Geriatrics Gerontology Int - 2016 - Le n - Ultra‐short version of the oral health impact profile in elderly Chileans

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Geriatr Gerontol Int 2017; 17: 277–285
ORIGINAL ARTICLE: EPIDEMIOLOGY,
CLINICAL PRACTICE AND HEALTH
Ultra-short version of the oral health impact profile in
elderly Chileans
Soraya León,1,2 Gloria Correa-Beltrán,2,3 Renato J De Marchi4 and Rodrigo A Giacaman1,2
1
Gerodontology Research Group (GIOG) and Caridology Unit, Department of Oral Rehabilitation, 2Interdisciplinary Excellence Research
Program on Healthy Aging (PIEI-ES), 3Institute of Mathematics and Physics, University of Talca, Talca, Chile; and 4Department of
Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Aim: The aim of the present study was to develop and validate an ultra-short Spanish version of the Oral Health
Impact Profile (OHIP) in an elderly Chilean population.
Methods: The OHIP-49Sp was applied to 490 older adults, and the seven questions with the higher impact on oral
health-related quality of life were selected through linear regression. These items were applied to 85 older adults
to test internal consistency (Cronbach’s alpha). A discriminative validity analysis was carried out along with
the assessment of sociodemographic and clinical variables. Data were analyzed using the Mann–Whitney U-test,
Student’s t-test and one-way ANOVA tests with a 95% confidence level.
Results: High internal consistency values were obtained for the OHIP-7Sp instrument (0.93). There was an
association between the OHIP-7Sp scores and the presence of caries, need for complex periodontal treatment,
prosthetic needs, and age younger than 70 years.
Conclusion: The OHIP-7Sp proved to be a consistent and valid tool to assess oral health-related quality of life in
Chilean older adults, and can be incorporated in epidemiological studies that include several other targets. Geriatr
Gerontol Int 2017; 17: 277–285.
Keywords: elderly, epidemiology, oral health, Oral Health Impact Profile, public health, quality of life, short
instruments, validation.
Introduction
The requirement to assess quality of life in dental
research for different settings; for example, clinical trials
and population-based studies, poses challenges in terms
of conciliating the need for information with the extent
of the surveys. Among the various Oral Health Related
Quality of Life (OHRQoL) instruments, the Oral Health
Impact Profile (OHIP) was developed with the aim of
providing a comprehensive measure of self-reported
dysfunction, discomfort and disability attributed to the
Accepted for publication 22 November 2015.
Correspondence: Dr Rodrigo A Giacaman DDS PhD,
Gerodontology Research Group (GIOG) and Cariology Unit,
Department of Oral Rehabilitation, University of Talca, Escuela
de Odontología, 2 Norte 685, Talca, 3460000, Chile. Email:
giacaman@utalca.cl
Soraya León is currently a PhD student at the Faculty of Dentistry
of the Federal University of Rio Grande do Sul, Porto Alegre,
Brazil.
© 2016 Japan Geriatrics Society
oral condition.1 The original OHIP contains 49 questions grouped in seven dimensions based on Locker’s
model of oral health, which was adapted from the World
Health Organization’s International Classification of
Impairments, Disabilities and Handicaps.1,2 The long
version of the OHIP gives detailed information when
OHRQoL is the primary outcome in a clinical setting.
Its use, however, is rather time-consuming and requires
substantial efforts for the respondents, especially for
older adults. Hence, short forms have been proposed for
settings such as national surveys or intervention studies,
where time needs to be optimized.
Among the various OHRQoL instruments, the
OHIP-14 is one of the most widely used.3 The OHIP-14
has been validated in various languages, including
Spanish.4–6 Even the abbreviated OHIP-14, however,
can be challenging when applied to frail older adults.
The importance of assessing OHRQoL has been
widely emphasized in the USA. Yet, no national survey
has evaluated the impact of oral diseases on the quality
of life of the USA population using standardized or
doi: 10.1111/ggi.12710
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validated instruments. Conversely, national surveys in
other countries have measured the adverse impact of
oral conditions on well-being using the multidimensional and validated OHIP-14.3
In Chile, only the 2003 version of the National
Health Survey included questions about OHRQoL,
but not using validated instruments. In fact, the
National Survey of Quality of life in the Elderly has
never included questions regarding OHRQoL. In this
type of country-targeted studies, validated instruments
previously used in other countries should be ideally
applied. Thus, the ultra-short version of OHIP,7–9
appears as a reasonable option. Although the 14-item6
and 49-item10 versions of the OHIP have been validated in Chile, the ultra-short version with only seven
items has not been used or validated. A brief instrument such as the ultra-short version of the OHIP represents a powerful tool to assess the impact of oral
health on the quality of life on the elderly population.
