Oral Health and Related Factors for the Elderly

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(1)Journal of Dental Hygiene Science Vol. 4, No. 3, pp. 91~ 95 (2004). Structural Equation Modelingj Û >Ô~ ÿÒ »]\Ú +K. 9 ; \. * ~* Oral Health and Related Factors for the Elderly Jeung-Hee Seung Daejeon Health Sciences College, Daejeon Metropolitan City, Daejeon 300-711, Korea. " "#! #!#. This study aims to analyze realities of oral health and related factors, and establish Structural Equation Modeling. The subjects of study were 9,340 elderly over age 65 who took the health examination(the first) for the local insured which National Health Insurance Corporation carried out in the survey area mentioned below from January 2002 to December 2002. The areas surveyed were 4 big cities including Seongbuk-ku, Seoul, 5 medium cities including Wonjusi, Gangwon-do, and 5 Counties including Yeong deok County, Kyeongbuk. Considering location and the scale of population, firstly, big unit areas(metropolitan city, province) were selected according to convenience, secondly, low unit areas(city, county, district) were selected randomly. The subjects were the elderly who took all tests including an oral examination and filled in the questionnaire. Major results from analysis are as follows: 1. Review of Composition Conception Validity As a result of analyzing composition conception validity of SEM including posture test, urine test, blood test, habits of eating, drinking and smoking, oral symptoms, and oral health status, using fit index such as GFI, CFI, TLI, and RMSEA, all were within fit range and composition conception validity was recognized. 2. As a result of analyzing SEM to find the relationship between each factor and oral health status, it was confirmed that all factors except urine test affected oral health status and the synthetic SEM to explain it could be established. In result, we could verify that the elderly of rural areas who had lesser experience of visiting a clinic and oral prophylaxis had a higher rate of caries, missing teeth, and denture need, and drinking and smoking negatively affected the rate of caries, periodontal, and missing teeth. Also, periodontal diseases were observed from 43.2% of the total elderly and much from the lower age. Most of oral disease can be prevented by right oral health behavior. Therefore through oral health professionals from each district public health center of the nation, oral health education for the elderly about right eating habits and oral health care should be carried out systematically and policy change to increase access to dental service is required lest that visiting a dental clinic should be impossible or oral health behaviors such as oral prophylaxis and denture wearing should be neglected by economic, geographical barriers. Also, to establish SEM to explain the relationship between oral health status and systemic health, more accurate test methods and effective index development should be preceded. Because items developed by National Health Insurance Corporation applied to this study without alteration, structuring a model had the uppermost limit. Continual study seems to be needed. ,FZ XP XPSE SETT Structural Equation Modeling=SEM. *. B® ;~ &Òöò .6j Â © jî¢ ;ê. ËV(7ª)f îR&æ Ú', ;', Ò²' 'Ëj AV r^ö j ~" ' ~ãj

(2) *>ö &j &æ 7" jº& ® . ~òV&~ Ïf B ;j Fæ~ î÷j .O~ ¾ ~ò~¶~º ;&N ¯* . ¯*º öB Þ/ ' G ö ò jî¢ ~òV&ö & 7"ê fê pf &NWj <º . Straussf Ronald º § ¶¢¾ j &çb ÒöB &ç¶~ 50.0% çf ~j& Îf â Î·, _. V. ï>«~ Ã&º jV~ Ü~ îö & &j <² ~&b, 7öBê " &7 &Nj &æ ®º ;ö & &f /³ê ¸jæ ® . ~ &Ú ;; Næ~º j7j ' r, ;f Corresponding author Tel: 011-450-5831 E-mail: ridia1129@naver.com. 1). .

