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

Abstract

Objectives: The aim of this study was to 1) assess the prevalence and trends of dental care utilization among US older adults≥65, and 2) determine the associations between dental care utilization and self-reported depressive symptoms and difficulty in physical functioning. Methods: This study was a secondary data analysis of a US National Health and Nutrition Examination Survey data, 2011-2018, a nationally representative health survey conducted in the United States (n=5434). Chi square analysis was conducted to describe dental care utilization among older adults ≥65 with five indicator variables (age, gender, race/ethnicity, educational level, and ratio of family income to poverty). Multivariable logistic regression analyses were performed to examine the associations between dental care utilization and 1) self-reported depressive symptoms (no symptoms, mild, and moderate to severe symptoms), and 2) difficulty in physical functioning (LEM: Lower extremity mobility, GPA: General physical activities, IADL: Instrumental activities of daily living, ADL: Activities of daily living and LSA: Leisure and social activities). Results: For older adults with difficulty in physical functioning and those who reported depressive symptoms, the lowest prevalence of dental care utilization was in males, NH-Blacks, individuals with a lower ratio of family income to poverty (≤1.35) and with less than a high school degree.

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 was statistically significant lower odds of utilizing dental services during the past year 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 prevalence of dental care utilization in individuals with depressive symptoms was lowest among older adults aged 65 and above who were in the moderate-severe depression group (50.53%). There was an overall increase in dental care utilization in all groups of depressive symptoms between 2011 to 2018; no symptoms (66.92%-70.45%), mild depression (57.60%-68.81%) and moderate to severe depression (49.19%-54.94%).

People who had moderate to severe depression had statistically significant lower odds of utilizing dental services during the past year compared to people who didn’t have symptoms of depression (AOR: 0.63, 95% CI (0.45-0.91)) Conclusions: Although dental care utilization increased between 2011 and 2018 for older adults aged ≥65 years with self-reported depressive symptoms and difficulty with physical functioning, disparities persisted among different race groups, those with lower educational levels, and those with lower ratios of family income to poverty. These groups face significant challenges in accessing and utilizing dental care, and as such, may require tailored strategies to increase their utilization of dental services.