- 學位論文
偏鄉社區老年人缺牙顆數、咀嚼能力及口腔健康生活品質之影響因素：以台南市某地區為例
Factors Contributing to Tooth Loss, Chewing Ability and Quality of Life among the Rural Elderly in Tainan City
摘要
背景：台灣65歲以上的老年人口平均缺牙顆數高達14顆，推估65歲以上老人全口無牙比率高達21％，缺牙率高升不下，影響老年人的身心健康、加速老化，並且引發多種系統性併發症疾病。嚴重缺牙會影響咀嚼能力進而影響口腔健康相關生活品質。 目的：本研究目的為了解老年人缺牙的影響因素，並探討缺牙顆數對於咀嚼能力及口腔健康相關生活品質的影響程度。 研究方法：研究對象為台南市東山區偏遠社區65歲以上老年人，使用橫斷性研究，採用立意取樣，收取樣本數300人。口腔檢查表記錄缺牙顆數，使用面對面訪談方式收集老年人人口學資料、口腔健康知識、態度、行為、環境因素、咀嚼能力、及口腔健康相關生活品質。 結果：使用多變項線性迴歸分析發現，在調整人口學變項後，年齡(75歲以上vs.74歲以下)(B=5.51；95%CI=4.01，7.01)，P值<0.001、性別(男vs.女)(B=1.77；95%CI=0.46，3.08)，P值=0.008、刷牙時間(未達二分鐘vs.二分鐘以上)(B=3.21；95%CI=0.72，5.70)，P值=0.012、使用牙膏牙粉刷牙(無vs.有)(B=4.04；95%CI=1.61，6.48)，P值=0.001、刷牙頻率(未達二次vs.二次以上)(B=2.03；95%CI=0.46，3.61)，P值=0.012、牙科可近性(遠vs.近)(B=-1.69；95%CI=0.32，3.06)，P值=0.016，以上與缺牙顆數有顯著相關。 年齡(75歲以上vs.74歲以下)(B=-2.82；95%CI=-4.57，-1.07)，P值=0.002、教育程度(國中以下vs.國中含以上)(B=-2.44；95%CI=-4.55，-0.33)，P值=0.024、缺牙顆數(B=-0.61；95%CI=-0.81，-0.41)，P值<0.001，以上與咀嚼能力有顯著相關。 性別(男vs.女)(B=1.80；95%CI=0.33，3.26)，P值=0.016、教育程度(國中以下vs.國中含以上)(B=4.78；95%CI=2.61，6.94)，P值<0.001、均月收入(10000以下vs.10001以上) (B=1.88；95%CI=0.36，3.41)，P值=0.015、咀嚼能力(B=-0.66；95%CI=-0.78，-0.54)，P值<0.001，以上與口腔健康相關生活品質有顯著相關。 結論：結果發現，偏鄉地區老年人的口腔潔牙行為及牙科就診可近性與其缺牙顆數有顯著相關，缺牙顆數對於咀嚼能力有顯著相關，咀嚼能力與口腔健康相關生活品質亦有顯著相關。因此，缺牙顆數與咀嚼能力及口腔健康生活品質是息息相關的，藉由改善就診的可進性，改善偏鄉醫療不足的問題，增加偏鄉地區的口腔衛生推廣，落實口腔潔牙行為，降低老年人缺牙機率，改善其咀嚼能力，提升口腔健康相關生活品質。
並列摘要
Background: With a mean number of 14 missing teeth founded in the elderly whose age are over 65-year-old in Taiwan, it is assumed that the percentage of the elderly with edentulous could be high up to 21%. Due to the percentage of edentulous occurred in the elderly keeps raised, the health of the elderly is affected and fastened the speed that people get aged, then cause many systematic complications as a result. When an old person has a serious situation of missing teeth, the chewing ability will be affected accordingly and thus his oral health-related quality of life gets affected as well. Objective: This study is aim to realize what factors causes the situation of missing teeth in the elderly and to find out how much degree that the numbers of missing teeth would affect one's chewing ability and oral health-related quality of life. Method: The participants for this study are the old people whose age over 65-year-old live in the Dongshan remote community in Tainan City. The 300 participants are chose by purposive sampling and study with cross-sectional study. The way to record the numbers of missing teeth is using oral check list and collect the population information, the oral health related information such knowledge, attitude and behaviors, surroundings, the chewing ability and oral health-related quality of life by interviewing with the elderly personally, Conclusion: When analyzing with multivariable linear regression analysis, we found out that after changing the variable of population, the factors such as Age(above 75yr vs. below 74yr)(B=5.51; 95%CI=4.01, 7.01), P value<0.001; Gender(male vs. female)(B=1.77; 95%CI=0.46, 3.08), P value=0.008; Time for brushing teeth(less than two minutes vs. two minutes or more)(B=3.21; 95%CI=0.72, 5.70), P value=0.012; Brush with toothpaste or tooth powder(yes vs. no)(B=4.04; 95%CI=1.61, 6.48), P value=0.001; Frequency of brushing(less than two times vs. two times or more)(B=2.03; 95%CI=0.46, 3.61), P value=0.012; availability to a dentistry(far vs. nearby)(B=-1.69; 95%CI=0.32, 3.06), P value=0.016, are significant correlation to the numbers of missing teeth. Factors such as Age(older than 75yr vs. younger than 74yr)(B=-2.82, 95%CI=-4.57, -1.07), P value=0.002; Education (below junior high school vs. above junior high school)(B=-2.44; 95%CI=-4.55, -0.33), P value=0.024; Numbers of missing teeth(B=-0.61; 95%CI=-0.81, -0.41), P value<0.001, are approved to be significant correlation to chewing ability. Factors such as Gender (male vs female) (B=1.80; 95%CI=0.33, 3.26), P value=0.016; Education (beyond junior high school vs. above junior high school) (B=4.78; 95%CI=2.61, 6.94), P value<0.001; Average monthly income(less than 10,000 vs. more than 10,001) (B=1.88; 95%CI=0.36, 3.41), P value=0.015; Chewing ability (B=-0.66; 95%CI=-0.78, -0.54), P value<0.001; are all significant correlation to oral health-related quality of life. Discussion: As the conclusion indicates, the teeth cleaning behavior and the availability to a dentistry for the elderly in remote community are strongly related to the numbers of missing teeth which is significant correlate to the chewing ability and then approved to be strongly connected to the oral health-related quality of life. The numbers of missing teeth are strongly closed to chewing ability and oral health-related quality of life. By improving the availability to a dentistry and insufficient medical resource in remote communities, promoting widely about oral health and exactly cleaning teeth and maintaining oral health do make some attributes to decrease the possibility to loss teeth for the elderly and thus to improve the chewing ability and increase the oral health-related quality of life. Keywords: the elderly, the number of missing teeth, chewing ability, oral health-related quality of life