以結構方程模式檢驗社區老年人口腔機能、身體功能與口腔健康生活品質之相關性

背景：老年人缺牙、齲齒、牙周病、口乾等不良口腔健康狀況跟全身健康問題是有相關的，進而影響社區老年人咀嚼、吞嚥功能及生活品質，然而鮮少有研究探討身體功能、口腔機能與生活品質之間相關性。目的：本研究的目的是使用結構方程模型(structural equation modeling, SEM)來檢驗臺灣老年人口腔機能、衰弱症、肌少症和口腔健康相關生活品質(oral health-related quality of life, OHRQoL)之間的相關性。方法：本研究採橫斷性研究設計針對高雄市1100名 ≥ 65歲以上的老年人進行結構式問卷與口腔健康狀況檢查。若有精神障礙、中、重度認知障礙、日常生活活動需中度以上依賴程度和語言表達困難的人將予以排除。口腔檢查由牙醫師執行，以一對一訪談收集問卷資料，包含基本人口學、口乾、食物質地咀嚼問卷、吞嚥功能、身體功能和老年人口腔健康相關生活品質(Geriatric Oral Health Assessment Index, GOHAI)。此外，使用變色口香糖客觀測量咀嚼表現以及10秒口腔輪替運動(oral diadochokinesis)。本研究使用多元迴歸模型分析了老年人身體功能與口腔狀況之間的關係。而最終模型使用結構方程模型(SEM)之路徑分析(path analysis)探討變項之間的直接和間接途徑。結果：約42.2%的參與者擁有少於20顆自然牙齒；16.1%有吞嚥困難；11.6%有口乾問題；27.1%有咀嚼表現不佳。在口腔機能方面，吞嚥困難的老年人與衰弱症相關(調整後的危險比[aOR=2.43])和肌少症(aOR=3.05)也顯著相關；口乾與衰弱症(aOR=2.48)和肌少症(aOR=2.60)顯著相關；OHRQoL的顯著影響因素是衰弱症(β= ‐1.69)、肌少症(β= ‐3.17)、功能牙<20顆(β=‐1.57)、口乾(β=‐4.11)和自覺吞嚥困難(β=‐2.98)。路徑分析結果顯示，口乾、衰弱症、肌少症、吞嚥困難、咀嚼表現對生活品質有直接影響(p<0.001)，模型經調整各變項後，總效應對GOHAI得分有顯著影響(p<0.001)。而口乾透過自然牙齒/功能性牙齒數量、吞嚥困難、咀嚼表現產生間接效應影響生活品質。結論：口乾在老年人口腔功能中扮演重要角色，不僅會影響吞嚥功能與身體機能，甚至造成生活品質變差。因此應在社區舉辦口腔健康促進活動，以改善老年人的口腔機能，促進口水分泌。此外，應更留意社區老年人中< 20顆存留牙齒、後牙咬合對數少、吞嚥和咀嚼機能差，以及有口乾問題者，來改善並提升他們的口腔健康相關生活品質。

關鍵字

口腔機能；口乾；牙齒狀態；肌少症；衰弱症；口腔健康相關生活品質；結構方程模式

並列摘要

Backgrounds: The oral functions associated with aging results in xerostomia and tooth loss, influencing the strength of chewing, swallowing and quality of life. Objectives: We aimed to use structural equation modeling (SEM) to assess the relations between oral function, frailty, sarcopenia and oral health-related quality of life (OHRQoL) in Taiwanese elderly. Methods: This cross-sectional survey recruited 1100 adults aged ≥ 65 years old. People with mental disorder, moderate to severe cognitive impairment and difficult language expression were excluded. Dental examination was implemented by dentists. Information concerning physical function, xerostomia index, food texture on chewing patterns, swallowing function, and Geriatric Oral Health Assessment Index (GOHAI) were collected via a face-to-face interview questionnaire. Moreover, 10 seconds oral diadochokinesis and masticatory function using color-changeable chewing gum were recorded. Multivariate regression models analyzed the relationship between physical function and oral status in the elderly. Structural equation modelling (SEM) was used to estimate direct and indirect pathways between the variables. Results: About 42.2% of participants had fewer than 20 teeth, 16.1% had swallowing problem, 11.6% had dry mouth problem and 27.1% had poor masticatory performance. The elderly with swallowing problem was significantly associated with frailty (adjusted odds ratio [aOR= 2.43]) and sarcopenia (aOR= 3.05). Dry mouth was significantly associated with frailty (aOR= 2.48) and sarcopenia (aOR= 2.60). The significant determinants of OHRQoL were frailty (β= −1.69), sarcopenia (β= −3.17), < 20 functional teeth (β= −1.57), dry mouth (β= −4.11) and swallowing problem (β= −2.98). Path analysis indicated that xerostomia had direct effects on number of natural teeth/ functional teeth, swallowing problem, masticatory performance and QoL (p < 0.001), and it had a total effect on OHRQoL in summary score (p < 0.001) which comprised some indirect effects via dysphagia, masticatory performance. Conclusions: Xerostomia plays an important role in the elderly. Oral health promotion activities should be given in community to improve the oral function in elderly people. Also, Special consideration should be given to community elderly with regard to < 20 teeth, occluding pairs, poor swallowing and masticatory function, and dry mouth concerns in order to improve their OHRQoL.