Its inclusion in national surveys might be an opportunity to easily obtain non-existent data in Chile, which
in turn can serve as health policy-generating information. Therefore, the purpose of the present study was
to develop and validate the Spanish version of the
OHIP-7 in an elderly Chilean population.
Methods
Sample group and data collection
Two different studies were carried out: a cross-sectional
study to develop the abbreviated OHIP-7Sp with 490
community-dwelling older adults and a retrospective
study to validate the OHIP-7Sp, which used a previously obtained database of 85 community-dwelling
older adults.10 A convenience sample of patients was
recruited from the School of Dentistry of the University
of Talca, the Dental Specialties Clinic of the Talca’s
Regional Hospital, social clubs for older adults and
community healthcare centers from Talca. Ten participants per each of the questions from the OHIP-49 was
required to obtain the sample size of 490 subjects.11 For
the cross-sectional and the retrospective study, eligible
participants should be community-dwelling and aged
60 years or older. Exclusion criteria were cognitive
impairment and alcoholism. The study protocol was
approved by the Ethics Committee of the University of
Talca. The study was carried out between June and
October, 2012.
After signing an informed consent Form, two trained
dentists applied the OHIP-49Sp, previously validated.10
To facilitate the answers, a printed chart with all the
possible answers in a Likert-type scale with clear and
large letters was shown to the participants. The questionnaires were completed by the researchers. The
survey approach was chosen due to the high number of
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Chilean older adults with low educational levels and the
high prevalence of visual problems at older ages.
Statistical analysis
By adding the final score of each of its seven domains,
the final OHIP-49Sp score was obtained, ranging
between 0 and 196 points. Using the OHIP-49Sp
results, a linear regression model was carried out to
obtain the abbreviated version of the instrument with
seven questions. A controlled stepwise selection procedure was used to select seven items that mainly contributed to R2, with the condition that only one item from
each conceptual dimension was permitted to enter the
regression model.
For the validation study, the seven previously selected
questions from the cross-sectional study were tested
against a retrospective cohort of 85 participants that had
been previously assessed during the validation of the
Spanish version of the OHIP-49.10 Internal consistency
was determined using the Cronbach’s α test, as well as
the inter-item and total-item correlations. Scores were
calculated using the additive method, considering
values between 0 and 28. Responses to questions about
the perceived impact of oral problems over the preceding year were presented as a five-point ordinal scale
coded 0 = never, 1 = hardly ever, 2 = occasionally,
3 = fairly often and 4 = very often. Each theoretical
dimension of the OHIP was represented by an OHIP7Sp question. Consistent with the system established by
Slade et al.12 and one previous national survey using the
OHIP-7,7 scores were used to obtain severity and prevalence outcomes, with higher values denoting poorer
OHQoL, as follows:
• Severity was the addition of all ordinal response
codes. Severity scores had a potential range of 0–28
across the seven items, used for discriminant validity.
• Prevalence was the percentage of people responding
“fairly often” or “very often” to one or more
questions.
For discriminant validity, the seven selected questions
in the cross-sectional study were contrasted with
sociodemographic and clinical variables obtained in the
retrospective study of 85 participants. Parametric oneway ANOVA and non-parametric Kruskal–Wallis tests
were used. Statistical analyses were carried out using R
and R commander version 3.0.1 software 2013, (R
Foundation for Statistical Computing c/o Institute for
Statistics and Mathematics, Vienna, Austria).
Results
Just two questions from Slade’s original OHIP-14
matched the present OHIP-7Sp: Q43 “difficulty doing
jobs” and Q48 “unable to function,” corresponding to
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S León et al.
