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

Han-A Cho; Hosung Shin

doi:10.11149/jkaoh.2015.39.2.102

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

Original Article

J Korean Acad Oral Health 2015;39(2):102-109.

Published online: 12 June 2015

DOI: https://doi.org/10.11149/jkaoh.2015.39.2.102

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

Han-A Cho, Hosung Shin

Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, Iksan, Korea

Corresponding Author: Hosung Shin Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460 Iksan-dearo, Iksan 570-749, Korea Tel: +82-63-850-6915 Fax: +82-63-850-6934 E-mail: shinhosung@gmail.com

Received 26 February 2015 Revised 2 April 2015 Accepted 13 April 2015

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: ADL, Dental Care Utilization, IADL, Korea Health Panel

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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)	χ²
Gender	Male	456	(28.6)	1,138	(71.4)	7.02**
Gender	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
Four levels	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
income	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
chronic disea	≥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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