Self-perceived oral health in older adults treated at a center specialized in geriatrics: prevalence and associated factorsAbstract
Objective To evaluate self-perception of oral health (SOH) and associated factors among elderly people treated at a center specialized in geriatrics in the north of Minas Gerais, Brazil
Methods This is an observational, cross-sectional, and analytical study.
Results A total of 277 elderly individuals participated in the study, the majority of whom were between 60 and 73 years old (52.7%), were female (78.0%) and literate (85.6%). The prevalence of negative ASB was 37.5% and the factors associated with worse ASB were: older age (PR: 1.73; 95% CI: 1.05-2.88; p=0.033), lower level of oral health literacy (PR: 1.71; 95% CI: 1.00-2.92; p=0.050), worse perception of general health status (PR: 1.26; 95% CI: 1.12-1.41; p<0.001) and presence of sarcopenia (PR: 2.19; 95% CI: 1.09-4.39; p=0.027).
Conclusion The need for well-established integrated care coordination and preparation to meet the particular oral health demands of the elderly population is highlighted.
Keywords
Oral Health; Geriatric dentistry; Self-perception; Elderly Health; Public health
Resumo
Objetivo Avaliar a autopercepção de saúde bucal (ASB) e os fatores associados entre pessoas idosas atendidas em um centro especializado em geriatria no norte do estado de Minas Gerais, Brasil.
Métodos Trata-se de um estudo observacional, transversal e analítico. Empregou-se o Oral Health Impact Profile (OHIP-14) para avaliar a autopercepção de ASB. As variáveis independentes referiram-se aos fatores sociodemográficos, subjetivos, práticas de autocuidado bucal e aspectos relacionados à condição clínica. Desenvolveram-se análises de regressões de Poisson simples e múltipla, para investigar associação entre a ASB e as potenciais variáveis preditoras.
Resultados Participaram do estudo 277 pessoas idosas, destas a maioria apresentava idade entre 60 e 73 anos (52,7%), eram do sexo feminino (78,0%) e alfabetizados (85,6%). A prevalência de ASB negativa foi de 37,5% e os fatores associados à pior ASB foram: maior idade (RP: 1,73; IC95%: 1,05-2,88; p=0,033), menor nível de letramento em saúde bucal (RP: 1,71; IC95%: 1,00-2,92; p=0,050), pior percepção do estado de saúde geral (RP: 1,26; IC95%: 1,12-1,41; p<0,001) e presença de sarcopenia (RP: 2,19; IC95%: 1,09-4,39; p=0,027).
Conclusão Ressalta-se a necessidade de uma coordenação do cuidado integrado bem instituída e preparada para atender as demandas particulares de saúde bucal da população idosa.
Palavras-Chave:
Saúde Bucal; Odontogeriatria; Autopercepção; Saúde do Idoso; Saúde Pública
INTRODUCTION
The increase in life expectancy in Brazil1 calls for the implementation of intersectoral strategies for producing and disseminating knowledge on physical, psychological and, particularly, oral health (often overlooked by public healthcare services) that promote successful aging, quality of life and disease or illness prevention, and seek to maintain autonomy and independence of the older population2.
In this respect, some studies suggest that oral health care behaviors are associated with better stomatognathic function3-10, nutritional status7 and muscle structure6,7, besides other mechanisms closely connected with the dental arch, such as number of teeth present in the oral cavity and quality of chewing action7.
Researchers5,7 note that oral dysfunctions (such as periodontal disease, gingivitis, dental caries and edentulism) can cause oral hypofunction, chewing difficulties or impairment, pain and discomfort, resulting in psychoemotional dissatisfaction, low motivation to engage in self-care or to seek dental health services5,7.
Oral health is essential to the general well-being of older individuals, having a major influence on quality of life and psychosocial aspects, such as self-esteem, self-image, interpersonal relationships, besides having economic repercussions (costs with health) for individuals and communities4,9,10. Psychosocial factors, such as social support, resilience, level of stress, perceived control over health and satisfaction with life, are deemed pivotal elements in preventing and coping with general and oral health problems1,4.
In this regard, self-rated health, encompassing objective and subjective elements rated by the individual10, is a construct widely employed in studies to assess and understand the behavior of individuals in the context of daily living, their ability to adopt healthy life styles, along with their experiences, and social and cultural influences on their health status9,10.
