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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 1  |  Page : 8-12

Institutionalized elderly people oral health status and treatment needs assessment in kathmandu district


Department of Community and Public Health Dentistry, Kantipur Dental College, Kathmandu, Nepal

Date of Web Publication11-Jun-2018

Correspondence Address:
Dr. Sunita Khanal
Kantipur Dental College, Basundhara, Kathmandu
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdas.jdas_5_17

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  Abstract 


Context: In Nepal, Senior citizens are the people who are 60 years and above as defined by the senior citizen act 2063. According to the 2011 census of Nepal, there were 2.1 million elderly inhabitants which constituted 8.1% of total population of Nepal. Aim: To assess the oral health status and treatment needs of institutionalized elderly people. Objectives: To assess the periodontal status, prosthetic status, and prosthetic needs and to compare community periodontal index and the loss of attachment (LOA) with age and gender. Setting and Design: A cross-sectional study was conducted in six different old age homes of Kathmandu district. Materials and Methods: The study was conducted among 200 elderly living in six old age homes of Kathmandu district after obtaining consent from the concerned authorities. The clinical findings were recorded using the World Health Organization Oral Health Assessment Form 1997. SPSS version 20 software was used for data analysis and P ≤ 0.05 was considered statistically significant. Results: Among 200 elderly examined, 69 (34.5%) were male and 131 (65.5%) were female. During probing, calculus was detected among 37.5% of people. The highest prevalence of LOA 4–5 mm was found among 40.5% of people. The prosthetic need was 83%, of which 20% required complete denture, 63% required partial denture. On applying Chi-square test, LOA score was found to be statistically significant between male and female (P = 0.015). Conclusion: The oral health status of the institutionalized elderly was found to be poor.

Keywords: Loss of attachment, old age home, prosthetic status and need, senior citizens


How to cite this article:
Khanal S, Bhattarai R, Rao G N, Shrestha S. Institutionalized elderly people oral health status and treatment needs assessment in kathmandu district. J Dent Allied Sci 2018;7:8-12

How to cite this URL:
Khanal S, Bhattarai R, Rao G N, Shrestha S. Institutionalized elderly people oral health status and treatment needs assessment in kathmandu district. J Dent Allied Sci [serial online] 2018 [cited 2018 Jun 21];7:8-12. Available from: http://www.jdas.in/text.asp?2018/7/1/8/234191




  Introduction Top


The multidimensional process of physical, psychological, and social change is called as aging.[1]

In Nepal, senior citizens are the people who are 60 years or above.[2] Approximately, 600 million people are aged 60 years and over worldwide and this will double by the year 2025. By 2050, it will be 2 billion and in developing countries 80% of people are living.[3],[4] In Nepal, there has been a sharp increase in the number of elderly persons between 2001, that is, 1,504,311 (2.5%) to 2,154,410 (8.1%) in 2011. The continuous growth of elderly population is evident around the world which is attributed to the larger life expectancy today.[2],[5],[6] The life span of an individual is increased with the discoveries in the field of medical science and the improvement of social conditions.[7] Aging is both medical and psychological problem indicating the greater demand for the health services of a community.[8] In older populations, several oral conditions such as tooth loss, denture wearing, dental caries experience, periodontal disease, xerostomia, and cancer are highly prevalent.[9] Elderly who are financially deprived, mentally and physically disabled are abandoned by the society and are left alone with no one to live with and care for them. Therefore, they have to look for an alternative home for security, companionship, care, and a life of dignity. In such situations, old age homes are an alternative.[10] A growing number of the elderly receiving institutional care has increased although a majority of the aged live independently in the community.[11] As very less studies have been conducted regarding the oral health status of elderly people residing in various old age homes in Nepal, this study was conducted to assess the oral health status and treatment needs of elderly people living in various old age homes of Kathmandu district.


