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Chewing ability and quality of life in an 80-year-old
K. FUJISAWA*, S. AKIFUSA\u2020& T. TAKEHARA \u2020*Divisions of General Internal Medicine and\u2020Community
Oral Health Science, Department of Health Promotion, Kyushu Dental College, Kitakyushu, Japan
SUMMARYAs quality of life (QOL) could be in\ufb02u-

enced by oral status in the elderly, we examined whether chewing ability or number of teeth affec- ted QOL in 80-year olds. A cross-sectional survey included dental examination, chewing self-assess- ment, and a QOL questionnaire. A total of 823 people who were 80 years old participated in this study. QOL was assessed in terms of satisfaction with physical condition, meals, daily living and social interactions, and with face-scale scores. After adjustment for gender, spouse and activities of daily living, dissatisfaction with social interac- tions was 3\u00c69 times more prevalent in individuals

able to chew four foods or fewer than in those chewing 15. Dissatisfaction with physical condi- tion, meals and daily living, and poor face-scale scores, were 2\u00c67, 2\u00c64, 3\u00c64, and 2\u00c64 times more prevalent, respectively, in subjects chewing four foods or fewer. The number of teeth showed little effect. In conclusion, self-assessed chewing ability but not number of teeth was associated with QOL in 80-year-old subjects.

KEYWORDS: elderly populations, quality of life, chew-
ing ability, number of teeth
Accepted for publication 29 July 2005

Tooth loss commonly occurs in association with ageing, compromising mastication of food (1\u20134). Impaired chewing ability may adversely affect nutritional status (5\u201310) and undermine general well-being (4, 8, 10\u201312). In a longitudinal study where subjects were followed up between age 75 and 80 years, a relationship between chewing problems and general functional limitations was evident (9).

Quality of life (QOL), de\ufb01ned as a person\u2019s sense of well-being derived from satisfaction with daily living, was reported to be closely related to chewing ability in elderly persons residing in a rural community in Japan (13). Better QOL was seen more often in dentulous than edentulous individuals aged\u202170 years (11). Simi- larly, in an Italian population aged 70\u201375 years, func- tional dental status was shown to be associated with several QOL domains and the authors encouraged

extensive use of dentures (14). In subjects with a mean age of 83 years, Canadian investigators (15) found a signi\ufb01cant effect of oral disorders on well-being and life satisfaction. Although several studies suggest a rela- tionship between chewing ability and QOL in the elderly as mentioned above, such an association has not yet been broadly established.

We concluded from observations in an 80-year-old Japanese population that decreased physical capacity associated with tooth loss could be improved by the use of dentures (16), and that a positive relationship existed between chewing ability and physical activity (17). More recently, we found an association between activities of daily living (ADL) scores and chewing ability in an 80-year-old population (18). In the present study, we therefore examined relationships of QOL status in 80-year olds to chewing ability as well as to number of teeth. The number of foods that the subjects could chew was used as an indicator of chewing ability.

\u00aa2006 Blackwell Publishing Ltd
doi: 10.1111/j.1365-2842.2005.01567.x
Journal of Oral Rehabilitation200633; 330\u2013334
Materials and methods

In 1998, we enrolled 1282 80-year-old individuals residing in one of three cities (Buzen, Yukuhashi or Munakata), four towns (Katsuyama, Tikujo, Toyotsu or Kanda), one village (Shinyoshitomi), or one ward (Tobata of Kikakyushu City) in the Fukuoka Prefecture of Japan to participate in the present study. Of the 1282 individuals, 823 participated (309 male and 514 female). As the other 36% of potential subjects declined to participate, self-selection factors could have introduced some bias in the present \ufb01ndings. The study was approved by the Human Investigations Committee of Kyushu Dental College, and informed consent was obtained from all participants. The authors performed dental examination of each subject in the manner recommended by the World Health Organization (19).

