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Impact of Social Support on Subjective Oral Health Status among Elderly People
J Dent Hyg Sci 2020;20:67-73
Published online June 30, 2020;  https://doi.org/10.17135/jdhs.2020.20.2.67
© 2020 Korean Society of Dental Hygiene Science.

Eunsuk Ahn1 , Jin-Ha Lee2 , and Sun-Mi Kim3,†

1Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon 35408,
2Department of Dental Hygiene, Kyungbok University, Pocheon 11138,
3Department of Dental Hygiene, Wonkwang Health Science University, Iksan 54538, Korea
Correspondence to: Sun-Mi Kim, https://orcid.org/0000-0003-0718-9419
Department of Dental Hygiene, Wonkwang Health Science University, 514 Iksan-daero, Iksan 54538, Korea
Tel: +82-63-840-1260, Fax: +82-63-840-1269, E-mail: dentalksm@naver.com
Received February 27, 2020; Revised March 24, 2020; Accepted April 1, 2020.
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
Background: Owing to the increase in the aging population, the health problems of the elderly have become important social problems. Social support has a positive effect on improving the quality of life and prolonging the life of elderly people. It is one of the major factors that affects the oral health status of elderly people. The purpose of this study was to examine the relationship between oral health status and social support in elderly people using representative data.
Methods: In this study, data from a community health survey in 2015 involving 63,929 elderly people aged over 65 years were analyzed. T-test and ANOVA analyses were performed to compare the general characteristics of and perception about social support. Additionally, a linear regression analysis was performed to confirm the relationship between perceptions about social support and subjective oral health status.
Results: We found that sex, age, household income, education level, the presence of a spouse, existence of an unmet dental need, and regular oral check-up had a significant effect on subjective oral health status (p<0.05). In addition, when controlled for all factors, social support has a significant impact on subjective oral health status.
Conclusion: The findings indicate that social support is associated with the subjective oral health status of Korean elderly. This suggests that community-level or government investment is required to improve the oral health of the elderly. In particular, policy interventions such as the establishment of facilities that promote social networks, especially facilities based on friendship networks, are needed.
Keywords : Aged, Oral health, Social support
Introduction

The health problems of the elderly are indisputably biological and sociological. Health is influenced by the social environment, and health problems result in social problems1,2 ). Health problems associated with aging include the decline of physical function and social and psychological deterioration, which is an economic burden. Integrated health care is very important for elderly people with chronic diseases3,4 ). Health care is an important positive variable for social support and self-esteem. It is an important factor for maintaining physical and psychological health5-8 ). Social support refers to a series of actions aimed at satisfying an individual's physical, material, and emotional needs through the individuals’ relationships with those around them9 ). Social support, which involves interaction with others, and self-esteem, which has to do with valuing one’s self, are components of health care in terms of personal and social integration, and experiences through support in the relationship between the environment and others2,10 ). Social support improves the quality of life and prolongs the life of the elderly and is seen as one of the major factors that affects the health status of the elderly2,9,11 ).

Oral health problems among the elderly are a major health problem. Oral health problems result in weakened teeth and high tooth loss rate. Additionally, the oral condition of elderly people is relatively poor than that of individuals in other age groups12-14 ). In particular, elderly people with low socioeconomic status experience social disconnection due to social isolation and alienation and the deterioration of their health and quality of life. Dental problems that require treatment seem to diminish one’s value and importance15,16 ). Social support and socioeconomic characteristics are considered fundamental determinants of oral health because they can affect proximal risk factors for oral disease, such as developing oral health-related behaviors and modifying lifestyles17,18 ). There is little research on the relationship between oral health and social support in Korea. The purpose of this study was to identify the relationship between oral health and social support in elderly people using representative data. We hope to provide basic data for the development of oral health policies for the elderly who experience social isolation frequently.

Materials and Methods

1.Research subjects

This study used Community Health Survey data from the Korea Centers for Disease Control and Prevention. The Community Health Survey is a survey to examine the health status and behavior of citizens over 19 years old to provide adequate data for the development of evidence- based health projects in the region. This survey includes items such as health, mental health, oral health, social support, and general characteristics. In this study, data from a Community Health Survey in 2015 involving 63,929 elderly people aged over 65 years were analyzed.

2. Research variables

In this study, the subjective oral health status, measured on a 5-point Likert scale, was used as the dependent variable. The higher the social support score, the more positive the perception of social support. Social support items were measured on a 5-point Likert scale. The score was then averaged and used for analysis. As independent variables, social support variables were calculated using the sex, age, household income, education level, Existence of spouse, oral healthcare behavior (regular oral check-up, existence of an unmet dental need), and social support questions (Table 1).

