Acessibilidade a serviços de saúde bucal por pessoas idosas: uma revisão integrativa

Use of oral health services among elderly Brazilians: mediation by tooth loss

The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Use of oral health services among elderly Brazilians: mediation by tooth loss

Abstract The present study analyzed factors associated with the use of oral health services among elderly Brazilians. This was a cross-sectional study with data from the latest National Oral Health Survey (SB Brazil 2010), which considered a sample of 7,619 elderly individuals (65-74 years) for analysis. Structural Equation Modeling (SEM) was used, investigating the association between latent or observed variables, directly or mediated, in relation to the use of oral health services. Least squares estimators adjusted by mean and variance, were used by means of standardized coefficients, and standard error and confidence intervals, by applying the bootstrapping method with 1,500 iterations. Elderly individuals with a higher socioeconomic status, fewer missing teeth, and the presence of impacts of oral health conditions on their lives were directly associated with the outcome. Other factors associated with the mediated use of oral health services among elderly Brazilians included socioeconomic status, gender, age, and the use of prostheses, in addition to finding a correlation between prosthesis use and missing teeth. Tooth loss, along with other factors, played a prominent role in this study regarding the use of oral health services among elderly Brazilians, pointing to the need to expand access to dental prostheses in primary care.

Use of dental services by the Brazilian elderly: latent class analysis

OBJECTIVE

To analyze the different profiles of dental service use by the Brazilian elderly and their possible association with sociodemographic factors, comorbidities, functionality and self-perception of oral health.

METHODS

Cross-sectional population-based study, using secondary data from the National Health Survey (PNS) of 2013. The sample size was 2,969 elderly individuals. Latent Class Analysis was used to construct the dependent variable "profile of dental service use" from questions related to this profile. The independent variables formed 3 blocks: sociodemographic; comorbidities; functionalities and self-perception of oral health. The Rao-Scott Test and Standardized Residue Analysis tested the association. To measure the effect of covariates, Odds Ratio was estimated using a multiple hierarchical model of multinomial logistic regression. Significance level was 5%.

RESULTS

Three latent classes were identified: Direct Disbursement Profile, Health Plan Profile and the Unified Health System (SUS) Profile. White elderly people were associated with the Direct Disbursement and Health Plans profile. The Health Plan profile was more associated with the married marital status or living with a spouse. In the multiple model, low schooling was associated with the profile of SUS users and elderly people diagnosed with cancer with the Health Plan profile. Self-perceiving oral health as bad or very bad increased the chances of belonging to the SUS profile.

CONCLUSION

Latent Class Analysis proved to be a powerful strategy for a subtle and detailed understanding of the profile of dental service use and its relationship with associated factors.

Implicações da saúde bucal na esfera funcional de idosos brasileiros

Resumo Objetivo Objetivou-se, por meio do estudo da Pesquisa Nacional de Saúde (PNS-2013), identificar fatores com alto grau de associação com quadros de dificuldade funcional (DF) em idosos brasileiros. Material e método Estudo transversal, quantitativo, com fonte de dados provenientes da PNS-2013, considerando a amostra total de indivíduos com 60 ou mais anos (n=23.815). Para a análise, foram consideradas duas variáveis dependentes nomeadas de: Atividades Básicas de Vida Diária e Atividades Instrumentais de Vida Diária, e 30 variáveis independentes, relacionadas a condições sociodemográficas e de saúde bucal. O software Waikato Environment for Knowledge Analysis foi utilizado para realizar as análises. Inicialmente, realizou-se o balanceamento do conjunto de dados e, na sequência, foi realizado o teste de redução de dimensionalidade, por intermédio do método de validação cruzada de 10 Fold. Finalmente, as variáveis relacionadas com as variáveis dependentes foram avaliadas por meio da regressão logística. Resultado Os resultados apontam a direta associação de DF de idosos com aspectos etários, principalmente para octogenários (ABVD OR=2,19 e AIVD OR=2,82), seguidos de idosos sem escolaridade (AIVD OR=1,96), aqueles que não convivem com cônjuge ou companheiro (AIVD OR=1,65) e aspectos de saúde bucal, como: presença de dificuldade para se alimentar decorrente de problemas com dentes ou próteses (ABVD OR=1,73 e AIVD OR=1,59), não realização de consulta com cirurgião-dentista ao longo da vida (ABVD OR=1,69) e ausência de dentes naturais (AIVD OR=1,64). Conclusão Com base nos achados, ressalta-se a importância do fortalecimento de estratégias preventivas voltadas à parcela de indivíduos com 60 ou mais anos, incluindo a saúde bucal.

Factors determining the negative perception of the health of Brazilian elderly people

Abstract Objective: To identify factors that determine the negative perception of the health of the Brazilian elderly, considering sociodemographic conditions, functional limitations and illness, patterns of utilization of health services and oral health condition. Method: A cross-sectional study with data from the National Health Survey (2013), involving 23,815 elderly persons was carried out. Once the database was treated, dimensionality reduction was performed using the Waikato Environment for Knowledge Analysis. The variables related to health perception were evaluated through logistic regression to measure the magnitude of the associations. Health perception and 36 independent variables were considered as outcome variables. Results: The variables most strongly related to the negative perception of the health of the elderly were illiteracy (OR=1.48), low educational level, total difficulty in performing instrumental activities of daily living (OR=2.04), impossibility of performing any activity (OR=3.20), presence of a diagnosis of physical or mental illness (OR=2.44), negative self-perception of oral health (OR=1.92), an increased need for health services in recent weeks (OR=1.16), medical visits and hospitalization in the last 12 months (OR=1.40). Conclusion: The use of multidimensional methodologies can identify the influence of determinants of a negative perception of health among Brazilian elderly persons, and can support the formulation of public health policies aimed at the elderly population.

Factors associated with the use of dental care by elderly residents of the state of São Paulo, Brazil

Abstract Objective: To investigate factors associated with the use of dental care services. Methods: A cross-sectional study with a representative sample of elderly individuals aged 65 years or older residing in the state of São Paulo in 2015 was performed. Hierarchical multivariate logistic regression analysis was used based on the theoretical model of access determination proposed by Andersen (1995) to predict dental care visits. Results: The prevalence of public service use by the elderly was 1.981 (37.8%), while 3.253 (62.2%) used the private service/ health plan/ other type of service. Hierarchical multiple analysis (p≤0.05) identified that less schooling or never having studied, non-white, lower income and motivated by pain/extraction were associated with the use of public dental services. The study showed a reduced use of public dental care among elderly persons who required some type of upper dentures (except complete dentures), need for some type of lower dentures (including complete dentures) and demonstrated a positive self-perception of oral health condition. Conclusions: A higher prevalence of the use of private dental care/health plan/other type of service was identified. Less schooling or never having studied, non-white skin color, lower income and seeking the dentist with pain or to extract teeth were factors associated with the use of public dental services by the elderly.