy behaviors accordingly. Furthermore, it was found that elderly population is a group that seek less dental service as they have lack of perception on their dental needs as compared to medical needs. The reasons for this to happen were because of their social background, cultural beliefs as well as economy status. People living in residential care homes would normally be the underprivileged population because of their physical disability, economy constraint, and lack of family support. Therefore, it is crucial to promote good oral health among this population in order to ensure a better quality of life.
Nonetheless, there were very few local studies carried out to assess the oral health and self-perceived oral health satisfaction of residents in care homes concurrently. Therefore, our research aimed to assess these areas and to assess the association between their oral health and self-perceived oral health satisfaction among residents in the largest care home in the East coast of Peninsular Malaysia.
| Materials and Methods|| |
Population and settings
A cross-sectional study was conducted among 75 residents from the largest care home in east coast Malaysia located in Terengganu state. It is called as “Rumah Ehsan.” The residents of this care home included those with chronic medical illnesses, physical disability, without family members, and those from low-socioeconomic background from all states across the country. Universal sampling was used in this study. The inclusion criteria of the study were all registered residents of “Rumah Ehsan Dungun” during the period of study (July–August 2018). The exclusion criteria of the study were those who were unable to give consent such as residents with cognitive impairment and residents who were hospitalized during the period of the study. Of 85 residents available, 10 were excluded from this study because five of them were unable to give consent and five were hospitalized. The final sample size was 75 residents. The selected residents were then underwent structured interviews and intraoral examination.
Ethical approval for this study was obtained from the Research Ethics Committee (IREC) of International Islamic University of Malaysia (IIUM) (Protocol no. IREC 2018–048) on January 31, 2018. Permission from Department of Welfare Malaysia was also granted prior to commencement of this study.
Data collection and research instrument
A brief explanation was given to all residents involved. Written consent was obtained. This was followed by intraoral examination carried out only by one examiner (dental specialist) throughout the study period to avoid interexaminers variability. All the residents were examined on their own bed in supine position as some of them were bedbound with the used of portable dental light, mouth mirrors, and dental periodontal probe. Number of DMF-T and dentate status were used as the indicators. After the intraoral examination, the residents were then interviewed individually for information on their sociodemographic data including age, race, and dependency in performing activity of daily living. Three questions were asked to assess their self-perception of the oral health status. The questions asked were their perceived self-oral health status, self-dental treatment needs, and self-oral health satisfaction.
All statistical analysis was carried out using the Statistical Package for the Social Sciences software for Windows, version 24.0 (IBM, Armonk, NY). The sociodemographic characteristics were reported as descriptive statistics using frequencies and percentages. Test of normality was performed for continuous data. The not normally distributed data were reported using median and interquartile range (IQR). Association between not normally distributed data and categorical data was analyzed using the independent Mann–Whitney U test. Association between two categorical data was analyzed using the chi-squared test. Multiple logistic regressions were carried out to determine the independent factors associated with oral health satisfaction of residents. Statistical significance was set at P < 0.05.
| Results|| |
[Table 1] shows that the median DMF-T score of the residents was 29 (12) and the highest score was “missing” with median score of 22 (23) teeth missed. Majority of them (72.0%) had partial dentition and only one (1.3%) resident still has full dentitions. [Table 2] shows that age is the only significant factor associated with DMF-T score among residents.,
|Table 2: Association between oral health status (total DMF-T score) and demographic profile|
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[Table 3] shows that majority of residents (64%) perceived that their oral health status were either good or very good. Slightly more than half of them (52%) perceived that they did not need dental treatment and 68% were satisfied with their current oral health status.
[Table 4] shows no significant association between oral health status and self-perceived oral health satisfaction
|Table 4: Association between actual oral health status and self-perceived oral health satisfaction|
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[Table 5] shows the results of the multivariate logistic regression analysis. Increased in age (adjusted odds ratio [AOR]: 0.91, 95% CI: 0.85–0.97, P = 0.005), Malay residents (AOR: 0.08, 95% CI: 0.006–0.99, P = 0.049), and residents who were eating dependently were less likely satisfied with their oral health status. Meanwhile, those who were dependent to the staff to brush their teeth were more likely satisfied with their oral health status (AOR: 6.72, 95% CI: 1.22–36.85, P = 0.028).
|Table 5: Multiple logistic regression to determine independent associated factors for self-perceived oral health satisfaction among residents|
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| Discussion|| |
The median number of DMF-T score especially missing teeth in our study [Table 1] was high and comparable with several previous studies carried out both locally and abroad.,, The DMF-T score found in our study was also high as compared to Malaysian elderly population aged 65 and older with the mean DMF-T score of 23.3 (3.4). A study conducted in German suggested that high DMF-T score among residents in care home may be due to lack of involvement from the nurses and medical team to help in oral health care routine. They also found that the organization of the care home itself was unable to provide adequate services to maintain optimum oral health condition of the residents. However, further research is necessary to confirm this and to find other possible factors contributing to high DMF-T score of residents of care homes especially in the local setting.