In the dentistry field, self-perceived oral health (SPOH) represents a relative indicator of the oral health-disease process10. In addition, investigations show that timely recognition of the factors determining SPOH can contribute to more effective health education interventions and initiatives9,10. Although studies investigating SPOH in primary care users10 and institutionalized older individuals11 are available, few studies center on older adults treated at secondary care centers and employ a conceptual-theoretical model.
Knowledge on SPOH of older adults can help provide an overview of health status and treatment needs in a swift, accessible and cost-effective manner2,10, given that oral health is an integral part of the health of the older population, contributing to their quality of life. Therefore, exploring this topic allows the assessment of oral health status and monitoring of improvements, as well as treatment adherence after implementation of health interventions, while contributing to care planning by health services7-10. Thus, the objective of the present study was to assess SPOH and its associated factors in older adults treated at a specialized geriatrics center in the north of Minas Gerais state, Brazil.
METHOD
This study is part of a larger project called “Prevalence and factors associated with literacy and self-perceived oral health of older adults treated at a center”, performed between June and August 2023. A cross-sectional, epidemiological descriptive analytical study of older adults treated at a center specialized in geriatrics and gerontology was conducted according to the checklist criteria in the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies12.
The investigation was carried out at the Eny Faria de Oliveira Referral Center for Health Care in Older Adults (CRASI) which serves a catchment area of 86 cities in the Northern macroregion of Minas Gerais state, Brazil, with a total estimated population of 1,676,413 people13. The service is supported by a multiprofessional care team comprising geriatricians, nurses, physiotherapists, speech-hearing therapists, dentists, nutritionists, physical educators, social workers and nursing technicians. The CRASI has a support facility, performs specialized exams, offers individualized treatment plans, dental procedures and counter-referral to Family Health Teams (eSF), in addition to continuous education activities and teaching-technical (collaborative) support. The center is incorporated into the Primary Care System (APS), the Health Care Network (RAS) and hospital care in an effort to integrate the different levels of care.
The target population of this study comprised older individuals who had made prior appointments for dental consultations at the referral center during the period spanning from June to August 2023. The center handles an average of 140 consultations per day, 12 of which are dental. Moreover, a total of 720 older adults were treated in dental consultations at the service during the 3 months leading up to the study. Minimum sample size was estimated by applying the formula for cross-sectional studies in a finite population. An estimated prevalence of 50% was assumed for the event studied, given this study is part of a larger project which assessed different outcomes, and due to the fact this rate yields the largest sample size14. A 95% confidence level and 5% sampling error were adopted. The minimum number of older people defined by the sample size calculation was 251 participants. This value was then increased by 10% to account for estimated losses, giving a minimum sample of 276 participants.
Older individuals (age ≥60 years) of both genders and treated at the CRASI were included in the study. Participants unable to take part in the investigation due to dementia or to cognitive, comprehension, reasoning and/or communication deficits (reported by companion or substantiated by medical reports when available) were excluded.
Patients were interviewed and assessed while waiting to be seen at the center (strategy used so as not to impact the service dynamics). Assessments were carried out by dental surgeons and students on undergraduate courses in health (nursing, medicine and dentistry), previously trained to apply the instruments and on the ethical approach in the study.
The outcome variable self-perceived oral health (SPOH) was assessed using the Oral Health Impact Profile (OHIP-14), a questionnaire measuring people´s perceptions of the impact of oral health condition15,16. The original instrument, developed by Slade and Spencer in 199417, contained 49 items. A short version of the OHIP-49 containing 14 items was later devised by Slade in 199715. The process of validating the OHIP-14 for use in Portuguese was reported by Afonso et al.16.
The OHIP constitutes a subjective indicator providing a measure of disability, discomfort and handicap attributed to self-perceived oral health condition. Responses are scored on a Likert-type scale with values from zero (0) to four (4). Points on the items are summed to give a total score ranging from 0 to 56. Higher ratings given by the respondent suggest worse SPOH and psychosocial impacts15,16. In the present study, SPOH was dichotomized based on median OHIP-14 total scores into: positive (good/very good/excellent) and negative (poor/fair)9.
