Associations between Xerostomia and Health Status Indicators in the Elderly
Matear, David W., Locker, D., Stephens, M., Lawrence, H. P., The Journal of the Royal Society for the Promotion of Health
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.
Elderly population; xerostomia
Xerostomia (dry mouth) is a frequent complaint in the elderly population. Prevalence has been estimated to range from 10% to 380%1-4 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 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. …