INTRODUCTION
South Korea is projected to become a super-aged society by 2025 [1], potentially worsening oral health issues among older adults, particularly those in single-person house-holds who struggle to maintain regular oral hygiene [2]. Poor oral health is linked to chronic diseases like cardio-vascular disease and diabetes, negatively impacting overall health [3]. Addressing oral health care in the older adults is crucial, especially for those living alone who face added challenges in maintaining hygiene [4]. Poor oral health affects their ability to eat, speak, and socialize, lowering their quality of life [2]. Therefore, professional oral health management is essential for this vulnerable population.
Problems with oral health can lead to tooth loss, which not only causes nutritional issues due to difficulties in chewing but also affects speech and appearance, thereby hindering smooth social interactions and negatively impacting mental and physical health, ultimately reducing QoL [5]. Nurses are critical in providing essential health services, including oral health care, to older adults with di-verse medical needs due to aging [4]. Oral health is a significant factor influencing overall health status and quality of life (QoL) [6]. Furthermore, impaired masticatory function can diminish the ability to perform daily activities and lower subjective QoL, increasing the risk of depression [2]. In particular, older adults living alone experience higher levels of isolation, loneliness, and depression compared to those living with others, and they often have limited access to healthcare [7]. Therefore, it is necessary to focus on social attention and provide this population access to professional health management. However, most older adults have low dental service utilization rates due to cost, fear, and lack of awareness about oral health. In particular, older adults living alone face difficulties accessing medical services due to limited mobility or poor health [6].
In South Korea, 64.5% of the population aged 60 and over consider oral health issues the most significant health concern, and among those aged 65 and older, 34.7% have reported oral functional limitations, while 33.7% have reported discomfort with chewing [8]. These findings indicate that more than one-third of older adults face challenges related to oral health. Despite the increasing need for oral health management among older adults, nurses often experience uncertainty regarding practical care, con-fidence, and motivation due to a lack of experience and role ambiguity in supporting oral health management [9]. Therefore, it is essential for nurses to clearly define their roles, engage in continuous education, and collaborate with oral health professionals to develop proactive management strategies.
Oral health-related quality of life (OHRQoL) encom-passes not only the maintenance of oral health but also aspects like aesthetics, self-esteem, and social interactions [10]. A higher OHRQoL is linked to better overall QoL [11]. The Geriatric Oral Health Assessment Index (GOHAI), which evaluates oral functional factors such as chewing and speaking, pain, discomfort, and psychosocial influen-ces, is widely used to measure OHRQoL among older adults [9]. Previous studies show that GOHAI positively correlates with health satisfaction and QoL, while negatively correlating with depression [12,13]. Factors affecting OHRQoL in older adults include the number of re-maining teeth [14,15], the presence of dentures, oral health behaviors, and systemic conditions like osteoporosis, diabetes, musculoskeletal disorders, and cognitive impairment [16,17].
Some studies [12-14] in South Korea have utilized secondary data to explore the relationship between oral health and OHRQoL among older adults living alone. However, most have focused on the general elderly population or specific regions, with research specifically targeting older adults living alone being relatively scarce. There is also a lack of studies from a nursing perspective that propose interventions to improve their quality of life. Nurses play a key role in addressing oral health problems and mitigating the decline in quality of life. This study distinguishes itself by focusing on this group and using large-scale data to propose nursing interventions.
1. Aims
The specific objectives of this study are as follows: (1) to identify the socio-demographic, oral health-related, and general health-related, and health behavior-related characteristics of community-dwelling older adults living alone; (2) to assess the differences in OHRQoL among com-munity-dwelling older adults living alone according to so-cio-demographic, oral health-related, and general health-related, and health behavior-related characteristics; and (3) to identify the factors influencing the OHRQoL in com-munity-dwelling older adults living alone.
METHODS
1. Research Design
This study is a secondary data analysis and descriptive correlational study aimed at identifying the factors affecting OHRQoL in community-dwelling older adults living alone, using data from the 9th wave of 2022 KLoSA.
2. Participants and Data Collection
The present study utilized secondary data from the 9th wave of the Korean Longitudinal Study of Aging (KLoSA), accessed through the Korea Employment Information Ser-vice. KLoSA is a comprehensive biennial survey targeting individuals aged 45 and older in South Korea, excluding Jeju Island, and gathers data on various social, economic, and health-related aspects. The first survey in 2006 established a panel of 10,254 individuals, and by the 9th wave, there were 6,057 participants. For this study, older adults living alone were defined as those aged 65 years or older who were the sole members of their household. Out of the 4,491 participants aged 65 or older, 1,038 community-dwel-ling older adults living alone were selected as the final study group. The survey was conducted using face-to-face interviews, providing a robust dataset for understanding the health and well-being of older adults living alone.