Study Variable

Classification Detail
Dependent variable
Subjective oral health 1=very poor, 2=poor, 3=medium, 4=good, 5=very good
Independent variable
Sex 1=male, 2=female
Age (y) 1=65∼74, 2=≥75
Household income per monthly (thousand won) 1=≤50, 2=≥50∼100, 3=≥101∼200, 4=≥201
Education level 1=≤elementary and below, 2=≥middle school and above
Existence of spouse 1=living together, 2=living apart, bereavement, divorce, unmarried
Regular oral check-up 1=yes, 2=no
Unmet dental need 1=yes, 2=no
Social support (5-point Likert scale) Can you trust and rely on each other in your neighborhood?
Are you satisfied with the natural environment in your neighborhood?
Are you satisfied with the living environment in your neighborhood?
Are you satisfied with the health care delivery system in your neighborhood?
How often do you see or communicate with the relatives (family) you contact the most?
How often do you see or contact the neighbors you contact the most?


3. Analysis methods

The general characteristics of the study subjects were investigated using frequency analysis. The t-test and one-way ANOVA were performed to compare the differences in the perceptions of social support according to the general characteristics. Bonferroni post-hoc tests were conducted to confirm significant differences between groups. Finally, linear regression analysis was conducted to confirm the relationship between the subjective oral health level, general characteristics, and social support. For all analysis, STATA software version 11.0 (Stata Corp., College Station, Tx, USA) was used, and the statistical significance level was set at 0.05.

Results

1.General characteristics of research subjects

The general characteristics of the study subjects are shown in Table 2. According to sex, 59.12% were females and 40.88% were males. Additionally, 57.13% of the subjects were young elders with ages ranging from 65∼74 years and the remaining 42.87% were old elders who were 75 years or older. The average monthly household income was 30.97% with more than 51∼100 thousand won being the highest. With regard to education level, only 66.02% of subjects attended elementary school. With regards to oral care, 80.18% of the subjects did not attend regular oral check-ups, and 19.48% of subjects had an existing unmet dental need.

Distribution and Rate of Study Subjects

Variable n (%)
Sex
Male 26,134 (40.88)
Female 37,795 (59.12)
Age (y)
65∼74 36,521 (57.13)
≥75 27,408 (42.87)
Household income per monthly (thousand won)
≤50 15,028 (23.70)
≥51∼100 19,640 (30.97)
≥101∼200 13,449 (21.21)
≥201 15,296 (24.12)
Education level
≤Elementary school 42,156 (66.02)
≥Middle school 21,699 (33.98)
Existence of spouse
Yes 39,710 (62.15)
No 24,179 (37.85)
Regular oral check-up
Yes 12,663 (19.82)
No 51,221 (80.18)
Unmet dental need
Yes 12,449 (19.48)
No 51,465 (80.52)


2.Social support perception according to the general characteristics

The general characteristics and social support perception of subjects are presented in Table 3. The score of the younger elderly was 3.19, which was higher than that of the older elderly (3.10; p<0.05). Additionally, as household income increased, social support increased significantly (p<0.05). Moreover, the presence of a spouse significantly affected the perception of social support (p<0.05).

Differences in Social Support and General Characteristics

Variable Social support

Mean±estimated standard deviation t/F p-value
Sex −3.20 <0.001
Male 3.14±0.75
Female 3.16±0.71
Age 16.32 <0.001
65∼74 3.19±0.74
≥75 3.10±0.70
Household income per monthly (thousand won) 156.48 <0.001
≤50 3.06±0.70
≥51∼100 3.15±0.70a
≥101∼200 3.20±0.73b
≥201 3.21±0.76c
Education level −12.92 <0.001
≤Elementary school 3.13±0.69
≥Middle school 3.21±0.78
Existence of spouse 19.74 <0.001
Yes 3.20±0.72
No 3.08±0.73


3.Factors affecting subjective oral health status

The results of the linear regression analysis to confirm the effect of social support on subjective oral health status are presented in Table 4. Sex, age, household income, education level, presence of a spouse, existence of an unmet dental need, regular oral check-up, and social support were found to have a significant effect on subjective oral health status (p<0.05). In particular, when all factors were adjusted, subjective oral health status increased as social support score increased. The subjective oral health score increased by 0.13 points each time the social support score increased by 1 point, regardless of the socioeconomic status of the elderly. The explanatory power of the regression model was 11.0%.

