Journal List > J Korean Acad Oral Health > v.39(2) > 1057634

Cho and Shin: Dental care utilization patterns by the status of ADL and IADL in the elderly

Abstract

Objectives

This study sought to analyze the effects of ADL and IADL on dental care utilization behaviors for the elderly 65 years of age and older.

Methods

Using data from the Korea Health Panel 2010-2011, we examined 2683 elderly people who did not use dental care and 12,550 cases of dental care utilization of 963 elderly people who used dental care among people aged 65 and older who responded to the items of ADL and IADL limitations. We employed two-part model (TPM) including logistic regression analysis in a first part of the model and negative binomial regression analysis in a second part of the model to estimate dental care utilization patterns associated with ADL and IADL of elderly adults.

Results

A frequency analysis revealed that dental care utilization was more frequent in the elderly with IADL limitations than in the elderly with ADL limitations. The first part of TPM predicted that dental care utilization was more likely to be present in males and younger age group along with increasing number of chronic diseases and independence in ADL and IADL. The results of the second part of TPM estimated the quantity of dental care utilization increased among high income groups.

Conclusions

Limitations in ADL and IADL were found to affect the decision to seek dental care utilization, but physical limitations to have no statistical effect on the quantity of dental care utilization, once dental care utilization was taken for treatment. These findings suggested that dental care utilization would be determined by supplier induced demand and patient’s own power to obtain treatment. Since decision to take dental care utilization, despite the barriers of limitations in activities, is an important factor which can satisfy medical needs, various policies to reflect oral health and physical fitness are required.

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Table 1.
Correlation of variables
Gender Age Married Education Income Chronic disease ADL IADL
Gender 1.00
Age 0.02 1.00
Married 0.45* 0.11* 1.00
Education ―0.39* ―0.08* ―0.28* 1.00
Income ―0.11* ―0.16* ―0.08* 0.26* 1.00
Chronic disease 0.16* 0.11* 0.08* ―0.04* ―0.10* 1.00
ADL 0.00 0.06* 0.04* ―0.04* 0.00 0.06* 1.00
IADL 0.06* 0.12* 0.12* ―0.13* ―0.04* 0.09* 0.68* 1.00

*P<.05 ADL, activities of daily living; IADL, instrumental activities of daily living.

Table 2.
Variance inflation factor (VIF) and tolerance on ADL, IADL
Variable VIF Tolerance
ADL, IADL 1.89 0.53
Condition number 8.25

ADL, activities of daily living; IADL, instrumental activities of daily living.

Table 3.
Dental care utilization and non dental care utilization for the elderly 65 years of age and older
Outpatient for the elderly 65 years of age and older (N=3,646)
Dental care utilization Non Dental care utilization χ2
N=963 (26.4) N=2.683 (73.6)
Gender Male 456 (28.6) 1,138 (71.4) 7.02**
Female 507 (24.7) 1,545 (75.3)
Age 65-69 361 (28.6) 903 (71.4) 17.83**
70-74 340 (27.6) 894 (72.4)
75-79 185 (24.8) 562 (75.2)
80-85 60 (21.4) 221 (78.6)
≥85 17 (14.2) 103 (85.8)
Martial status Married 665 (27.2) 1,778 (72.8) 3.09
Divorced/Widowed/Separated 296 (24.7) 902 (75.3)
Unmarried 2 (40.0) 3 (60.0)
Education ≤Primary school 541 (24.3) 1,686 (75.7) 13.39**
Middle school 172 (29.2) 417 (70.8)
High school 169 (30.0) 394 (70.0)
≥College 81 (30.3) 186 (69.7)
Household income quartile Low 226 (24.5) 696 (75.5) 3.60
Low-middle 234 (25.8) 673 (74.2)
High-middle 248 (27.2) 663 (72.8)
High 255 (28.1) 651 (71.9)
Number of chronic disease 1-2 283 (23.6) 915 (76.4) 7.70*
3-4 324 (27.1) 870 (72.9)
5-6 200 (28.1) 511 (71.9)
≥7 156 (28.7) 387 (71.3)
ADL Independent 918 (27.2) 2,459 (72.8) 21.14***
Independent with difficulty 38 (21.1) 137 (78.9)
Needs help 7 (9.5) 67 (90.5)
Dependent 0 (0.0) 20 (100)
IADL Independent 724 (28.3) 1,832 (71.7) 26.81***
Independent with difficulty 209 (23.7) 674 (76.3)
Needs help 27 (18.0) 123 (82.0)
Dependent 3 (5.3) 54 (94.7)

*P<.1, **P<.05, ***P<.0001. ADL, activities of daily living; IADL, instrumental activities of daily living.