3. Research Variables
The dependent variable in this study is OHRQoL, while the independent variables were extracted from the 9th wave of KLoSA data. These variables include those previously reported to influence OHRQoL in prior studies. The independent variables were categorized into socio-demographic, oral health-related, general health-related, and health behavior-related characteristics. Each variable was used as classified in KLoSA or reclassified by the re-searchers for this study.
1) Dependent variable: OHRQoL
To measure OHRQoL, the scores obtained using the Korean version of the Geriatric Oral Health Assessment Index (GOHAI) were utilized [10]. This instrument em-ploys a 6-point Likert scale, ranging from 0 (“ always”) to 5 (“ never”), with a total possible score range of 0 to 60. Higher scores on the scale indicate a better OHRQoL. The original study reported a Cronbach's ⍺ of .83 [10], while the reliability in the present study was found to be Cronbach's ⍺=.80.
2) Independent variables
The socio-demographic characteristics included sex, age, education, and perceived socioeconomic status. Sex was categorized as male or female, while age was calculated by subtracting the participant's birth year from the survey year. Education was divided into four categories: elementary school graduation or below, middle school graduation, high school graduation, and bachelor's degree or higher. Perceived socioeconomic status was categorized as “ middle or above” and “ below middle.”
The oral health-related characteristics included denture use and the count of natural teeth. The natural tooth count refers to the current number of all teeth, including roots, excluding wisdom teeth. The natural tooth count was categorized into two groups: fewer than 20 teeth and 20 or more teeth.
The general health-related characteristics examined in this study included subjective health status, difficulties in daily activities due to vision and hearing impairments, and various medical conditions. Conditions such as hypertension, DM, cancer, COPD, heart disease, cerebrovascular disease, mental illness, and arthritis were defined as having been diagnosed by a physician and currently receiving medication. Dementia was defined as having re-ceived a diagnosis of dementia. Subjective health status was categorized into three levels: good, moderate, or poor. ADL and IADL were assessed using the Korean version of the Functional Independence Measure, developed by Won et al. [18], specifically for individuals aged 65 and older with functional disabilities. This instrument demonstrated high internal consistency and validity, with a Cronbach's ⍺ of .94 at its development. ADL was evaluated using a 7-item Korean tool designed for daily living activities, with scores ranging from 0 to 7, where higher scores indicated greater dependence on daily living tasks. IADL was assessed using a 10-item Korean tool for instrumental daily living activities, with scores ranging from 0 to 10, where higher scores reflected a greater dependence on instrumental activities. Depression was assessed using scores from the Korean-translated version of the Center for Epidemiologic Studies Depression Scale (CES-D10) [19]. The CES-D10 measures the level of depressive symptoms experienced over the preceding week, with higher scores indicating increased levels of depression. Responses to the 10 survey items were coded as ‘ yes’ or ‘ no,’ corresponding to scores of ‘1’ and ‘0,’ respectively, and the total score was calculated. The CES-D10 has been validated as an effective screening tool for depressive symptoms among older Korean individuals; however, a definitive cutoff value has yet to be established, so raw scores were used in this study. The scale demonstrated good reliability during its initial development, with a Cronbach's ⍺ of .80, and the current study reported a reliability coefficient of Cronbach's ⍺= .76.
Health behavior-related characteristics included regular meal habits, Body Mass Index (BMI), smoking, and drinking. Regular meal habits were assessed based on consumption of breakfast, lunch, and dinner over the past two days. Consuming all six meals over the two days was categorized as ‘ regular,’ while consuming only a portion was categorized as ‘ irregular.’ BMI was classified into un-derweight (<18.5 kg/m²), normal weight (18.5∼22.9 kg/m²), overweight, and obese (≥23.0 kg/m²) groups.
4. Data Analysis
Data analysis for this study was conducted using the SPSS/WIN 26.0 software (IBM Corp, Armonk, USA). Stratification variables used in the 2022 KLoSA sample design, along with the survey districts extracted from each stratum, were designated as cluster variables. Weighting was applied to create a complex sample design analysis file, and complex sample data analysis was then perform-ed. The characteristics of the subjects were analyzed using unweighted counts, weighted percentages, weighted means, and standard errors. The OHRQoL in relation to the subjects’ characteristics was analyzed using the Complex Sam-ple General Linear Model (CSGLM) for univariate analysis, with post-hoc analysis validated using the Bonferroni correction method. Factors influencing the OHRQoL of community-dwelling older adults living alone were examined through multivariate analysis using CSGLM.
