Social gradients in quality of life of older people

Objectives: This study aimed to: 1) assess whether there was an educational gradient in oral impacts among older people in London, and 2) further explore whether this persisted after adjusting for the effect of other social factors and the use of dentures.

Methods: Secondary analysis of baseline data from a randomised controlled trial of health risk appraisal. The sample consisted of 1090 community-dwelling non-disabled people aged 65 and over registered with three group medical practices in suburban London. Oral health-related quality of life (OHRQoL) was measured through the GOHAI index. Regression models allowed for the assessment of associations between GOHAI score with education and denture wearing, adjusted for age, sex and pension status.

Results: Overall, 30.6% reported high and 30.3% moderate levels of oral impacts. Impacts in relation to “swallowing” and “eating without discomfort” were frequently experienced by over 1/5 of the sample. Significant variations in OHRQoL were observed between socioeconomic groups. Participants receiving only state pension reported worse OHRQoL compared to those receiving pension from both the state and another source (p=0.010). Furthermore, lower education level was associated with worse OHRQoL; 31.2% of the lower education group, 41.3% of the middle group and 47.7% among higher educated participants were in the “normal” GOHAI group. After adjusting for age, sex, pension status and denture wearing, higher educated subjects had significantly better OHRQoL than those who completed education at a younger age (p=0.017). In addition, wearing dentures was independently associated with having worse OHRQoL.

Conclusion: Oral impacts on quality of life were prevalent but not frequent among older adults. This study has shown a clear and significant educational gradient for oral health-related quality of life among older adults, with worse perceptions at each lower level of education.

(Funding sources: European Commission, project QLK6-CT-1999-02205; Federal Education Science Ministry, Switzerland, project BBW 990311.1).