(3) . Oral Health and Related Factors for the Elderly. V, _º © ¶VV, _V¾ bV, Þn ö 'Ëj ~ 7 38.0%º ~j& ¢>' ;ö 'Ëj ~&b McGrathf Bedi º 876«~ 65^ ç j Z ·* F;~ ;;ç 5 ;¯**~ &ê¢ Ò Ö" Ò²' æö îæï ~" O^ê~ *" îæï ~"O^~ F, ¶V B ~jF~>, ~~çf &N ®º ©b ®, Petersen f Ò4jîj W~ ;; ÒöB 65.0%f 0f W 55.0%º * ö ~j¾ ;b Û~ ãþj &æ ®îb ~" O^(1j *)f 0f W~ ãÖ 60.0%, ~ ã Ö ~ 43.0% ©b ~& . Gilbert, Branchf Orav º *Ú $º ¦ª'b ~j& ² B Ò² J®J ~ " ~ò¢ z ¶" Aæ pb ~òj¢ æ® ËK z ì ;*¯ÿj z '² >¯ º ê ® . Sheiham f ;;çf Úîïæ>*~ &ê ï&ö B 65^ ç ~ ;¦Òf V 5 Ú G;' ¦Ò¢ Af Ö", ~j& ìº Ò² (12.3%)f 11B ç~ ~j¢ &ê Ò² (2.9%) Ú7 F &ËW F~~ ² ¾æÒb, Úîï æ>~ ãÖ, 1-10B~ ~j¢ &ê Ò ² " 11B ç~ ~j¢ &ê Ò² Òö Ûê'b. Ö F~ N& &VB:, '' 24.0%f 2.9%& Ú7 î . 21B ò~ ¶~¢ &ê Ò² f ï 21-32 B~ ~j¢ &ê Ò² jò¢ &ËW 3V z ¸~. ~& . ~ ;;f *;" &7 &NW ®b º ~ Ü~ î" çÖB " > ® . V ¢B ~ ;;çö ~º 'Ë Zíæ¢ C® ~ ;;j ËçÒ > ®º ;k&n j Bnb ÖÒ¾¢ ~ ;; {¢ Û §'b Ü~ îj ËçÒ > ®º On îNF jº& ® . ö º ";þöB ~ ; ¦ê¶ò¢ Ï~ ~ ;;çö 'Ëj ~º æ j ªC~, ~ ;;" *;"~ &NWj «~ ~ ;;j ÃêÊV * J« Îj B~¶ ~& . 2). 3). 4). 5). \ç5O». \ç 5 `Ò8* j 1ú¦V 12úræ ";þ æ &«¶ ;¦ê(1N)j Af 65^ ç 9,340«j &ç b ~& . æ~ F;f *~f Î¢ J~ 1N &*(7, ê)º Þ~ºÂj ~ 2ê ~¦*æ (, , )f Z·* ºÂ~& . 2. ª+O» >÷B ¶òº Bê ¦^z ·ë" >;·ëj ö SPSS WIN 10.0" AMOS 4.0j Ï~ ªC~& . ªCO»b ªÖ ªCj ~Vöº '~æ pf ¿ ê W>Ú ®º ãÖ 2ª; ¿ê >;~&. Î~ 'ê 6;f 'ê æ>(GFI: goodness-of-fitindex), jv 'ê æ>(CFI: comparative fit index), jR 'ê æ>(TLI: Turker-Lewis index), "Òö² ï¶ßº 1.. 2002. N(RMSEA: root mean square error of approximation) ~& . ;;çö & ¶Î ãê>~ F~Wf V'j(Critical Ratio)¢ V&b ~&b, Ûê' F~>& f .&~& 1.96 ç(p<0.05), 2.576 ç(p<0.01), 3.291 ç(p<0.001)b 6~& . Ö 1.. . Ú*¦Òf \;;çf~ N9. Ú*¦Òf ;;çf~ &NWj ¦Ã~V * Î j » ê Î 'ê¢ ÚÚ Ö", GFI& 0.998, CFI& 0.955, TLI& 0.911, RMSEA& 0.023b 'ê& ;>î . ãê>º 0.09îb V'j(CR)º 6.017 (p<0.000) ¾æ¾ Ú*¦Òº ;;çö F~~² 'Ë j ~ ®î (Fig. 1).. ya1: obesity level ya2: acuity ya3: audition ya4: blood pressure yb1: urine sugar yb2: urine protein yb3: urine occult yb4: urine pH yc1: hematoglobin yc2: blood sugar yc3: total cholesterol yc4: SGOT yc5: SGPT yc6: γGTP yh1: dental caries yd1: sweet food yd2: tough and hard food yd3: snack ye1: drinking frequency ye2: smoking frequency ye3: drinking amount yf1: visiting a clinic yf2: oral prophylaxis yf3: toothbrushing yg1: tooth sensitivity to cold food yg2: tooth sensitivity to toothbrushing yg3: gingival bleeding yg4: temporomandibular joint sound yg5: temporomandibular joint pain yg6: halitosis yh1: dental caries yh2: missing teeth yh3: periodontal disease yh4: dental abrasion 'JH . Relation of Each Factor to Oral Health Status. º ¦Òf \;;çf~ N9 º ¦Òf ;;çf~ &NWj ¦Ã~V * Îj » ê Î 'ê¢ ÚÚ Ö", GFI& 0.998, CFI & 0.961, TLI& 0.933, RMSEA& 0.020b 'ê& ;>î . ¾ ãê>º 0.00îb V'j(CR)& 1.286 ¾æ¾ º ¦Òº ;;çö 'Ëj ~æ p~ 2..