  Materials and Methods Top


A cross-sectional study was conducted among 200 elderly living in six different old age homes of Kathmandu district during the 4 months' period, from July to October 2016. Ethical clearance was taken from the institutional review committee of Kantipur dental college teaching hospital and research center. Informed consent was taken from each patient before participating them in the study. Purposive sampling technique was used for data collection. Based on the list of old age homes obtained from the internet, almost all the old age homes of Kathmandu district were visited. The sample size was calculated using the prevalence of community periodontal index (CPI) for >50 years.[12] The sample size was calculated to be 176. Oral examination was performed by the researcher alone, but for data entry one trained assistant was used. The data collection was done using the World Health Organization Oral health assessment form 1997.[13] ADA type 3 examination was done. The CPI, Loss of Attachment (LOA), prosthetic status, and prosthetic need were recorded. Instruments used were Mouth mirror, explorer, and CPITN probe. Data regarding general information, oral hygiene practices were obtained through interview and recorded in the proforma.

Inclusion criteria

Those individuals who were residing in six old age homes of Kathmandu district with ≥60 years and who gave consent to participate in the study were included in the study.

Exclusion criteria

Those individuals who were severely ill and did not give consent to participate in the study were not included in the study.

Statistical analysis

SPSS 20 version software was used for data analysis. Chi-square test was used and P ≤ 0.05 was considered statistically significant.


  Results Top


Out of total 200 elderly examined, 34.5% were male and 65.5% were female. In 60–69 years there were 27.5% elderly, in 70–79 years 31% were there and in ≥80 years 41.5% elderly were there [Table 1]. Of total elderly examined, 50.5% used toothbrush and toothpaste to clean their teeth. [Figure 1] and 49% of the elderly used to rinse their mouth more than twice [Figure 2]. Majority of them were smokers [Figure 3]. Maximum elderly were hypertensive [Figure 4]. While comparing gender and CPI score, they were statistically insignificant [Table 2]. However, Gender and LOA were statistically significant [Table 3]. The comparison of age with CPI and LOA was statistically insignificant [Table 4] and [Table 5]. Out of total 200 elderlies, 194 required some sort of oral treatment [Figure 5]. The prosthetic status and prosthetic need are shown in [Table 6] and [Table 7].
Table 1: Age- and sex-wise distribution of elderly

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Figure 1: Oral hygiene practices in the elderly

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Figure 2: Oral rinsing habits in the elderly

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Figure 3: Various harmful habits in the elderly

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Figure 4: Status of medical problems in elderly

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Table 2: Sex-wise community periodontal index score in the elderly

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Table 3: Sex-wise loss of attachment score in the elderly

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Table 4: Age-wise community periodontal index score in the elderly

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Table 5: Age-wise loss of attachment score in the elderly

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Figure 5: Various treatment requirements in the elderly

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Table 6: Upper and lower arch prosthetic status of elderly

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Table 7: Upper and lower arch prosthetic need of elderly