Factors Influencing Subjective Oral Health

Variable Coef. SE t p-value
Sex
Male (Ref.)
Female 0.09 0.01 10.54 <0.001
Age
65∼74 (Ref.)
≥75 −0.19 0.01 −23.70 <0.001
Household income per monthly (thousand won)
≤50 (Ref.)
≥51∼100 0.06 0.01 5.46 <0.001
≥101∼200 0.12 0.01 10.36 <0.001
≥201 0.16 0.01 14.23 <0.001
Education level
≤Elementary school (Ref.)
≥Middle school 0.20 0.01 22.96 <0.001
Existence of spouse
Yes (Ref.)
No −0.07 0.01 −7.35 <0.001
Regular oral check-up
No (Ref.)
Yes 0.15 0.01 16.30 <0.001
Unmet dental need
No (Ref.)
Yes −0.48 0.01 −51.68 <0.001
Social support 0.13 0.01 25.45 <0.001
Constant 1.85 0.03 59.20 <0.001

Data are analysed by multiple linear regression statistics.

Coef.:coefficient, SE:standard errors, Ref.: reference.


Discussion

This is one of the first studies to explore the link between social support and oral health in elderly people nationwide. The data used in this study are representative of the national perspective. The data were obtained from a large population and have undergone representative sampling processes19 ).

Among the elderly, the difference in perception of social support according to sex was statistically significant. According to age, the perception of social support was lower among the older elderly people than among the younger elderly people. This is owing to the decrease in the frequency of contact with children and siblings20 ). In general, the size of social networks and the frequency of social exchanges decrease with age2,5,8 ). This is because physical and mental activities are more limited as one ages. In this study, the higher the household income and education levels, the higher the recognition of social support. The results are consistent with those of previous studies. Elderly people with high socioeconomic status may be more economically active than those with low socioeconomic status. Accordingly, it is thought that social support is highly recognized when people participate more actively in social activities17,18 ). Additionally, the perception of social support among elderly people with spouses was higher. This is consistent with the results of previous studies that reported that elderly people without spouses had weaker social relations than those with spouses2 ). This finding suggests that elderly people without spouses need practical intervention in order to form and maintain supportive friendships. As a result, social support alleviates the stress of older people and provides specific protection and support. In addition, it can be seen that it not only improves immunity to disease, but also maximizes adaptability and resilience, affecting psychological well-being20-22 ). The higher the education level of the elderly, the more positive their subjective oral health status. Among the elderly, the level of education adequately reflects changes in past socioeconomic positions and generally affects the subjective oral health status3,14,18 ). These findings are thought to be due to the fact that the lower the economic and educational levels, the greater the risk of oral health problems, and the lower the accessibility to medical information and health care. In addition, elderly people with spouses had higher subjective oral health levels than those without spouses. This is because elderly people who live alone feel alienated and lonely when they do not receive the support of their family members; hence, their physical, mental, and social health conditions deteriorate20,21 ).

After adjusting for sociodemographic factors (such as sex, age, education level, and household income) and oral health behavioral covariates that are known to affect subjective oral health status, social support was found to be significantly associated with the subjective oral health status17,18 ). This result suggests that social support influences the subjective oral health status of elderly people1,21-23 ). In general, socioeconomic factors and oral health behaviors are considered the main factors that affect oral health22,24 ). Even when these major factors have been adjusted and examined, the effect of social support on subjective oral health was still significant. While poverty has a negative health effect, even among the poor, this negative effect may be alleviated if social support is provided24 ). Therefore, in addition to improving the economic status, efforts should be made to recognize the importance of social support and to provide a formal social support system through community linkage and social welfare programs. In addition, among elderly people, the role of social support can become increasingly important in relation to the additional need of time, resources, and policies for the oral health care of the community system1,9,23 ). During old age, factors that negatively affect social support increase because of the decrease in economic power due to retirement, decrease in physical ability, and death of a spouse. As these factors increase, social support is likely to decrease, which may have a negative impact on health5,11,22 ). Moreover, these factors can have a direct negative effect on health18,20,21 ). Our results emphasize the need for community level action or governmental investment to establish amenities that promote the building of social capital, especially that related on friendship networks. In conclusion, social support is associated with self-reported oral health status among Korean elderly. Obviously, the interdependence of social support and the oral health of elderly people should not be underestimated and should be further investigated.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Ethical approval

This study was approved by Institutional Review Board of the Daejeon Institute of Science and Technology (IRB- 2019-003-017).

Author contributions

Conceptualization: Eunsuk Ahn. Data acquisition: Eunsuk Ahn, Sun-Mi Kim. Formal analysis : Eunsuk Ahn, Jin-Ha Lee. Supervision: Eunsuk Ahn, Sun-Mi Kim. Writing-original draft: Eunsuk Ahn, Jin-Ha Lee, Sun-Mi Kim. Writing-review & editing: Sun-Mi Kim.

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