Social Disability and Handicap domains, respectively
(Table 1). Each question of the seven items consisted in
a five-point Likert Scale, including “never” = 0, “hardly
ever” = 1, “occasionally” = 2, “fairly often” = 3 and
“very often” = 4. Thus, the maximum score was 28 and
the minimal was 0. The cut-off point to consider a
negative impact of the OHRQoL was set at a final score
above 7. The most negative impact on the OHIP-7Sp
score arose from the physical pain and psychological
discomfort domains (33%). Specifically, in the questions “sensitive teeth” and “dental problems made you
miserable.” The negative impact in the psychological
disability, social disability and handicap domains was
very low (questions ranging from 10 to 11%; Table 1).
Once obtained, the OHIP-7Sp internal consistency
was assessed using the database with 85 participants.10
The sample was 61.18% women and 38.82% men, with
an average age of 69.02 ± 7.82 years. Among them,
32.94% of the participants had between 20 and 28 teeth,
and 27.06% were edentulous. Among participants who
had at least one tooth, 52.9% had at least one carious
lesion and 100% required periodontal treatment, either
simple or complex (Community Periodontal Index of
Treatment Needs [CPITN] 2 or 3). Prosthetic needs for
either complete or removable partial denture was
74.12% and between those already wearing one.
By analyzing the matrix of inter-item correlations
(Table 2), a positive correlation between all items was
found, ranging from 0.05 (the relationship between
“sensitive teeth” and “difficulty doing jobs,” weak) to
0.59 (the relationship between “dental problems made
you miserable” and “others misunderstood,” acceptable). No correlation resulted negative or high enough
for any item to be redundant.
The homogeneity of the scale was evaluated based on
the corrected total-item correlation coefficient. These
analyses consider the correlation between each individual item in the scale and the rest of the scale with the
item of interest eliminated. The corrected total-item
correlation coefficient ranged from 0.34 to 0.75. All
values were above the minimum corrected total-item
correlation of 0.20, which has been recommended for
the inclusion of an item in a scale.13 Cronbach’s α for
the total instrument total was 0.93 (Table 3).
Regarding the prevalence estimate, three items ranked
among the top three (Table 4) “dental problems made
you miserable” (29.4%), “digestion worse” and “sensitive teeth” (15.3%). Participants were more inclined to
report an impact that affected them “hardly ever” or
“never.” When analyzing the OHIP-7Sp global score,
the mean and median were 7.21 (SD 6.18) and 6 (range
0–22), respectively.
Results from the discriminative validity tests showed
that the global OHIP-7Sp scores had no significant relationship with the number of remaining teeth (Table 5).
A statistically significant association was found between
© 2016 Japan Geriatrics Society
the global OHIP-7Sp score and caries (P = 0.01).
Regarding the CPITN, all participants had simple (TN2)
or complex periodontal treatment needs (TN3). A statistically significant association was observed between
CPITN and the global OHIP-7Sp score (P = 0.003;
Table 5). Likewise, a statistically significant association
(P = 0.0003) was observed between the global OHIP7Sp and prosthetic needs (Table 5). When age was considered, the highest OHIP-7Sp scores were observed in
the youngest group (60–69 years). A significant association was also found between the OHIP-7Sp (P = 0.0001)
and the other domains, except for physical pain
(Table 5).
Discussion
As in the original study of the OHIP-14, the method to
obtain the OHIP-7Sp in the present study was a linear
regression with one question per dimension.3 This item
selection method has been shown to be more adequate
than the internal reliability analysis or factor analysis.14
In addition to Slade’s approach to obtain a shortened
OHIP version, Locker and Allen developed a different
strategy, based on the modified clinical impact
method.14 Both methodologies were applied in the
development of the German short forms of the OHIP,
and the authors concluded that, regardless of the methodologies used, the short and ultra-short OHIP questionnaires maintain the idea of the OHRQoL as a
construct.15
Despite obtaining a low internal consistency in some
domains, a high internal consistency was shown for the
global instrument (Cronbach’s alpha of 0.93). The
global consistency found here was higher than other
ultra-short versions of OHIP.15–17 Although, Cronbach’s
alpha between 0.70 and 0.80 is considered satisfactory
to make reliable comparisons among groups. Thus, the
high alpha value of 0.93 does indicate that the seven
items of the OHIP-7Sp accurately measure the same
construct as the whole original instrument.