The independent variables were sociodemographic and subjective factors, oral self-care and aspects related to clinical status. The sociodemographic characteristics analyzed were: age (dichotomized based on median); sex (female and male); education (literate and illiterate); self-reported skin color (white and non-white); and living arrangement (living with family members/spouse or living alone).
The subjective variables assessed were: oral health literacy (OHL) and self-rated general health (SRH). OHL was investigated by applying the Health Literacy in Dentistry instrument (HeLD-14)18, validated for Brazilian Portuguese19, comprising 14 items which subjectively assess an individual´s capacity to obtain, understand and use oral health information to make appropriate oral health decisions. The tool assesses 7 domains of oral health literacy (OHL): understanding, communication, access, receptivity, support, utilization and financial aspects. Each item is rated on a Likert-type scale ranging from zero (0) to four (4). Item scores are summed to give a total score from 0 to 56 points, where high scores indicate high OHL18,19. SRH was measured using the following question: How would you rate your current health status? (dichotomized into excellent/good and poor/fair)20.
The following variables related to oral self-care practices were assessed: use of tooth brush (yes or no); use of dentifrice (yes or no); use of dental floss (yes or no); and brushing habit (≥3 times a day and ≤2 times a day).
Clinical conditions were assessed using the Portuguese version of the Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F)21 to determine sarcopenia risk. The SARC-F comprises 5 assessment components: strength, ambulation (walking independence), rising from chair, climbing stairs and falls. Each item is rated on a Likert-type scale ranging from zero (0) to two (2). Component scores are summed, where total scores ≥4 points indicate sarcopenia21,22. In addition, the presence of diabetes and/or hypertension was assessed by the question: has a doctor previously said that you have diabetes or hypertension? (dichotomized into yes or no)23.
In the present investigation, the independent variables were organized into 4 levels, as per the model by Oliveira-Júnior and Mialhe10. Moreover, the sarcopenia variable was included because some studies have shown an association between oral health and sarcopenia and/or its diagnostic factors, such as hand-grip strength, gait speed and muscle mass24. Importantly, this conceptual-theoretical model has been developed for assessment in the dental setting10. The variables were selected according to the best adaptation to the model components and based on a review of the scientific literature in dentistry25.
Variables were divided into 4 levels: 1st - Sociodemographic factors (age, sex, education, skin color and living arrangement); 2nd - Subjective factors (oral health literacy and self-rated general health); 3rd - Oral health self-care practices (use of toothbrush, use of dentifrice, use of dental floss and brushing habits); and 4th – Clinical factors (chronic diseases and sarcopenia risk), as shown in Figure 1.
Conceptual-theoretical model employed to investigate factors associated with self-perceived oral health in older adults treated at a secondary care center. Montes Claros, Minas Gerais state, 2023.
Descriptive analyses (absolute and relative frequencies) of the variables assessed, measures of central tendency and measures of dispersion were first performed. For the analyses of association between independent variables and SPOH, Poisson regression models were applied with simple analysis and hierarchized multiple factors analysis, estimating crude and adjusted prevalence ratios (PR), with respective 95% confidence intervals (95%CI).
Variables found to be associated on simple analysis, up to 20% level (p≤0.20), were included in the hierarchical multivariate models. Only variables associated up to a 5% level (p≤0.05) were retained in the final models. The factors were entered into the multiple models from the 1st to the 4th levels, with adjustment for variables of the same level and preceding levels.
This study complied with the precepts of Resolution no. 466/12 of the National Board of Health (CNS) for conducting research involving humans. The Referral Center for Health Care in Older Adults (CRASI) was provided with the Institution Consent Form, whereas participants received the Free and Informed Consent Form.
The present study was approved by the Research Ethics Committee (CEP) of the UNIFIPMoc University Center, with granting of a permit on the Brasil platform under no. 6.101.412/2023.
RESULTS
A total of 277 older adults treated at the secondary care service were assessed and the sample was predominantly female. Of the total participants assessed, most were aged 60-73 years and mean age was 73.82 years (95%CI: 72.89-74.74; SD=7.79 years). Regarding education, the vast majority of participants were literate. The majority of participants declared they were non-white and living with family members/spouse.