5. Ethical Considerations
This study was conducted as a secondary data analysis (IRB No. 2024-07-045) with an exemption from review by the Bioethics Committee of the researcher's institution. The Korean Longitudinal Study of Aging (KLoSA) provides de-identified data by Article 17 of the Statistics Act, and no information that could identify individuals was included.
RESULTS
1. OHRQoL level and Subjects' Characteristics
The average GOHAI score among the 1,038 participants was 37.47±0.35 out of 60. Among the socio-demographic characteristics, 157 participants (17.0%) were male, and 881 participants (83.0%) were female, with an average age of 77.26 years. The age groups included 65∼74 years (39.9%), 75∼84 years (38.8%), and 85 years and older (21.3%). Most participants (59.3%) had an elementary school education level or less, and 59.8% perceived themselves as below middle socioeconomic status.
In terms of oral health, 31.3% wore dentures, and 42.8% had fewer than 20 natural teeth. Regarding general health, 55.0% had hypertension, 24.8% had diabetes, and 29.4% had arthritis. Vision problems affected 4.2%, while hearing difficulties were reported by 7.9%. The mean ADL score was 0.24±0.03, the mean IADL score was 0.82±0.07, and the mean depression score was 1.71±0.08 out of 10 points.
For health behaviors, 83.1% were non-smokers, 61.7% were non-drinkers, and 83.5% reported having regular meals. Regarding body weight, 53.6% were overweight or obese, 41.0% had a normal weight, and 5.4% were under-weight (Table 1).
Table 1.
Geriatric Oral Health Assessment Index Scores and Participants' Characteristics (N=1,038)
| Variables | Characteristics | Categories | n (%)† | M± SE |
|---|---|---|---|---|
| GOHAI | 37.47±0.35 | |||
| Socio-demographic characteristics | Gender | Men | 157(17.0) | |
| Women | 881(83.0) | |||
| Age (year) | 65∼74 | 295(39.9) | 77.26±0.30 | |
| 75∼84 | 454(38.8) | |||
| ≥85 | 289(21.3) | |||
| Education | ≤ Elementary school graduate | 699(59.3) | ||
| Middle school | 162(18.3) | |||
| High school | 143(18.2) | |||
| ≥ Bachelor's degree | 34(4.2) | |||
| Perceived socioeconomic status (n=1,037) | Middle or above | 421(40.2) | ||
| Below middle | 616(59.8) | |||
| Oral health-related characteristics | Wearing dentures | Yes | 372(31.3) | |
| No | 666(68.7) | |||
| Natural teeth count (n=1,026) | ＜20 | 477(42.8) | ||
| ≥20 | 549(57.2) | |||
| Health-related characteristics | Subjective health status | Good | 303(31.2) | |
| Moderate | 417(40.2) | |||
| Poor | 318(28.6) | |||
| Difficulties in daily activities due to vision impairments (n=1,033) | Yes | 48(4.2) | ||
| No | 985(95.8) | |||
| Difficulties in daily activities due to hearing impairments | Yes | 89(7.9) | ||
| No | 949(92.1) | |||
| Hypertension | Yes | 582(55.0) | ||
| No | 456(45.0) | |||
| DM | Yes | 265(24.8) | ||
| No | 773(75.2) | |||
| Cancer | Yes | 24(1.7) | ||
| No | 1,014(98.3) | |||
| COPD | Yes | (2.8)28 | ||
| No | (97.2)1,010 | |||
| Heart disease | Yes | (10.7)123 | ||
| No | (89.3)915 | |||
| Cerebrovascular disease | Yes | (5.6)57 | ||
| No | (94.4)981 | |||
| Mental illness | Yes | (5.3)50 | ||
| No | (94.7)988 | |||
| Arthritis | Yes | (29.4)331 | ||
| No | (70.6)707 | |||
| Dementia | Yes | (2.4)32 | ||
| No | (97.6)1,006 | |||
| ADL | 0.24±0.03 | |||
| IADL | 0.82±0.07 | |||
| Depression | 1.71±0.08 | |||
| Health behavior-related characteristics | Smoking | None | 891(83.1) | |
| Ex-smoker | 112(11.9) | |||
| Current | 35(5.0) | |||
| Drinking | None | 673(61.7) | ||
| Ex-drinker | 232(22.9) | |||
| Current | 133(15.4) | |||
| Regular meal habits | Regular | 881(83.5) | ||
| Irregular | 157(16.5) | |||
| BMI | Overweight and obese | 528(53.6) | ||
| Normal weight | 438(41.0) | |||
| Underweight | 54(5.4) |
2. OHRQoL According to Participant Characteristics
The analysis of OHRQoL according to participant characteristics in this study revealed significant differences between groups for all variables except sex, cancer, COPD, smoking, regular meals, and BMI (Table 2). OHRQoL scores were higher among younger participants: 33.46± 0.59 for those aged 85+, 36.92±0.42 for ages 75∼84, and 40.13±0.63 for ages 65∼74 (F=32.45, p<.001). Participants with higher education levels had better OHRQoL scores, with elementary graduates scoring 36.04±0.40, high school graduates at 40.34±0.99, and those with a bachelor's or higher degree scoring 40.45±0.97 (F=9.59, p<.001). Those perceiving themselves as middle or above socioeconomic status also had higher OHRQoL (39.04±0.48) compared to those below the middle (36.41±0.48)(t=15.16, p<.001).