In this context, has been discussed that the current
notion of the OHIP might not provide an adequate
description of its dimensional validity, and its items
might not represent the seven constructs of oral health
as originally proposed.18 In fact, evidence from a study
with Spanish workers showed that just three components explained 58.1% of variance OHIP-14, when confirmatory factorial analysis was carried out.19 Also, dos
Santos et al. investigated the dimensional structure of
the OHIP-14 with the use of confirmatory factorial
analysis in two different samples of Brazilians, concluding that the OHIP-14 is, in fact, a single construct
scale.20 Hence, in the present study, all analyses were
carried out using global scores of the instruments,
showing an excellent internal consistency. The use of
this instrument, therefore, should be considered only
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Validation of the OHIP-7Sp
Table 1 Regression analysis of the Spanish version of the Oral Health Impact Profile items and prevalence of
negative impact among participants
Domains and items
OHIP-49Sp
Functional limitation
Q1: difficulty chewing
Q2: trouble pronouncing words
Q3: noticed tooth that doesn’t look right
Q4: appearance affected
Q5: breath stale
Q6: taste worse
Q7: food catching
Q8: digestion worse†
Q9: dentures not fitting
Physical pain
Q10: painful aching
Q11: sore jaw
Q12: headaches
Q13: sensitive teeth†
Q14: toothache
Q15: painful gums
Q16: uncomfortable to eat
Q17: sore spots
Q18: uncomfortable dentures
Psychological discomfort
Q19: worried by dental problems
Q20: self-conscious
Q21: dental problems made you miserable†
Q22: felt uncomfortable about the appearance
Q23: felt tense
Physical disability
Q24:speech unclear
Q25: others misunderstood†
Q26: less flavor in food
Q27: unable to brush teeth
Q28: avoid eating
Q29: diet unsatisfactory
Q30: unable to eat (dentures)
Q31: avoid smiling
Q32: interrupt meals
Psychological disability
Q33: sleep interrupted†
Q34: upset
Q35: difficult to relax
Q36: depressed
Q37: concentration affected
Q38: been embarrassed
Social disability
Q39: avoid going out
Q40: less tolerant of others
Q41: trouble getting on with others
Q42: irritable with others
Q43: difficulty doing jobs†
Handicap
Q44: your general health has worsened
Q45: financial loss
Q46: unable to enjoy people’s company
Q47: life unsatisfying
Q48: unable to function†
Q49: unable to work
R2 for
OHIP-7Sp†
R2 for
OHIP-14
(Slade)‡
Participants
with negative
impact (%)
*
*
*
*
*
*
*
0.12
*
*
0.016
*
*
*
0.032
*
*
*
54
35
48
42
46
43
75
19
40
*
*
*
0.14
*
*
*
*
*
0.024
*
*
*
*
*
0.14
*
*
37
28
8
33
35
47
59
46
39
*
*
0.08
*
*
*
0.057
*
*
0.56
68
41
33
39
36
*
0.09
*
*
*
*
*
*
*
*
*
*
*
*
0.003
*
*
0.004
34
21
43
25
47
22
25
33
30
0.13
*
*
*
*
*
*
*
0.087
*
*
0.006
10
26
27
27
20
39
*
*
*
*
0.09
*
*
*
0.002
0.007
16
11
20
12
11
*
*
*
*
0.06
*
*
*
*
0.011
0.001
*
21
15
20
28
11
11
Q1–Q49: Questions of the OHIP-49Sp. †Items selected for the Spanish version of the Oral Health Impact Profile (OHIP-7Sp). ‡Items of the original Oral Health
Impact Profile (OHIP)-14 developed by Slade.
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© 2016 Japan Geriatrics Society
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S León et al.