Table 4.
Mean number of dental care utilization by ADL, IADL
Four levels ADL IADL
Mean Sd Mean Sd
Independent 13.1 16.5 13.4 17.3
Independent with difficulty 12.6 16.6 12.2 13.8
Needs help 7.7 11.4 8.9 9.0
Dependent 0.0 0.0 6.0 2.6

ADL: activities of daily living, IADL: instrumental activities of daily living.

Table 5.
Impact of ADL, IADL on dental care utilization: results from TPM
Model 1 Model 2 Model 3
Logistic(n=3646) Negative Binomial(n=963) Logistic(n=3646) Negative Binomial(n=963) Logistic(n=3646) Negative Binomial(n=963)
OR P IRR P OR P IRR P OR P IRR P
Sociodemographics
Gender Female 0.82 0.033 0.94 0.456 0.82 0.032 0.94 0.436 0.82 0.032 0.94 0.425
Age 65-69 2.05 0.010 1.82 0.025 1.84 0.031 1.60 0.084 1.89 0.023 1.65 0.061
70-74 1.98 0.014 1.76 0.033 1.79 0.038 1.56 0.100 1.84 0.030 1.61 0.075
75-79 1.75 0.046 1.71 0.048 1.61 0.092 1.54 0.113 1.66 0.075 1.59 0.086
80-85 1.48 0.202 1.13 0.673 1.36 0.307 1.01 0.961 1.40 0.266 1.05 0.877
Martial status Divorced 1.76 0.540 0.79 0.749 1.74 0.549 0.78 0.734 1.73 0.553 0.78 0.734
Widowed
Separated
Unmarried 1.08 0.390 1.04 0.670 1.09 0.367 1.03 0.726 1.09 0.379 1.03 0.720
Socioeconomics
Education Middle school 1.17 0.136 1.07 0.468 1.16 0.179 1.07 0.478 1.16 0.175 1.07 0.467
High school 1.18 0.150 1.06 0.577 1.15 0.211 1.04 0.678 1.15 0.210 1.04 0.674
≥College 1.21 0.218 1.16 0.253 1.18 0.287 1.16 0.259 1.19 0.266 1.17 0.247
Household Low-middle 1.03 0.757 1.24 0.029 1.03 0.776 1.22 0.041 1.03 0.775 1.22 0.037
income High-middle 1.10 0.388 1.21 0.045 1.10 0.376 1.20 0.060 1.10 0.381 1.20 0.057
High 1.13 0.286 1.18 0.094 1.12 0.298 1.17 0.117 1.12 0.307 1.16 0.121
Health status
Number of 3-4 1.27 0.012 0.88 0.148 1.27 0.012 0.89 0.177 1.27 0.012 0.89 0.192
chronic disea 5-6 1.37 0.005 1.01 0.933 1.38 0.004 1.02 0.839 1.38 0.004 1.02 0.839
≥7 1.44 0.002 1.11 0.330 1.45 0.002 1.12 0.265 1.45 0.002 1.12 0.265
ADL Independent 0.83 0.330 1.08 0.668
with difficulty
Needs help 0.29 0.002 0.61 0.214
Dependent (om mitted) (om itted)
IADL Independent 0.84 0.072 0.94 0.483
with difficulty
Needs help 0.65 0.056 0.76 0.196
Dependent 0.15 0.002 0.52 0.300
ADL+IADL Independent 0.85 0.088 0.94 0.476
with difficulty
Needs help 0.61 0.038 0.76 0.237
Dependent 0.11 0.002 0.39 0.216

* P<.05. Reference: Male, ≥85 years, Married, ≤Primary school, Low, 1-2, Independent. Model 1: sociodempgraphic and socioeconomic and health status including ADL, Model 2: including IADL except for ADL, Model 3: including the sum of IADL and ADL expect for ADL, IADL, respectively. OR, odds ratio; SE, standard error; IRR, incidence rate ratios; ADL, activities of daily living; IADL, instrumental activities of daily living.

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