Quality of life status was determined using a prepared questionnaire with multiple choices for responses. Queried items included the following: \u2018have a spouse\u2019 (1, yes; 2, no); \u2018satis\ufb01ed with physical condition\u2019 (1, yes; 2, no); \u2018good mood after a meal\u2019 (1, yes; 2, no); \u2018satis\ufb01ed with daily life\u2019 (1, yes; 2, no); and \u2018satis\ufb01ed with social interactions\u2019 (1, yes; 2, no). Face-scale scores (20) (1, score of 1 or 6; 2, score of 10\u201320) and ADL status (1, independent; 2, dependent) were determined by public health nurses who classi\ufb01ed subjects as either independent or dependent (i.e. requiring day-to-day assistance) using the guidelines of the Health, Labor, and Welfare Ministry of Japan.

Oral health-related QOL instruments, such as Geri- atric Oral Health Assessment Index (GOHAI) (21) and Oral Health Impact Pro\ufb01le (OHIP) (22), were developed in 1990 and 1994 respectively. However, the Japanese versions of these instruments were not established until 2004 for GOHAI (23) and 2002 for OHIP (24). As the present study was performed in 1998, these instru- ments for evaluating QOL related to oral health were not yet established in Japan.

Questionnaires concerning food intake have proven valuable in epidemiological surveys of masticatory function in the elderly (3, 25\u201327). Accordingly, each subject was asked about his/her ability to chew the following 15 foods: peanuts, yellow pickled radish, hard rice cracker, French bread, beefsteak, octopus in vinegar, pickled shallots, dried scallops, dried cuttle\ufb01sh, squid sashimi, konnyaku, a tubular roll of boiled \ufb01sh paste, boiled rice, tuna sashimi, and grilled eel. These 15 foods were selected to represent four groups: three

foods that are very hard to chew, six foods moderately hard to chew, three foods slightly hard to chew, and three foods easy to chew (28). The number of these foods that a subject could chew was used as an index of chewing ability, which was assessed as a possible independent in\ufb02uence on QOL status by logistic regression analyses. The factors gender, spouse and ADL were considered as possible in\ufb02uences upon number of teeth, number of foods reported to be chewable and QOL. Adjustments were made for these categorical factors in order to identify independent risk factors for QOL compromise.

All data are reported as the mean\u00c6 s.d. Logistic regression analysis was carried out to evaluate which factors were related to QOL after adjustment for confounding variables. All statistical analyses were performed using StatView 5\u00c60*. Results were considered statistically signi\ufb01cant whenP-value was below 0\u00c605.


The mean number of teeth was 7\u00c65\u00c6 8\u00c67, and the mean number of foods that subjects could chew was 11\u00c62\u00c6 3\u00c68. QOL was evaluated in 813 individuals. The number of subjects satis\ufb01ed with their health status was 331 (40\u00c67%), while 482 (59\u00c63%) were dissatis\ufb01ed. While 454 subjects (56\u00c62%) felt satis\ufb01ed after a meal, 354 (43\u00c68%) did not. Most subjects (677; 83\u00c68%) were satis\ufb01ed with their daily life, while 131 (16\u00c62%) were not satis\ufb01ed. The number of individuals satis\ufb01ed with interactions with family or friends was 698 (86\u00c67%), while 107 subjects (13\u00c63%) were dissatis\ufb01ed. Face-scale groups of 1 and 6 were classi\ufb01ed as good QOL (n\u00bc 436; 56\u00c64%), with those of 10, 15 and 20 representing poor QOL (n\u00bc 337; 43\u00c66%).

Subjects were divided into four groups according to number of foods chewed (0\u20134, 5\u20139, 10\u201314 or 15), which was used as an index of chewing ability, and also were classi\ufb01ed into four groups by number of teeth (0, 1\u20139, 10\u201319 or\u202120). Compared by logistic regression analysis to \ufb01ndings in subjects who were able to chew 15 foods, dissatisfaction with physical condition was 2\u00c61 times prevalent in individuals with 5\u20139 chewable foods and 2\u00c69 times prevalent in those chewing 0\u20134 foods. Unhappy moods after meals were signi\ufb01cantly more prevalent in subjects who could chew only 10\u201314, 5\u20139 or 0\u20134 foods than in those chewing 15 foods.