Table 2 Reliability analysis based on the Spanish version of the Oral
Health Impact Profile inter-item correlation
Impact item
1
2
3
1 Digestion worse
2 Sensitive teeth
3 Dental problems made
you miserable
4 Others misunderstood
5 Sleep interrupted
6 Difficulty doing jobs
7 Unable to function
1
0.36
0.45
1
0.27
1
0.53
0.44
0.41
0.52
0.27
0.26
0.05
0.24
0.59
0.33
0.45
0.55
4
5
6
7
1
0.34
0.55
0.55
1
0.35
0.55
1
0.53
1
Table 3 Reliability analysis based on the corrected total-item correlation
and Cronbach’s alpha coefficient if item deleted
Impact item
Corrected
total-item
correlation
Cronbach’s
alpha if
item deleted
1 Digestion worse
2 Sensitive teeth
3 Dental problems made
you miserable
4 Others misunderstood
5 Sleep interrupted
6 Difficulty doing jobs
7 Unable to function
Global
0.63
0.34
0.67
0.79
0.84
0.79
0.65
0.51
0.46
0.75
0.79
0.81
0.82
0.77
0.93
Table 4 Distribution of responses at different frequency thresholds to Spanish version of the Oral Health Impact
Profile items
Individual OHIP Items
1 Digestion worse
2 Sensitive teeth
3 Dental problems made you miserable
4 Others misunderstood
5 Sleep interrupted
6 Difficulty doing jobs
7 Unable to function
Global
Never, hardly
ever
%
75.3
43.5
43.5
70.6
74.1
81.2
76.5
Mean‡ (SD)
Median‡
(range)
%
Fairly often,
very often
%
Rank†
9.4
41.2
27.1
22.4
16.5
9.4
10.6
15.3
15.3
29.4
7.1
9.4
9.4
12.9
0.89 (1.34)
1.45 (1.27)
1.74 (1.45)
0.80 (1.09)
0.86 (1.15)
0.67 (1.16)
0.80 (1.34)
7.21 (6.18)
0 (0–4)
2 (0–4)
2 (0–4)
0 (0–4)
0 (0–4)
0 (0–4)
0 (0–4)
6 (0–22)
Occasionally
2
2
1
5
4
4
3
†
Presented in rank order of prevalence scores; that is, percentage of adults reporting one or more items “fairly often” or “very
often.” ‡Mean (SD) and median (range) scores in relation to severity.
when the main purpose is the characterization of
OHRQoL as a construct.15 Generally, the benefit arising
from a reduction in the number of questionnaire items
implies a concomitant reduced validity. In this case, no
loss of validity was evident, nevertheless.
© 2016 Japan Geriatrics Society
A positive correlation inter-item was found, ranging
from 0.05 to 0.59. A mean inter-item correlation of
0.15–0.20 is acceptable for scales measuring broad characteristics, whereas 0.40–0.50 is acceptable for scales
measuring narrower concepts, as in the present study.21
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Validation of the OHIP-7Sp
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© 2016 Japan Geriatrics Society
No. teeth
0.36 (0.68) 0
1.05 (1.54) 0
1.4 (1.68) 1
1.09 (1.38) 1
0.1
Caries lesion
1(1.38) 0
0.35 (1.06) 0
0.03
CPITN
0.52 (1.09) 0
1.13 (1.48) 0
0.06
Prosthetic need
0.09 (0.29) 0
1.17 (1.44) 1
0.0004
Age (years)
1.15 (1.45) 0
0.48 (1.03) 0
0.01
Domain
Functional
limitation
1.60 (1.39) 2
1.21 (1.02) 2
0.2
1.27 (1.16) 1.5
1.51 (1.31) 2
0.4
1.42 (1.29) 2
1.87 (1.18) 2
0.1
1.84 (1.28) 2
1.12 (0.99) 2
0.04
1.64 (1.06) 2
1.47 (1.43) 2
1.87 (1.36) 2
0.91 (1.2) 0
0.09
Physical pain
CPITN, Community Periodontal Index of Treatment Needs.