Table 2.
Difference in OHRQoL According to Participants' Characteristics (N=1,038)
| Variables | Characteristics | Categories | M± SE | t or F or r | p | post-hoc‖ |
|---|---|---|---|---|---|---|
| Socio-demographic characteristics | Gender | Men | 38.83±0.85 | 3.03† | .082 | |
| Women | 37.18±0.39 | |||||
| Age (year) | ≥85a | 33.46±0.59 | 32.45‡ | ＜.001 | a＜ b＜ c | |
| 75∼84b | 36.92±0.42 | |||||
| 65∼74c | 40.13±0.63 | |||||
| Education | ≤ Elementary schoola | 36.04±0.40 | 9.59‡ | ＜.001 | c, d＞ a | |
| Middle schoolb | 38.55±0.87 | |||||
| High schoolc | 40.34±0.99 | |||||
| ≥ Bachelor's degreed | 40.45±0.97 | |||||
| Perceived socioeconomic status | Middle or above | 39.04±0.48 | 15.16† | ＜.001 | ||
| Below middle | 36.41±0.48 | |||||
| Oral health-related characteristics | Wearing dentures | Yes | 34.29±0.60 | 39.46† | ＜.001 | |
| No | 38.91±0.41 | |||||
| Natural teeth count | ＜20 | 34.95±0.53 | 44.40† | ＜.001 | ||
| ≥20 | 39.46±0.43 | |||||
| Health-related characteristics | Subjective health status | Gooda | 40.15±0.68 | 24.19‡ | ＜.001 | a＞ b＞ c |
| Moderateb | 37.98±0.43 | |||||
| Poorc | 33.82±0.65 | |||||
| Difficulties in daily activities due to vision impairments | Yes | 31.11±1.52 | 17.60† | ＜.001 | ||
| No | 37.74±0.36 | |||||
| Difficulties in daily activities due to hearing impairments | Yes | 30.57±1.39 | 26.80† | ＜.001 | ||
| No | 38.06±0.36 | |||||
| Hypertension | Yes | 36.47±0.44 | 9.49† | .002 | ||
| No | 38.69±0.57 | |||||
| DM | Yes | 36.00±0.56 | 8.03† | .005 | ||
| No | 37.95±0.42 | |||||
| Cancer | Yes | 36.61±1.40 | 0.37† | .545 | ||
| No | 37.48±0.35 | |||||
| COPD | Yes | 39.64±2.01 | 1.22† | .270 | ||
| No | 37.40±0.35 | |||||
| Heart disease | Yes | 33.75±1.10 | 12.60† | ＜.001 | ||
| No | 37.91±0.36 | |||||
| Cerebrovascular disease | Yes | 32.01±1.56 | 13.06† | ＜.001 | ||
| No | 37.79±0.35 | |||||
| Mental illness | Yes | 32.87±2.08 | 5.38† | .021 | ||
| No | 37.72±0.34 | |||||
| Arthritis | Yes | 35.72±0.59 | 12.43† | ＜.001 | ||
| No | 38.19±0.41 | |||||
| Dementia | Yes | 30.03±2.19 | 11.85† | .001 | ||
| No | 37.65±0.35 | |||||
| ADL | -.16§ | ＜.001 | ||||
| IADL | -.24§ | ＜.001 | ||||
| Depression | -.41§ | ＜.001 | ||||
| Health behavior-related characteristics | Smoking status | Current | 41.27±2.51 | 1.48‡ | .228 | |
| Ex-smoker | 37.18±0.98 | |||||
| None | 37.27±0.36 | |||||
| Drinking | Currenta | 40.12±0.98 | 5.20‡ | .006 | a＞ b, c | |
| Ex-drinkerb | 37.21±0.69 | |||||
| Nonec | 36.90±0.43 | |||||
| Regular meal habits | Regular | 37.53±0.33 | 0.09† | .767 | ||
| Irregular | 37.16±1.21 | |||||
| BMI | Overweight and obses | 38.21±0.42 | 2.19‡ | .113 | ||
| Normal weight | 37.35±0.53 | |||||
| Underweight | 34.27±2.20 |
Participants who wore dentures had a significantly lower OHRQoL score (34.29±0.60) compared to those who did not (38.91±0.41) (t=39.46, p<.001). Similarly, those with fewer than 20 natural teeth scored lower (34.95±0.53) than those with 20 or more teeth (39.46±0.43) (t=44.40, p<.001).