Results showed that 50.5% of individuals had HeLD-14 scores below the median value for the sample, indicating low oral health literacy. Moreover, most participants rated their general health as fair or poor.
The assessment of SPOH of the participants showed that 37.5% rated their oral health negatively. On crude analyses, the variables associated with negative SPOH, up to 20% level (p<0.20) were: age ≥ 73 years; illiteracy; low oral health literacy; fair/poor SRH; and sarcopenia risk (Table 1).
Characteristics and crude associations of sociodemographic factors, subjective factors, oral self-care practices and clinical aspects with self-perceived oral health in older adults treated at a specialized center (N=277). Montes Claros, Minas Gerais state, 2023.
The hierarchical multivariate model (adjusted) revealed that older adults aged ≥73 years (PR: 1.73; 95%CI: 1.05-2.88; p=0.033), with low oral health literacy (PR: 1.71; 95%CI: 1.00-2.92; p=0.050), poor self-rated general health (PR: 1.26; 95%CI: 1.12-1.41; p<0.001) and sarcopenia risk (PR: 2.19; 95%CI: 1.09-4.39; p=0.027) had higher rates of negative SPOH. These characteristics, along with others pertaining to the group assessed, are presented in Table 2.
Adjusted associations of sociodemographic factors, subjective factors, oral self-care practices and clinical aspects with self-perceived oral health in older adults treated at a specialized center (N=277). Montes Claros, Minas Gerais state, 2023.
DISCUSSION
The present study found a rate of negative SPOH of 37.5% among older users of a center specialized in geriatrics and gerontology in the north of Minas Gerais state, Brazil. In addition, participants aged ≥73 years, with low oral health literacy, poor/fair SRH and sarcopenia risk had higher rates of negative SPOH.
Similarly, other investigations involving older adults in Thailand and Malaysia reported high rates of negative SPOH of 45.8%25 and 33.0%10, respectively. In Brazil, a cross-sectional study of institutionalized older adults in the state of Paraná found a rate of poor SPOH of 35.1%26. Another study drawing on the ELSI-Brasil (Brazilian Longitudinal Study of Aging) showed a prevalence of poor SPOH of 43.8% in older adults from 70 cities across different regions of Brazil27. The high rate of negative SPOH in older participants of the present study can be explained by the presence of more complex oral conditions, such as tooth loss and periodontal diseases, common conditions in older individuals seeking treatment at a secondary referral center. These factors reflect the severity of the oral health conditions which lead patients to seek specialized care, contributing to a negative perception of oral health10.
SPOH encompasses physical, cognitive and psychoemotional aspects of the individual, serving as a broad indicator of health. The broader conceptions of oral health center on a biopsychosocial perspective and should include patient perceptions of their condition, as well as impact of stomatognathic changes on functional and psychological well-being28.
An individual´s perception of their oral health needs can determine their behavior, self-care habits and adherence to dental treatment. A common reason why individuals fail to seek dental services is linked to a mistaken or distorted perception of their own needs. Thus, assessing this indicator can be helpful to professionals during dental clinical practice in understanding the needs of older individuals, choosing optimal treatment and monitoring oral health status, besides enabling actions preventing negative health outcomes2,8.
Overall, the sample had low oral health literacy and poor/fair SPOH. Other studies conducted in older adults in Brazil have also documented a predominance of low oral health literacy (53,3%)10 and negative SRH (54.2%)29. In addition, the present study revealed that a high proportion of participants did not use dental floss and brushed only twice a day or less, behaviors which point to the need for health education actions targeting the older population9,10.
The multivariate model revealed that participants of more advanced age had higher rates of poor SPOH. This finding corroborates a previous study of community-dwelling older adults which found a correlation between age and SPOH13. Other international publications suggest that oral health-related quality of life (OHRQoL) commonly decreases with older age, particularly in individuals aged ≥75 years, often owing to conditions such as edentulism, also associated with socioeconomic status, which negatively influences SPOH30,31.