*SAS Institute, Cary, NC, USA
Q O L A N D C H E W I N G I N T H E E L D E R L Y 331
\u00aa2006 Blackwell Publishing Ltd,Journal of Oral Rehabilitation33; 330\u2013334

Prevalence of dissatisfaction with daily life was 3\u00c67 times greater in individuals able to chew\u00a34 foods than in those who could chew 15 foods; such dissatisfaction was 2\u00c61 times as prevalent in those who had 10\u201319 teeth than in those with\u202120 teeth. Dissatisfaction with interactions with family or friends also was more prevalent in individuals with\u00a39 chewable foods. A face-scale of 10\u201320, indicating negative mood, was more prevalent in individuals with\u00a34 chewable foods and in those with 10\u201319 teeth.

Similarly, subjects were divided into four groups according to chewing ability using the number of chewable foods. Logistic regression analysis after adjust- ment for gender difference, spouse status, and ADL status revealed odds ratios (OR) and 95% con\ufb01dence intervals (CI) for a poor QOL (Table 1). These three potential confounders were included in aggregate in the logistic regression analysis. Compared with individuals able to chew 15 foods, dissatisfaction with physical condition was signi\ufb01cantly more prevalent among individuals able to chew only 5\u20139 foods, or\u00a34 foods (Table 1). Prevalence of unhappiness after a meal in individuals able to chew 10\u201314, 5\u20139 and\u00a34 foods was 1\u00c67, 2\u00c62 and 2\u00c64 times higher, respectively, than those chewing 15 foods. Dissatisfaction with daily life in subjects able to chew\u00a34 foods was 3\u00c64 times more likely than in those chewing 15 foods. Dissatisfaction with interactions involving family or friends also was pre-

valent in individuals with 5\u20139 chewable foods or those with\u00a34 foods. Similarly, a face-scale score indicating a negative mood, was more prevalent in individuals with

\u00a34 chewable foods. Compared with individuals able to

chew 15 foods, those with a reduced number of chewable foods showed more dissatisfaction according to all scales used (Table 1). In contrast, no consistent difference in prevalence of poor QOL status was found between four groups de\ufb01ned by remaining numbers of teeth, using logistic regression analysis with adjust- ment. However, dissatisfaction with daily life was more prevalent in groups with 10\u201319 teeth, and an unfa- vourable face-scale score was more prevalent in indi- viduals with 10\u201319 teeth or no teeth than in subjects with\u202120 teeth. Dissatisfaction with daily life or with social interactions was signi\ufb01cantly more prevalent in dependent subjects than in independent subjects. Gen- der difference was also slightly observed in satisfaction with daily life or social interactions (Table 1).


In the present study, we found a relationship between poor chewing ability and poor QOL status in 80-year- old subjects. The relationship was con\ufb01rmed by logistic regression analysis with adjustment for confounding factors. No consistent signi\ufb01cant relationship was found between number of teeth and QOL status. Thus,