OHRQoL scores were higher for participants who felt healthy (40.15±0.68) compared to those who felt average (37.98±0.43) or unhealthy (33.82±0.65), showing significant differences (F=24.19, p<.001). Those with vision difficulties had an OHRQoL score of 31.11±1.52, versus 37.74 ±0.36 for those without (t=17.60, p<.001). Similarly, hearing difficulties resulted in lower scores (30.57±1.39) compared to no difficulties (38.06±0.36) (t=26.80, p<.001). Significant differences were also found for hypertension (t=9.49, p=.002), diabetes (t=8.03, p=.005), heart disease (t=12.60, p<.001), cerebrovascular disease (t=13.60, p<.001), mental illness (t=5.38, p=.021), arthritis (t=12.43, p<.001), and dementia (t=11.85, p =.001). There were significant negative correlations between OHRQoL and ADL (r=-.16, p<.001), IADL (r=-.24, p<.001), and depression scores (r=-.41, p<.001). Current drinkers had higher OHRQoL scores (40.12±0.98) than former drinkers (37.21±0.69) and non-drinkers (36.90±0.43)(F=5.20, p=.006).
3. Factors influencing OHRQoL
To identify the factors influencing OHRQoL in the subjects, a multivariate CSGLM analysis was conducted. Independent variables that showed significant differences in OHRQoL in the univariate CSGLM were included in the analysis. Factors influencing OHRQoL in older adults included age (85 years and older), denture use (yes), difficulties in daily activities due to vision impairment (yes), hearing difficulties (yes), and depression. Older adults aged 85 and above had significantly lower OHRQoL scores compared to those aged 65∼74 (B=-2.43, p=.003), indicating a trend of decreasing OHRQoL with advancing age. Participants who wore dentures had significantly lower OHRQoL scores than non-denture wearers (B=-1.44, p=.035). Those with difficulties in daily activities due to vision impairment (B=-2.79, p=.024) and hearing difficulties (B=-2.53, p=.028) also had significantly lower OHRQoL scores. Higher depression scores were associated with significantly lower OHRQoL (B=-1.30, p<.001), indicating that increased levels of depression negatively affected OHRQoL (Table 3).
Table 3.
Factors Influencing OHRQoL (N=1,038)
DISCUSSION
This study aims to comprehensively evaluate the factors influencing the OHRQoL of community-dwelling old-er adults living alone, using multivariate analysis and data from the 9th wave of the KLoSA. The goal is to provide baseline data for developing nursing intervention programs that target modifiable factors affecting OHRQoL, thereby improving the QoL for these individuals.
In this study, the average OHRQoL score for commun-ity-dwelling older adults living alone was 37.47 out of 60 points, closely aligning with the 37.52 score reported for older adults receiving family support using the same GOHAI assessment tool [17]. While the score difference is minimal, it underscores the unique social and emotional challenges faced by those living alone. Studies consis-tently show that older adults living alone tend to have slightly lower OHRQoL than those living with family [20], likely reflecting broader social and emotional disparities affecting their health and quality of life. Family members often provide critical consent, emotional support, and fol-low-up care during dental treatment [21]. Without this support, older adults living alone may face barriers to timely dental care, leading to poorer oral health and di-minished quality of life [22]. Therefore, targeted interventions are crucial to address the specific oral health needs of this vulnerable population, ensuring they receive adequate care and support
This study conducted a multivariate linear regression analysis on a complex sample to identify factors affecting the OHRQoL of research participants. Significant factors included age (85 years and older), denture use, vision and hearing impairments, and depression. Specifically, older adults in the “65∼74 years” group had higher OHRQoL scores than those aged “85 years and older.” These findings align with previous research suggesting that as adults age, they experience more oral health problems, such as missing teeth, which negatively affect their OHRQoL and overall quality of life [17,23].
