الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The prolongation of life span and life expectancy emphasized the importance of the geriatric population which is rapidly growing, especially in the last decades. Worldwide, there is an increasing interest in the measurement of quality of life (QOL) which is used for the assessment of patients‟ physical, mental, and social well-being. Dental epidemiology recently used several measures to assess the extent to which oral conditions may disrupt the normal social role that would lead to major changes in the individual‟s behavior. Such measures are known as socio-dental indicators or Oral Health Related Quality of Life measures (OHRQoL). Subjective Oral Health Status Indicators, SOHSI, is a tool that was essentially developed to describe the functional, social and psychological outcomes of oral disorders and conditions that affect elder‟s quality of life.
In Egypt, there are very few updated statistical database regarding the oral health condition of the elderly which encouraged further research to investigate the various factors affecting the quality of life of this rapidly growing priority group. Therefore, the present study‟s rationale was to detect the relevance of oral health and access to dental care to the quality of life of Egyptian institutionalized elderly, 65+ years old, in Alexandria, using the already validated subjective oral health status indicators, SOHSI.
The aim of the study was fulfilled through four main objectives; assessing the oral health conditions of institutionalized elderly, assessing their access to dental care, evaluating their oral Health Related Quality of Life and detecting its relation with oral health and access to dental care.
The current study was a cross-sectional, analytical design. It surveyed 1238 institutionalized elderly, sixty five years and older, of whom 990 individuals were actually included and 248 were excluded as they were either Alzheimer‟s patients, demented, had psychological or mental problems, uncooperative, or refused to participate in the study. Both genders were comprised in the survey, with a mean age of 74±7 years. They were recruited from all private and public geriatric institutions in Alexandria, Egypt. They were examined and interviewed, using a specially designed questionnaire that included three main parts; the first part assessed the socio-demographic data, whereas the second part enquired about access to dental care and the third part investigated the quality of life of the studied population using the Subjective Oral Health Status Indicators (SOHSI) (appendix VI, VII). The SOHSI index consisted of six domains that enquired about the ability to chew and speak, oral and facial pain symptoms, other oral symptoms, dry mouth complains and the eating impact scale. After filling these three parts; a clinical examination was performed by the researcher using disposable mirrors, and CPI dental probes, to assess the elder‟s oral health status.
The statistical package for social sciences (SPSS, version 20.0) was utilized for data analysis and tabulation.Results of the current study showed that more than two thirds of the surveyed elderly suffered from hypertension (68.5%) whereas 43% had diabetes mellitus. Although many of the present study participants were well educated (43%) and belonged to private institutions (62.8%), they still had bad oral hygiene with nearly one quarter having calculus deposits and more than half never brushed their teeth. A high prevalence of periodontal disease, decayed and missing teeth was detected and more than one third of the participating elders had oral mucosal lesions. The majority of the surveyed elderly had access to dental care when needed, however, less than 10% were regular users of the service; 86% reported it was expensive and 85.5% found it satisfactory. More than half of the study population (58.8%) reported the inability to get a dental appointment as the main barrier for receiving dental care; followed by lack of transportation (36.8%). The majority of elders had decreased salivation due to polypharmacy, especially high intake of antihypertensive and antidepressant drugs, which ultimately increased xerostomia and dry mouth, affected their ability to chew and speak and resulted in high prevalence of root caries and periodontal disease. Regression analysis showed a significant impact of root caries and oral mucosal lesions on the quality of life of the study participants that was not affected by access to care Based on the results of the present study, it can be concluded that elders. oral health condition as well as regular access to care are intimately related to their OHRQoL, therefore, overall quality of life. Good oral health is essential to an older adult‟s general health and well-being. Since dental prostheses are still a poor substitute for natural dentition, prevention of total tooth loss is, hence, recommended for people of any age. Yet, many elderly experience significant barriers to obtaining the necessary dental care. Thus, it is recommended to educate the staff of geriatric institutions, patients, and caregivers; to provide and/or increase the accessibility of oral hygiene aids such as toothbrushes, toothpastes and mouthwashes in elderly homes. Furthermore, health authorities must address special attention when planning interventions on oral health for the elderly population.