Oral health literacy proved another variable that significantly impacted SPOH score in the present study. Low oral health literacy was reported to be a factor associated with greater risk of negative SPOH in a Brazilian study of adults and older users of dental services in primary care10. Similar results were also documented in a multi-center study of older adults in Portugal32. This finding can be explained by the difficulty faced by individuals with low oral health literacy in understanding and following oral health care advice, a situation which can lead to low adherence to oral hygiene practices and to inadequate or insufficient utilization of health services9. Also, older adults can experience barriers in accessing information and making decisions on their oral health, owing to inequality in access to services and health education, promoting a negative perception of oral health status10.
Health literacy competencies are pivotal to maintaining and improving the oral health of the older population. As individuals age, health literacy becomes an even more valuable tool for the understanding and ability of older adults to adopt health lifestyle and adequate oral self-care33. Understanding the knowledge, attitudes and beliefs held by older adults about oral health represents a crucial step in designing programs and initiatives promoting the health of the older population9,10.
Poor self-rated general health remained associated with negative SPOH. Similar findings have been reported in previous studies9,34. Researchers state there is no dissociation between subjective constructs, i.e., individuals with negative perception of general health tend to also self-rate their oral health as poor10. Thus, subjective health is a key element not only for diagnosing and treating the health issues of older individuals, but also for formulating educational, social and preventive plans34.
Another factor which also showed a statistically significant association with SPOH was the presence of sarcopenia. This relationship was reported in a previous study, which also employed the OHIP-14 and found that patients with sarcopenia had poorer perceived oral health status and OHRQol35. Studies highlight that impaired oral health status can lead to malnutrition, particularly in older individuals and, consequently, reduced protein and vitamin intake, constituting risk factors for sarcopenia4,5. Therefore, low OHRQol can be a predisposing factor for sarcopenia. Conversely, sarcopenia can cause dysphagia, chewing difficulty and oral hypofunction. In this respect, progressive loss of muscle mass can result in oral health problems35.
The study results should be interpreted in the context of some limitations. For example, the cross-sectional design of the study precluded any inferences regarding causality. Moreover, only users of the health center were asked to take part in the study, where this may have introduced bias in SPOH, given these participants might have different perceptions compared to individuals not seeking treatment.
CONCLUSION
The present study revealed a high rate of negative SPOH, strongly associated with older age, lower oral health literacy, poor self-rated general health and presence of sarcopenia. This study can help inform health managers in care planning and devising health education strategies, contributing to the application of Evidence Based Practice (EBP) toward improving the oral health status of the population.
Furthermore, the results reiterate the need for continuous education and teaching-technical (collaborative) support for services and health professionals involved in the dental care setting to establish coordinated integrated care that is solid and appropriate to meet the specific needs of the older population. In this context, future studies should further investigate the current findings, such as the mechanisms underlying the association between sarcopenia and oral health.
-
There was no funding for the execution of this work.
-
DATA AVAILABILITY
The complete dataset underpinning the results of the present study are available on Figshare and can be accessed at https://doi.org/10.6084/m9.figshare.27224406.
References
-
1 Szwarcwald CL, Almeida W da S de, Souza Júnior PRB de, Rodrigues JM, Romero DE. Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019. Cad Saúde Pública. 2022 [Acesso 16 de julho de 2024]; 38:e00124421. Disponível em: https://doi.org/10.1590/0102-311X00124421