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  Discussion Top


Three ages namely chronicle, biological and mental play their roles in shaping the personality of a person once a person is born. The chronological age of a person is the time duration from birth. The advancement in this age is accompanied by a steady growth in other ages. The growth of biological age results in the development in the physique of the person and mental age grows with gradual advancement in intelligence levels of the person.[14] An important public health issue that is the growing burden to countries worldwide is poor oral health among old aged people.[3] Furthermore, the residents of the old age homes rely on caregivers for their daily oral hygiene maintenance so, they have poor oral health.[15] In this study, 50.5% used toothbrush and toothpaste to clean their teeth and 49% used to rinse their mouth with water which is similar to other study.[15] Maximum people had the habit of cigarette smoking followed by tobacco chewing and alcoholism. Similar findings were reported by other study.[15] Surprisingly, no oral mucosal lesions were found in them. Shaheen et al.[15] in their study found that (64.0%) of the study participants had oral mucosal lesions. The most common being oral ulceration (46.2%) followed by candidiasis (26.4%) and abscess (20.7%). Only few subjects reported malignant tumor (0.5%), leukoplakia (4.2%), and other conditions (1.1%) in their oral cavity. Similarly, Mary et al.[16] in their study found the prevalence of oral mucosal lesions as 7.1%. ulcerations in commissures was found in 0.6%, 1.9% had ulcerations in vermillion border and 0.6% had enlarged lymph nodes in head and neck region. Majority of the elderly were found to be hypertensive which is similar to other studies.[15],[17] Calculus was detected in majority, that is, 81 elderly people. Pocket 4–5 mm were detected in 57 of them. These findings were similar to other studies.[10],[18],[19] LOA 4–5 mm was seen in majority, that is, 75 of the examined people. These findings are similar to the study conducted by Agrawal et al.[10] but contradictory to the study conducted by Shaheen et al.[15] Out of total elderly examined, 97% required some sort of oral treatment. Among them, 83% required some sort of prosthesis. Of which 20% required complete denture and 63% required partial denture whereas 17% did not require any prosthesis and 9.5% already had prosthesis. These findings are similar to the studies conducted by Kumar et al.[7] and Bertolini et al.[20] The LOA score between male and female was found to be statistically significant which is in contrast to the study conducted by Shaheen et al.[15] LOA and age was found to be statistically insignificant which is similar to the study conducted by Mary et al.[16] but in contrast to the study conducted by Agrawal et al.[10]


  Conclusion Top


The elderly people residing in old age homes of Kathmandu district had poor oral health and the unfilled treatment need was high. Almost all the elderly (97%) required some sort of oral treatment. The prosthetic need was higher among all the other treatment needs. Government, nongovernment agencies and private institutions can play a major role to improve the overall quality of life and well-being of the old people by conducting various health care programs for them. This study can provide the baseline data regarding the oral health status of institutionalized elderly people of Kathmandu district. To generalize the findings in Nepal, further study should be done on a large scale.

Limitations

Study was carried out on small number of population and purposive sampling technique was used so, generalizability cannot be done.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Agrawal R, Gautam NR, Kumar PM, Kadhiresan R, Saxena V, Jain S. Assessment of dental caries and periodontal disease status among elderly residing in old age homes of Madhya Pradesh. J Int Oral Health 2015;7:57-64.  Back to cited text no. 10
    
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World Health Organization. Oral Health Surveys: Basic Methods. WHO Library Cataloguing in Publication Data. World Health Organization; 1997.  Back to cited text no. 13
    
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Central Bureau of Statistics. Population Monograph of Nepal; Government of Nepal; 2014.  Back to cited text no. 14
    
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Shaheen SS, Kulkarni S, Doshi D, Reddy S, Reddy P. Oral health status and treatment need among institutionalized elderly in India. Indian J Dent Res 2015;26:493-9.  Back to cited text no. 15
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Mary AV, Ebenezar AV, Chaly PE, Ingle N, Reddy VC. Oral health status and treatment needs of geriatric population of old age homes of Chennai city, India. J Oral Health Res 2010;1:82-6.  Back to cited text no. 16
    
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Subedi L, Sah RB. study of the health status of geriatric age group in Chitwan district of Nepal. J chitwan Med Coll 2015;5:11-7.  Back to cited text no. 17
    
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Syed A, Abdul B, Mirza Q, Izhar F, Khan AA. Oral health status of the elderly in Lahore district of Pakistan. Pak Oral Dent J 2012;32:271-4.  Back to cited text no. 18
    
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Al-Shehri SA. Oral health status of older people in residential homes in Saudi Arabia. Open J Stomatol 2012;2:307-13.  Back to cited text no. 19
    
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Bertolini M, Luiz F, Montenegro B, Arcas SP, Hiratsuka M, Leonardo R, et al. Oral health status, hygiene habits and treatment needs among elderly Brazilians: A cross-sectional study. World J Dent 2012;3:22-5.  Back to cited text no. 20
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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