(4) . Journal of Dental Hygiene Science Vol. 4, No. 3, pp. 91~95 (2004). (Fig. 1). 3.. .W¦Òf \;;çf~ N9. .¦Òf ;;çf~ &NWj ¦Ã~V * Î j » ê Î 'ê¢ ÚÚ Ö", GFI& 0.996, CFI& 0.971, TLI& 0.959 RMSEA& 0.024 'ê& ; >î . ãê>º 0.08îb V'j(CR)º 2.491(p<0.013) ¾æ¾ .¦Òº ;;çö F~~² 'Ëj ~ ®î (Fig. 1). 4.. Û \;;çf~ N9. Û&" ;;çf~ &NWj ¦Ã~V * Îj » ê Î 'ê¢ ÚÚ Ö", GFI& 0.993, CFI & 0.965, TLI& 0.934, RMSEA& 0.044 'ê& ; >î . ãê>º 0.11îb V'j(CR)& 3.822(p<0.000) ¾æ¾ Û&f ;;çö F~~² 'Ëj ~ ®î (Fig. 1).. r" . W \;;çf~ N9 r" . " ;;çf~ &NWj ¦Ã~V * Î j » ê Î 'ê¢ ÚÚ Ö", GFI& 0.998, CFI& 0.996, TLI& 0.993, RMSEA& 0.021 'ê& ;>î . ãê>º 0.13îb V'j(CR)& 6.511 (p<0.000) ¾æ¾ r" . f ;;çö F~~² ' Ëj ~ ®î (Fig. 1). 6. ~ò . .O \;;çf~ N9 ~ò . .O" ;;çf~ &NWj ¦Ã~V * Î j » ê Î 'ê¢ ÚÚ Ö", GFI& 0.995, CFI& 0.950, TLI& 0.904, RMSEA& 0.040b 'ê& ;>î . ãê>º 0.12&b V'j(CR)º 4.097 (p<0.000) ¾æ¾ ;Ãçf ;;çö F~~² 'Ë j ~ ®î (Fig. 1). 7. \;Ãç \;;çf~ N9 ;Ãç" ;;çf~ &NWj ¦Ã~V * Î j » ê Î 'ê¢ ÚÚ Ö", GFI& 0.994, CFI& 0.978, TLI& 0.964, RMSEA& 0.029 'ê& ;>î . ãê>º 0.30îb V'j(CR)º 9.651 (p<0.000)b ¾æ¾ ;Ãçf ;;çö F~~² ' Ëj ~ ®î (Fig. 1). 8. ' º \;;çf~ N9 ' º" ;;çf~ &NWj ¦Ã~V * Îj » ê Î 'ê¢ ÚÚ Ö", GFI& 0.974, CFI & 0.912, TLI& 0.901, RMSEA& 0.030b 'ê& ;>î . Ú*¦Òf ;;çf~ &êöB ãê>º 0.05, V'j(CR) 4.233(p<0.000), .¦Òf ;;çf ~ &êöB ãê>º 0.01, V'j(CR) 1.977(p<0.05), Û&" ;;çf~ &êöB ãê>º 0.08, V'j (CR) 5.310(p<0.0 00) r" . " ;;çf~ &êö B ãê>º 0.10, V'j(CR) 3.288(p<0.001), ~ò . .O 5.. " ;;çf~ &êöBº ãê>º 0.60, V'j(CR) 12.476(p<0.000), ;Ãç" ;;çf~ &êöB ã ê>º 0.27, V'j(CR) 11.801(p<0.000) ¾æ¾ F~~² 'Ëj ~ ®î . Ú*¦Ò, .¦Ò, Û&, r" . , ~ò ..O, ;Ãç ;;çö F~~² 'Ëj ~ ®º ©b C&r (Fig. 1). . V. f ¶~ ; ÚöB ² rW Ã&~ ~;W /ê>Ú ~"î~~ . V; ~f"f b ~jÖÃræ BÎ ~&b Linden" Mullally ~ öBê B~f ~Fö ±æ pf 'Ëj ~º ©b ~& . öBê ¶f r"¶º j¶, jr"¶ö j ~jÖÃ" ~"î~, ~jÖ¶N ¸~ . Krall" Dawson -Hughes º çö ~ ~j ¶ j Ò~V * ÊÊ MAö B ºÂB W(40-70^) 584«" ÎW 1,231«(21-75^)j &çb Ò Ö" *Ò ¶& *Ò j¶º "ö j Ò² ~j ¶ ç® ¸~b, 248« ~ W (º'ÒV*=6Û2j)" 977«~ ÎW (Mean=18Û 7j)j ê³ &V Ö" j æ³ Ò² f j¶ö j ~j ¶ *þê& ÎWf 2.4V ¸~ Wf 3.5V ¸~ . ÎWf j 7 ê *&~² *Ú îæò j ¶ º *® ¸~. ÎW f ~j ¶ *þê & 4.5V Ã&® . Taani º 3Bú ÿn C 1,098B ~ B~B ~j¢ &æ Ö", Ï~(56.4%)& B~~ "º öîb ~"î~(23.4%) rb ô~ ºf 20.2%¢ ~ Ö"¢ ææ~& . Michelle, Henshaw, Calabrese ö ~~ ~~¢ Ò². f &¦ª~ '·² S >& ; ~j¢ &ê Ò² ö j 20% Ôj, '·çº ;î~~ B÷" ê¯ö ' Ëj ~ ç^·Ïf ö² ®ÚB ß® 7º ~ . Ö f ~~& ¾ º Ò²ö² Nê r Fj BÊV r^ . j* ~~¢ Ò² f j* ~j¢ &æ ®¾ ¦ª'b &æ ®º Ò² ö j "¢" ¢j¢ _º ©b rJ^ ® . V¢B ~~ ËO¶ '·Sö ÚJæ ì² ; ®º '·j S > ®ê R&zB BB jº © . Þ, ~"²º ~"î~ö ~ 'Ëj Aº *W î~~ B æ>¢ BÒ~& . ¯ ~" 6"f ¢¦ Ò². ~ * ;ö ç 'Ëj > ®b ¢; *W î~~ *þ æRB~ j > ® BR~& . Hujoel f ~"î~" .