» https://doi.org/10.1590/0102-311X00124421 -
2 Liu F, Song S, Ye X, Huang S, He J, Wang G, Hu X. Oral health-related multiple outcomes of holistic health in elderly individuals: An umbrella review of systematic reviews and meta-analyses. Front Public Health. 2022 [Acesso 16 de julho de 2024]; 10:1021104. Disponível em: https://doi.org/10.3389/fpubh.2022.1021104
» https://doi.org/10.3389/fpubh.2022.1021104 -
3 Limpuangthip N, Komin O. Association between oral hypofunction and general health: a systematic review. BMC Oral Health. 2023 [Acesso 16 de julho de 2024]; 23(1):591. Disponível em: https://doi.org/10.1186/s12903-023-03305-3
» https://doi.org/10.1186/s12903-023-03305-3 -
4 de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients. 2022 [Acesso 16 de julho de 2024]; 14(5):982. Disponível em: https://doi.org/10.3390/nu14050982
» https://doi.org/10.3390/nu14050982 -
5 Kugimiya Y, Iwasaki M, Ohara Y, Motokawa K, Edahiro A, Shirobe M, Watanabe Y, Taniguchi Y, Seino S, Abe T, Obuchi S, Kawai H, Kera T, Fujiwara Y, Kitamura A, Ihara K, Kim H, Shinkai S, Hirano H. Association between sarcopenia and oral functions in community-dwelling older adults: A cross-sectional study. J Cachexia Sarcopenia Muscle. 2023 [Acesso 16 de julho de 2024]; 14(1):429-438. Disponível em: https://doi.org/10.1002/jcsm.13145
» https://doi.org/10.1002/jcsm.13145 -
6 Lourenço MAG, Guimarães TM, Miranda ABS, Pazinatto RB, Calderon PDS, Melo LA, Leite FPP. Factors associated with total edentulism in the elderly and their impact on the self-perception of oral health and food. Int J Prosthodont. 2023[Acesso 16 de julho de 2024]; 0(0). Disponível em: https://doi.org/10.11607/ijp.8534
» https://doi.org/10.11607/ijp.8534 -
7 Venegas-Sanabria LC, Moreno-Echeverry MM, Borda MG, Chavarro-Carvajal DA, Cano-Gutierrez CA. Oral health and self-rated health in community-dwelling older adults in Colombia. BMC Oral Health. 2023 [Acesso 16 de julho de 2024];23(1):772. Disponível em: https://doi.org/10.1186/s12903-023-03401-4
» https://doi.org/10.1186/s12903-023-03401-4 -
8 Parker EJ, Haag DG, Spencer AJ, Roberts-Thomson K, Jamieson LM. Self-efficacy and oral health outcomes in a regional Australian Aboriginal population. BMC Oral Health. 2022 [Acesso 16 de julho de 2024]; 22(1):447. Disponível em: https://doi.org/10.1186/s12903-022-02471-0
» https://doi.org/10.1186/s12903-022-02471-0 -
9 Fuad MAM, Yacob H, Mohamed N, Wong NI. Association of sociodemographic factors and self-perception of health status on oral healthrelated quality of life among the older persons in Malaysia. Geriatr Gerontol Int. 2020 [Acesso 16 de julho de 2024]; 20 (Suppl 2):57-62. Disponível em: https://doi.org/10.1111/ggi.13969
» https://doi.org/10.1111/ggi.13969 -
10 Oliveira Júnior AJ de, Mialhe FL. Letramento em saúde bucal e variáveis associadas a autopercepção de saúde bucal em adultos e idosos usuários da atenção básica: um estudo exploratório. Cad saúde colet. 2022 [Acesso 16 de julho de 2024]; 30(2):255–64. Disponível em: https://doi.org/10.1590/1414-462X202230020132
» https://doi.org/10.1590/1414-462X202230020132 -
11 Ribeiro AE, Santos GS dos, Baldani, M. Edentulismo, necessidade de prótese e autopercepção de saúde bucal entre idosos institucionalizados. Saúde em Debate 2023 [Acesso 16 de julho de 2024]; 47(137): 222-241. Disponível em: https://doi.org/10.1590/0103-1104202313716
» https://doi.org/10.1590/0103-1104202313716 -
12 Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE)statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 [Acesso 16 de julho de 2024]; 61(4):344-9. Disponível em: https://doi.org/10.1016/j.jclinepi.2007.11.008
» https://doi.org/10.1016/j.jclinepi.2007.11.008 -
13 Minas Gerais. Secretaria de Estado de Saúde. Deliberação CIB-SUS/MG nº 3.013, de 23 de outubro de 2019. A descrição dos municípios de minas gerais por microrregião e macrorregião de saúde*, conforme o ajuste de 2019 do plano diretor de regionalização SUS/MG. Belo Horizonte: SES-MG, 2019. Disponível em: https://www.saude.mg.gov.br/images/documentos/Del%203013%20-%20SUBGR_SDCAR_DREA%20-%20Ajuste%20PDR%20vers%C3%A3o%20CIB%20-%20alterada%2015.10.pdf
» https://www.saude.mg.gov.br/images/documentos/Del%203013%20-%20SUBGR_SDCAR_DREA%20-%20Ajuste%20PDR%20vers%C3%A3o%20CIB%20-%20alterada%2015.10.pdf - 14 Luiz RR, Magnanini MMF. A lógica da determinação do tamanho da amostra em investigações epidemiológicas. Cad Saude Colet. 2000 [Acesso 02 de maio de 2024];8(2):928.
