Dental Care Utilization and Oral Diseases Among US Older Adults with Depressive Symptoms and Difficulty with Physical Functioning

Abstract

Objectives: To investigate the oral health status and the prevalence of dental care utilization among older adults experiencing depressive symptoms and difficulty with physical functioning.

Methods: This study was a secondary data analysis of a US National Health and Nutrition Examination Survey data, 2011-2018. Individuals aged ≥65 years who completed the oral health examination, oral health questionnaire, physical functioning questionnaire and depression screening were included (n=5434). Several indicator variables were analyzed. Descriptive statistics examined dental care utilization in individuals with varying depressive symptoms and difficulty in physical function. Multivariable logistic regression models assessed associations with dental care utilization. Trends were analyzed from 2011 to 2018. Poisson regression determined the association between untreated dental caries and missing teeth in individuals with depressive symptoms and difficulty in physical function.

Results: Among older adults aged 65 and above, the prevalence of dental care utilization in individuals with depressive symptoms was lowest in the moderate to severe depression group (50.53%). Between 2011 and 2018, there was an overall increase in dental care utilization across all groups with depressive symptoms: no symptoms (from 66.92% to 70.45%), mild depression (from 57.60% to 68.81%), and moderate to severe depression (from 49.19% to 54.94%). People with moderate to severe depression had statistically significant lower odds of utilizing dental services during the past year compared to those without symptoms of depression (AOR: 0.63, 95% CI [0.45-0.91]). Among those who have difficulty in physical functioning, the prevalence of dental care utilization was highest among older adults ≥65 in the GPA domain 61.99% (95% CI: 58.99-65.00) and lowest was in the LSA domain 52.23% (95% CI: 48.08-56.39). From 2011 to 2018, there was an overall increase in dental care utilization in all physical function domains; LEM (55.96%- 65.76%), GPA (58.46%-66.09%), IADL (53.67%-62.53%), ADL (52.87%-62.09%), LSA (49.62%- 59.73%). There were statistically significant lower odds of utilizing dental services during the past year for individuals who exhibited difficulties in physical functioning compared to people who didn’t have difficulties in physical functioning [IADL (AOR: 0.68, 95% CI (0.58-0.81)), ADL (AOR: 0.75, 95% CI (0.6-0.91)), GPA (AOR: 0.63, 95% CI (0.52-0.75)) and LSA (AOR: 0.59, 95% CI (0.48-0.73)]. The highest overall mean number of missing teeth and untreated dental caries was among those with ADL, LSA, and IADL difficulties. People with LEM (AOR: 1.61, 95% CI (1.11-2.32)) and IADL (AOR: 1.57, 95% CI (1.09-2.25)) had higher odds of teeth decay, while those with IADL (AOR: 1.31, 95% CI (1.16-1.48)), ADL (AOR: 1.26, 95% CI (1.10-1.44)), and LSA (AOR: 1.24, 95% CI (1.07- 1.43)) had higher odds of missing teeth in the past year compared to people without these difficulties.

Conclusions: From 2011 to 2018, dental care utilization increased for older adults with depressive symptoms and difficulty in physical function. Those with moderate to severe depression or difficulty in most physical function domains had significantly lower odds of utilizing dental services. Utilization differences were observed among various racial groups, lower educational levels, and lower income-to-poverty ratios. Tailored strategies are needed for these groups facing challenges in utilizing dental care. A multidisciplinary approach is necessary to address barriers and improve oral health outcomes.