Our study found that only age had significant association with the oral health status of the residents in this care home [Table 2]. Age-related diseases may directly or indirectly impede oral hygiene practices and oral health what more for those living dependently in care homes. Furthermore, elderly who live in care homes might heavily medicated because of chronic diseases such as hypertension and diabetes, which then may cause dry mouth or xerostomia. For those who have debilitating diseases such as stroke, Parkinson’s, and dementia, the capability of oral self-care may be jeopardized and may therefore affect their oral health status. It was also found that carers faced many obstacles in performing routine oral hygiene care to the elderly who cognitively impaired (including persons with Parkinson and dementia) due to difficulty in communication, giving consent, and behavioral problems. Dependencies to care givers in providing oral hygiene may also affect the oral health status of the residents. However, our study showed no significant association between their oral health status and their dependency on brushing teeth. This may suggest that the oral health care given by the care giver in this care home was likely to be adequate.
Interestingly, our study found that majority of the residents perceived that they have either good or very good oral health status and were satisfied with their current oral health status [Table 3]. On top of that, more than half of them perceived they did not need dental treatments. This means that although their actual oral health status were considered poor with high score of DMF-T and missing teeth, it did not affect their self-perceived oral health status in which majority were satisfied with their current oral health (68%) [Table 3]. These findings were in agreement with studies carried out among 53 elderly in a care home in Lima, Peru, and in Southern Nevada in which the former reported 54.7% were either neutral or satisfied with their oral health and 91% of the latter study reported their oral hygiene was fair., These consistent findings in terms of their satisfaction on self-oral health status could be viewed from good and bad perspective for us as dental practitioners. The high satisfaction of the residents could be contributed to the fact that they were comfortable with their current overall health and life condition especially living in care home and would rather not complaint much about anything. In addition, it could also mean that the care provided by the staff of the care home was good and meeting the expectations of the residents. However, from another perspective, this high satisfaction especially when it did not tally with their actual oral health status could bring further damage to their oral health. Wrong perceptions on self-oral health status and low perceived dental needs may lead to inadequate oral care and subsequently may cause further worsening of oral health. From our findings, it showed that there was no significant association between the DMF-T score with their self-perceived oral health satisfaction [Table 4]. Again, this finding means that majority of the residents in our study were satisfied with their oral health status regardless of how good or bad it is in reality.
Although majority of the residents in our study were satisfied with their oral health status, our study also found that there were a few factors that can affect their satisfaction [Table 5]. Our study found that with increasing age, they were less likely satisfied with their oral health. This finding is in accordance with the findings from a study carried out among 810 community-dwelling older adults aged 65 and older in the Piedmont region of North Carolina in which the end-of-life group rated their overall oral health as bad. Among possible reason for this consistent was the fact that aging processes affect the periodontal tissue and result in tooth loss and thus affect the quality of life of elderly population. It was also found that those who were dependent to the care givers on eating were less likely satisfied with their oral health. This can be because of functional dependency in activities of daily living (ADL) including eating or drinking, brushing teeth, and going to the toilet have implications to oral health. However, it was interesting finding that those who were dependent on care givers to brush their teeth were more likely satisfied with their oral health. This could be either oral health care provided by the staff in the care home were sufficient or the residents have low perceived dental needs due to lack of oral health awareness as they were dependent to the carers for their ADL. Hence, it is very important for dental practitioners to continue emphasizing and educating both staff and residents about good oral care to ensure a satisfying oral health related quality of life. Residents who were independent should be empowered to do their self-oral care properly and adequately.
Strength and limitation
The strength of this study is that it captures the data on oral health status and self-perceived oral health status simultaneously. There is no similar local study carried out addressing these two issues together up to this date. This study also involved the largest care home in the east coast of Peninsular Malaysia comprising the residents from all states in Malaysia; hence, it improved the generalizability of this study. On the contrary, the weakness of this study is it that involved only one care home and hence may not be able to represent other care homes in Malaysia.
As expected, the oral health status of residents was poor with high DMF-T score, similar with previous findings. However, interestingly, majority of the residents were satisfied with their oral health status with no significant association seen between their satisfaction and the actual oral health status measured by DMF-T score. Those with increasing age, Malay residents, and residents who were eating dependently were less likely satisfied with their oral health. More interestingly, those who were dependent to staff to brush their teeth were more likely satisfied with their oral health status. Every effort is necessary to improve the oral health status of residents in care homes. Adequate and continuous education to both residents and staff of care homes is undoubtedly crucial.
Ethical policy and institutional review board statement
Ethical approval for this study was obtained from the Research Ethics Committee (IREC) of International Islamic University of Malaysia (IIUM) (Protocol no. IREC 2018–048) on January 31, 2018.
We would like to thank all staff in Rumah Ehsan Dungun, Terengganu for their warm hospitality during the data collection procedures especially Sister Zuraini bt Kating. Our gratitude also goes to Department of Welfare Malaysia for giving us permission to conduct this study in one of their facilities.
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], [Table 5]