-
15 Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol. 1997 [Acesso 02 de maio de 2024]; 25(4): 284–90. Disponível em: https://doi.org/10.1111/j.1600-0528.1997.tb00941.x
» https://doi.org/10.1111/j.1600-0528.1997.tb00941.x -
16 Afonso A, Silva I, Meneses R, Frias-Bulhosa. Qualidade de vida relacionada com a saúde oral: validação portuguesa de OHIP-14. Psicologia, Saúde & Doenças. 2017 [Acesso 02 de maio de 2024]; 18(2):374-388. Disponível em: http://dx.doi.org/10.15309/17psd180208
» https://doi.org/10.15309/17psd180208 - 17 Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994 [Acesso 02 de maio de 2024]; 11(1):3–11.
-
18 Ju X, Brennan DS, Parker E, Chrisopoulos S, Jamieson L. Confirmatory factor analysis of the health literacy in dentistry scale (HeLD) in the Australian population. Community Dent Health. 2018 [Acesso 02 de maio de 2024]; 35(3):140-7. Disponível em: https://doi.org/10.1922/CDH_4325Ju08
» https://doi.org/10.1922/CDH_4325Ju08 -
19 Mialhe FL, Bado FMR, Brennan D, Ju X, Jamieson L. Validation of the Health Literacy in Dentistry Scale (HeLD) in Brazilian adults. Int Dent J. 2019 [Acesso 02 de maio de 2024]; 35:140-7. Disponível em: https://doi.org/10.1111/IDJ.12531
» https://doi.org/10.1111/IDJ.12531 -
20 Silva VH, Rocha JSB, Caldeira AP. Fatores associados à autopercepção negativa de saúde em mulheres climatéricas. Ciênc saúde coletiva. 2018 [Acesso 02 de maio de 2024];23(5):1611–20. Disponível em: https://doi.org/10.1590/1413-81232018235.17112016
» https://doi.org/10.1590/1413-81232018235.17112016 -
21 Malmstrom TK, Miller DK, Simonsick EM, Ferrucci L, Morley JE. SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle. 2016 [Acesso 02 de maio de 2024];7(1):28-36. Disponível em: https://doi.org/10.1002/jcsm.12048
» https://doi.org/10.1002/jcsm.12048 -
22 Barbosa-Silva TG, Menezes AMB, Bielemann RM, Malmstrom TK, Gonzalez MC. Enhancing SARC-F: Improving Sarcopenia Screening in the Clinical Practice. J Am Med Dir Assoc. 2016 [Acesso 02 de maio de 2024]; 17(12):1136-41. Disponível em: https://doi.org/10.1016/j.jamda.2016.08.004
» https://doi.org/10.1016/j.jamda.2016.08.004 -
23 Gomes CS, Bernal RTI, Moreira AD, Teixeira RA, Cardoso LS de M, Ribeiro ALP, et al. Estimates of hypertension and diabetes mellitus prevalence according to Health Vulnerability Index in Belo Horizonte, MG, Brazil. Rev bras epidemiol. 2021 [Acesso 02 de maio de 2024];24:e210015. Disponível em: https://doi.org/10.1590/1980-549720210015.supl.1
» https://doi.org/10.1590/1980-549720210015.supl.1 -
24 Hatta K, Ikebe K. Association between oral health and sarcopenia: A literature review. J Prosthodont Res. 2021 [Acesso 02 de maio de 2024];65(2):131-136. Disponível em: https://doi.org/10.2186/jpr.JPOR_2019_567
» https://doi.org/10.2186/jpr.JPOR_2019_567 -
25 Khamrin P, Boonyathee S, Bootsikeaw S, Ong-Artborirak P, Seangpraw K. Factors Associated with Health Literacy, Self-Efficacy, Social Support, and Oral Health Care Behaviors Among Elderly in Northern Border Community Thailand. Clin Interv Aging. 2021 [Acesso 29 agosto de 2024];16:1427-1437. Disponível em: https://doi.org/10.2147/CIA.S320900
» https://doi.org/10.2147/CIA.S320900 -