Table 1.Logistic regression analysis of prevalence of poor QOL, adjusted for various confounding factors, in relation to number of
chewable foods or number of teeth
Satisfaction with
physical condition
Mood after
a meal
Satisfaction with
daily life
Satisfaction with
social interactions
Number of chewable foods
10 to 14
1\u00c62 (0\u00c69\u20131\u00c68)
1\u00c67 (1\u00c62\u20132\u00c64)**
1\u00c61 (0\u00c67\u20131\u00c69)
1\u00c64 (0\u00c68\u20132\u00c66)
1\u00c63 (0\u00c69\u20131\u00c69)
5 to 9
2\u00c61 (1\u00c63\u20133\u00c62)**
2\u00c62 (1\u00c64\u20133\u00c63)***
1\u00c66 (0\u00c69\u20132\u00c69)
3\u00c68 (2\u00c60\u20137\u00c62)***
1\u00c62 (0\u00c68\u20131\u00c69)
0 to 4
2\u00c67 (1\u00c64\u20135\u00c64)**
2\u00c64 (1\u00c63\u20134\u00c65)**
3\u00c64 (1\u00c66\u20137\u00c60)***
3\u00c69 (1\u00c67\u20138\u00c69)**
2\u00c64 (0\u00c63\u20134\u00c66)**
Gender difference
1\u00c60 (0\u00c67\u20131\u00c65)
0\u00c69 (0\u00c66\u20131\u00c62)
0\u00c66 (0\u00c64\u20131\u00c60)*
0\u00c65 (0\u00c63\u20130\u00c69)*
0\u00c69 (0\u00c66\u20131\u00c63)
Spouse status
1\u00c61 (0\u00c67\u20131\u00c65)
1\u00c60 (0\u00c67\u20131\u00c64)
1\u00c65 (0\u00c69\u20132\u00c64)
0\u00c69 (0\u00c65\u20131\u00c66)
0\u00c68 (0\u00c65\u20131\u00c61)
ADL status
1\u00c60 (0\u00c66\u20131\u00c67)
1\u00c62 (0\u00c67\u20132\u00c60)
2\u00c60 (1\u00c61\u20133\u00c65)*
2\u00c64 (1\u00c63\u20134\u00c63)**
1\u00c62 (0\u00c67\u20132\u00c61)
Number of teeth
10 to 19
1\u00c60 (0\u00c66\u20131\u00c66)
1\u00c64 (0\u00c68\u20132\u00c63)
2\u00c63 (1\u00c61\u20134\u00c67)*
1\u00c64 (0\u00c67\u20133\u00c60)
1\u00c69 (1\u00c62\u20133\u00c62)*
1 to 9
0\u00c69 (0\u00c65\u20131\u00c64)
1\u00c65 (1\u00c60\u20132\u00c65)
1\u00c65 (0\u00c68\u20133\u00c61)
1\u00c62 (0\u00c66\u20132\u00c66)
1\u00c65 (0\u00c69\u20132\u00c64)
0\u00c69 (0\u00c66\u20131\u00c64)
1\u00c66 (1\u00c60\u20132\u00c65)
1\u00c64 (0\u00c67\u20132\u00c67)
1\u00c64 (0\u00c67\u20132\u00c68)
1\u00c66 (1\u00c60\u20132\u00c66)*
Gender difference
1\u00c61 (0\u00c68\u20131\u00c66)
0\u00c69 (0\u00c66\u20131\u00c63)
0\u00c67 (0\u00c64\u20131\u00c61)
0\u00c66 (0\u00c64\u20131\u00c60)
0\u00c69 (0\u00c66\u20131\u00c62)
Spouse status
1\u00c60 (0\u00c67\u20131\u00c65)
1\u00c60 (0\u00c67\u20131\u00c64)
1\u00c64 (0\u00c69\u20132\u00c63)
1\u00c60 (0\u00c66\u20131\u00c66)
0\u00c68 (0\u00c65\u20131\u00c61)
ADL status
1\u00c62 (0\u00c68\u20132\u00c60)
1\u00c64 (0\u00c69\u20132\u00c63)
2\u00c67 (1\u00c66\u20134\u00c65)***
2\u00c69 (1\u00c67\u20135\u00c61)***
1\u00c63 (0\u00c68\u20132\u00c62)
Values are given as OR (95% CI). *P < 0.05, **P < 0.01, ***P < 0.001.
Y. TAKATAet al.
\u00aa2006 Blackwell Publishing Ltd,Journal of Oral Rehabilitation33; 330\u2013334

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