60–69 (n = 52)
≥70 n = 33)
P
No (n = 22)
Yes (n = 63)
P
TN2 (n = 31)
TN3 (n = 31)
P
Yes (n = 45)
No (n = 17)
P
20–28 (n = 28)
10–19 (n = 19)
1–9 (n = 15)
Edentate (n = 23)
P
Variable
2.10 (1.43) 2
1.18 (1.31) 1
0.004
1.23 (1.31) 1
1.92 (1.46) 2
0.05
1.58 (1.36) 2
2.29 (1.47) 2
0.05
2.07 (1.45) 2
1.59 (1.42) 2
0.2
1.61 (1.31) 2
1.84 (1.46) 2
2.67 (1.50) 3
1.22 (1.35) 1
0.02
Psychological
discomfort
0.98 (1.21) 0
0.52 (0.80) 0
0.03
0.09 (0.29) 0
1.05 (1.16) 1
0.0002
0.42 (0.85) 0
1.16 (1.19)1
0.006
1 (1.15) 1
0.24 (0.66) 0
0.007
0.64 (1.1) 0
0.47 (0.96) 0
1.47 (0.99) 2
0.83 (1.11) 0
0.04
Physical
disability
1.17 (1.29) 1
0.36 (0.60) 0
0.0002
0.32 (0.65) 0
1.05 (1.22) 1
0.008
0.68 (1.22) 0
1.06 (1.12) 1
0.2
1 (1.26) 0
0.53 (0.87) 0
0.2
0.71 (1.18) 0
1.11 (1.2) 1
0.87 (1.19) 0
0.83 (1.07) 1
0.7
Psychological
disability
0.88 (1.25) 0
0.33 (0.92) 0
0.03
0.14 (0.47) 0
0.86 (1.27) 0
0.005
0.35 (1.02) 0
0.97 (1.2) 1
0.03
0.69 (1.06) 0
0.59 (1.37) 0
0.2
0.64 (1.16) 0
0.37 (0.68) 0
1.07 (1.49) 0
0.7 (1.22) 0
0.4
Social
disability
1.15 (1.56) 0
0.24 (0.56) 0
0.0003
0.05 (0.21) 0
1.06 (1.47) 0
0.0009
0.32 (0.79) 0
1.39 (1.67) 0
0.002
0.98 (1.42) 0
0.53 (1.33) 0
0.2
0.57 (1.23) 0
0.89 (1.41) 0
1.33 (1.63) 0
0.65 (1.19) 0
0.3
Handicap
9.04 (6.87) 7
4.33 (3.33) 4
0.0001
3.18 (2.48) 3
8.62 (6.47) 7
0.0003
5.29 (5.4) 4
9.97 (6.28) 9
0.003
8.58 (6.04) 8
4.94 (6.2) 3
0.01
6.18 (5.15) 4.5
7.21 (7) 5
10.67 (6.47) 10
6.22 (6.01) 5
0.1
Global
OHIP-7Sp
Table 5 Discriminant validity of the Spanish version of the Oral Health Impact Profile based on the oral variables and age of the participants. Mean,
(SD), median
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S León et al.
However, in the corrected total-item correlation, coefficients ranged from 0.34 to 0.75, which were above the
recommended minimum level of 0.20. These results
show good homogeneity of the entire instrument, and
avoid the need to eliminate items from the OHIP-7Sp.
Yet, our scores are lower than those found by John
et al.,15 but they are similar to those found by Larsson
et al.17
The items with the highest response rate were
“dental problems made you miserable” (29.4%),
“digestion worse” and “sensitive teeth” (15.3%),
belonging to the first three dimensions: functional
limitation, physical pain and psychological discomfort.
A similar trend has been shown in a previous study by
Sanders et al.7 These results also corroborate previous
evidence from two studies using exploratory factor
analysis,22,23 and one study using confirmatory factorial
analysis,19 which confirmed the existence of a set of
three underlying factors considered as functional limitation, pain-discomfort and psychosocial impacts, that
showed high consistency when integrated with the
Locker model.2
In addition, the mean score for the global OHIP-7Sp
was higher than other studies.7 It is interesting to highlight that in the studies with Australian and North
American populations, there is a higher tendency to
report items as “hardly ever” or “never” with the
National Health and Nutrition Examination Survey
(NHANES)-OHIP survey. The resulting scores, therefore, were lower than among Chileans. Prevalence has
been frequently used to assess populations at the nation
level, as they are easier to understand. From a methodological point of view, the use of prevalence is convenient to allow comparisons with other populations or
the same population over time.