26 Ribeiro AE, Santos GS dos, Baldani MH. Edentulismo, necessidade de prótese e autopercepção de saúde bucal entre idosos institucionalizados. Saúde debate. 2023 [Acesso 29 agosto de 2024]; 47(137):222–41. Disponível em: https://doi.org/10.1590/0103- 11042023137167
» https://doi.org/10.1590/0103- 11042023137167 -
27 Amaral Júnior OL, Fagundes MLB, Menegazzo GR, Giordani JM do A. Wealth index association with self-reported oral health between white and non-white older Brazilians. Cad Saúde Pública. 2023 [Acesso 29 agosto de 2024];39(6):e00188122. Disponível em: https://doi.org/10.1590/0102-311XEN188122
» https://doi.org/10.1590/0102-311XEN188122 -
28 Kreve S, D’Ávilla GC, Santos LO, Reis AC. Self-perception of oral health in older adults. Clin Lab Res Den. 2020 [Acesso 29 agosto de 2024]: 1-9. Disponível em: http://dx.doi.org/10.11606/issn.2357-8041.clrd.2020.160816
» https://doi.org/10.11606/issn.2357-8041.clrd.2020.160816 -
29 Kretschmer AC, Loch MR. Autopercepção de saúde em idosos de baixa escolaridade: fatores demográficos, sociais e de comportamentos em saúde relacionados. Rev bras geriatr gerontol. 2022 [Acesso 29 agosto de 2024]; 25(1):e220102. Disponível em: https://doi.org/10.1590/1981-22562022025.220102.pt
» https://doi.org/10.1590/1981-22562022025.220102.pt -
30 Masood M, Newton T, Bakri NN, Khalid T, Masood Y. The relationship between oral health and oral health related quality of life among elderly people in United Kingdom. J Dent. 2017 [Acesso 29 agosto de 2024];56:78-83. Disponível em: https://doi.org/10.1016/j.jdent.2016.11.002
» https://doi.org/10.1016/j.jdent.2016.11.002 -
31 Zusman SP, Kushnir D, Natapov L, Goldsmith R, Dichtiar R. Oral Health-Related Quality of Life in the Elderly in Israel--Results from the National Health and Nutrition Survey of the Elderly 2005-2006. Oral Health Prev Dent. 2016 [Acesso 29 agosto de 2024];14(2):117-23. Disponível em: https://doi.org/10.3290/j.ohpd.a34998
» https://doi.org/10.3290/j.ohpd.a34998 -
32 Borges K, Sécio Faria C, Silva CM, Mendonça L. Self-perceived oral health among the elderly in four family health units. Aten Primaria. 2022 [Acesso 29 agosto de 2024];54(11):102473. Disponível em: https://doi.org/10.1016/j.aprim.2022.102473
» https://doi.org/10.1016/j.aprim.2022.102473 - 33 Martins AMEBL, Almeida ER, Oliveira CC, Oliveira RCN, Pelino JEP, Santos ASF, Costa AS, Souza GM, Batista BTP, Ferreira EF. Alfabetização em saúde bucal: uma revisão da literatura. Rev Assoc Paul Cir Dent. 2015 [Acesso 29 agosto de 2024];69(4):317-26.
-
34 Bado FMR, De Checchi MHR, Cortellazzi KL, Ju X, Jamieson L, Mialhe FL. Oral health literacy, self-rated oral health, and oral health-related quality of life in Brazilian adults. Eur J Oral Sci. 2020 [Acesso 29 agosto de 2024];128(3):218-225. Disponível em: https://doi.org/10.1111/eos.12695
» https://doi.org/10.1111/eos.12695 -
35 Takahashi M, Maeda K, Wakabayashi H. Prevalence of sarcopenia and association with oral health-related quality of life and oral health status in older dental clinic outpatients. Geriatr Gerontol Int. 2018 [Acesso 29 agosto de 2024];18(6):915-921. Disponível em: https://doi.org/10.1111/ggi.13279
» https://doi.org/10.1111/ggi.13279
Edited by
-
Edited by: Larissa Neves Quadros
The complete dataset underpinning the results of the present study are available on Figshare and can be accessed at https://doi.org/10.6084/m9.figshare.27224406.