& Òö 7º &NWj B~&b, Joshipura f k ;;" &çÿ Ëî~(CHD)*~ &Wj "î, ; *^ j &çb 6j*~ º'(HPFS)öB ~"î~ ®º © b B ÎW &Ú ~j>& 10 ~ Ò²f ~j >& 25 Ò²ö j CHD*þê& ¸~b F¯ ~"î ~ ìº Ò² ÒöBº &N ìº ©j «~& . F¯~ Ö"ö On~ ¶º ~ Ú*¦ Ò, º ¦Ò, .¦Ò, Û&, r"f , ;Ãç"~ & Wynder, Bross, Feldman6) (Gram) 7). 8). 9). 10). 11). 12). 13). 14). 12).

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(7) Î ¦êj A ^êR¢ ·W . ªC~ "ºÖ"º r" ?. 1. WBvæWö & ¦Æ Ú*¦Ò, º ¦Ò, .¦Ò, Û&, r" ., ~ ò . .O, ;Ãç, ;;ç ¶Î~ W BvæWf 'ê æ> GFI, CFI, TLI, RMSEA¢ Ï~ ªC Ö" Îv ' º*ö ®îbæ WBvæWf ;>î . 2. ' º" ;;çf~ &NWj V * O ; Îj ªC Ö" º ¦Ò¢ B Î º ;;çö 'Ëj ~ ®r {>îb ¢ J« «' Îj » > ®î . ç~ Ö", ~" O^" ~^î ãþ 'f ³2æ êæö j ~jÖÃ, ~j Ö¶N, ~~jº¶N ¸ ~b, r" . ~jÖÃ, ~"î~, ~jÖ¶Nö ¦;' 'Ëj " ®rj { > ®î . $ ~"î~f * Ú~ 43.2%öB &V>îb Ôf _öB ô {>î . &¦ª~ ;î~f R: ;;¯ÿ~ Âb .O &Ë~æ * ' æ ²¢ 7b ;*^&ö ~ : Û&" ;;&Òö & ;vG Úê'b Ú^¢ ~, ãB', æÒ' Ë ~"V&j O^~æ á~¾ ~^î, ~~ËO ~ ; ;¯*¢ ²f® ~æ pê ~V * ~" ~òBjÊ 7"ê¢ ¸®º ;k*~ ºB . $, ;;çf *;"~ &NWj J«~V * Îj »~V *Bº ;{ ¦ÒO»" Î"' æR BB F¯>Ú¢ . öBº ";þ öB BB Ïj & 'Ï~&V r^ö Î W ö ê6 ®î . Ëê ê³' & jº ©b Ò òB . ^^ò 1. Strauss RP, Ronald JH: Understanding the value of teeth to older adults: Influences on the qualty of life. J A D A 124: 105-114, 1993. 2. McGrath C, Bedi R: Influences of social support on the oral health of older people in Britain. Journal of oral rehabilitation 29: 918-922, 2002. 3. Petersen PE, et al.: Oral health behavior and attitudes of adults in Lithuania. Acta Odontol Scand 58: 243-248, 2000. 4. Gilbert GH, Branch LG, Orav EJ: Predictors of older adults longitudinal dental care use: Ten year results. Medical Care 28(12): 1165-1180, 1990. 5. Sheiham A, et al.: The relationship between oral health status and Body Mass Index among older people: A national survey of older people in Great Britain. British Dental Journal 192: 703706, 2002. 6. Wynder EL, Bross LJ, Feldman RM: A study of the etiological factors in cancer of the mouth cancer. Dent Res 10: 1300, 1967. 7. Derdivanis JP, Bushmaker S, Dagenais F: Effects of a mouth wash in an irrigating device on accumulation and maturation of.

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