When evaluating discriminative validity based on clinical variables, the most robust associations were observed
between the presence of carious lesions, CPITN and
prosthetic needs. As other validation studies of the ultrashort version of the OHIP have not used the same clinical
variables, no comparison was possible. When compared
with the results of our own validation of the short version
of the OHIP (OHIP-14Sp), it is possible to find similar
associations.6 Discriminative validation was not related
with number of teeth in the OHIP-7Sp. It is reasonable to
speculate that the use of dentures minimizes the consequences of tooth loss.24 Indeed, older adults with few
teeth most likely will be denture wearers, so even if their
prostheses are not functional, self-perception of quality
of life might be interpreted as satisfactory if they have
esthetically acceptable prostheses. Indeed, for some
older people, edentulous and poor oral health are considered a part of “normal” aging. This apparent discrepancy might be a consequence of cultural and behavioral
conditions, where tooth loss is perceived as a normal
feature of aging.25
© 2016 Japan Geriatrics Society
In addition, older individuals presented a lower negative impact of the oral diseases in their quality of life
than younger individuals. The inverse relationship
between age and the OHIP scores has been observed
previously, where it was proposed that different historical experiences of birth cohorts altered expectations
about oral health, thereby accounting for the observed
age-group differences.7,26 It is widely acknowledged,
however, that cross-sectional studies cannot satisfactorily explain the effects of aging on any given cohort.
Hence, the current findings should not be interpreted as
an indication that aging somehow attenuates adverse
impacts of oral health on quality of life.
As it has been proposed, the theory of response shift
might explain why community-dwelling older adults,
and the elderly population in general, might report
lower impact in certain domains.27 Slade and Sanders
analyzed the paradox of the better subjective oral health
perception in older age.28 Their findings showed that
experience of oral disease is more deleterious to subjective oral health when it occurs early in adulthood than
when it occurs at older ages, likely reflecting high expectations of young generations and higher resilience in the
oldest generation.
Resilience and coping mechanisms might explain why
many older people who experience limitations related to
the aging process also report good levels of wellbeing.29,30 Furthermore, it suggested that the OHRQoL
instruments are usually too disease oriented, assuming
that disability and handicap will necessarily result from
oral problems.30 Yet, such problems might be less of a
priority at this age, and people might cope and adapt
with limitations related to oral health, in a positive
manner.
The limitations of the present study were the crosssectional study design and the descriptive nature of the
analyses. These constraints mean that caution is
required in data interpretation. Yet, the purpose of
cross-sectional surveys is to provide prevalence estimates for the study population and to lead to new
hypotheses. Thus, the present design appears as appropriate, as it allows its further use during a future first
national survey of the impact of oral conditions on
quality of life in Chile. We deem it important to
acknowledge that for the discriminative validity analysis,
the sample size was calculated for the OHIP-49Sp and
not for the OHIP-7Sp.10
The present study has implications for public health
and for future studies on OHRQoL. Using the association between oral health conditions and quality of life
can be an effective mechanism to convey to
policymakers the importance of oral health and equal
access to care. Along those lines, the main goal of the
Policy of Positive Aging 2012–2025 in Chile is to
improve quality of life for all Chilean older adults.
Hence, it is critically important that OHRQoL can be
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14470594, 2017, 2, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/ggi.12710 by Universidade Andres Bello, Wiley Online Library on [07/05/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Validation of the OHIP-7Sp
included in national health surveys to raise awareness of
the importance of oral health in the quality of life of the
population. We strongly suggest including the OHIP7Sp in future surveys to monitor the achievements of
the Chilean Policy of Positive Aging 2012–2025.
In conclusion, results from the present study corroborate the ultra-short Spanish version of the OHIP as
a valid instrument to assess OHRQoL in elderly Chileans. The ultra-short version of the OHIP offers
OHRQoL assessment in almost any setting. It is
expected that this validated version of the OHIP-7Sp
will be a useful alternative to the OHIP-14Sp in situations where time and resources are restricted, and it
might be incorporated in epidemiological studies that
include several other variables. The OHIP-7Sp, therefore, appears now as a suitable tool for cross-national
comparisons of OHRQoL.
Acknowledgments
The authors appreciate the collaboration of Professor
Cecilia Albala for her insights in the planning of this
study. We also thank Francisca Espinoza and Francia
Fuentes, predoctoral dental students at the time of the
study, for their help in data collection and registration.
This research was partially funded by an Internal
Grant from the Research Direction of the University of
Talca and a Chile’s Government Grant Fondecyt
1140623 to RAG. The funders did not participate in the
study design, data collection or the analysis.
Disclosure statement
The authors declare no conflict of interest.
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Validation of the OHIP-7Sp