Community-dwelling older adults living alone who wore dentures also had lower OHRQoL scores than those without dentures. This is consistent with previous studies showing that denture wearers often have poorer oral health [24]. While dental prosthetics can restore chewing function and improve nutrition, maintaining oral hygiene be-comes more difficult with a higher number of prosthe-ses, potentially leading to conditions like dry mouth, bad breath, stomatitis, and oral candidiasis, further lowering OHRQoL [3,25]. Therefore, it is important to revise and en-hance structured oral care interventions specifically targeting older adults who wear dentures, addressing their unique needs. Developing community programs to support comprehensive and accessible oral health management for older adults is essential for improving their overall well-being.
In this study, older adults with vision difficulties had lower OHRQoL than those without visual impairments. Visual impairments can make it challenging for individuals to maintain proper oral hygiene, leading to higher levels of gum inflammation and an increased need for dental treatment [26]. For visually impaired patients, it is essential to use alternative communication methods, such as audio recordings and Braille pamphlets, to explain oral hygiene procedures effectively [27]. Similarly, older adults with hearing impairments also exhibited lower OHRQoL. Hearing impairments can create barriers to effective communication during dental visits, potentially leading to de-layed treatment or inadequate oral care, which may negatively affect their oral health [26]. A previous study on individuals with hearing impairments reported an OHRQoL score of 14.44, suggesting a lower quality of life than individuals without hearing impairments [28]. In both cases, managing these disabilities may take precedence over oral care, emphasizing the need for interdisciplinary measures to ensure that individuals with vision or hearing impairments receive necessary care from dental, social, and medical professionals [29].
It has been noted that older adults with poor oral health are more likely to experience episodes of depression [30]. Depression can negatively affect oral health by causing individuals to neglect oral hygiene practices, consume cav-ity-causing foods, and avoid necessary dental care, ultimately increasing susceptibility to dental caries and periodontal disease [31]. The oral health of older adults is closely linked to negative psychological symptoms, such as depression, experienced in later life. Therefore, to maintain the physical and emotional well-being of older adults, it is crucial to implement systematic prevention and management of oral diseases, including the incorporation of various emotional management programs.
This study found that as levels of depression increased among community-dwelling older adults living alone, their OHRQoL decreased. These findings align with previous research showing a negative correlation between depression levels, dental status, the number of missing teeth, and dry mouth [31]. Specifically, older adults with higher levels of depression have been found to experience more severe tooth loss and dry mouth, conditions that exacerbate oral discomfort and make eating difficult, thus further contributing to poor nutrition and overall well-being [13]. Dry mouth, often caused by medications for depression, reduces saliva flow, which is essential for maintaining oral health by neutralizing acids and washing away food particles. A reduction in saliva can lead to an increased risk of cavities and periodontal disease [13]. Additionally, depression can negatively affect oral health by causing individuals to neglect oral hygiene practices, consume cavity-causing foods, and avoid necessary dental care, ultimately increasing susceptibility to dental caries and periodontal disease [30].
The relationship between oral health and depression may be explained by a cyclical pattern: poor oral health can exacerbate depressive symptoms, while depression can lead to neglect of oral health, resulting in further dental problems. Research indicates that individuals with missing teeth are more likely to experience social isolation and reduced self-esteem, which are risk factors for depression in older adults [30]. Therefore, the systematic prevention and management of oral diseases, combined with emotional management programs, is crucial for maintaining the physical and emotional well-being of older adults.
This study has several limitations. First, the 9th wave of KLoSA data is cross-sectional, meaning it measures variables at a single point in time, limiting the ability to explain causal relationships between factors related to the OHRQoL of community-dwelling older adults living alone. Cross-sectional studies do not track changes over time, making it difficult to determine whether poor oral health leads to increased depression or whether depression worsens oral health. Future research should use longitudinal analysis to understand better how these factors interact over time. Second, the study did not include detailed psychological variables such as self-esteem and stress, which are essential for understanding OHRQoL in older adults. Additionally, only a portion of the available data was used, limiting the scope of analysis. Despite these limitations, this study provides valuable insights by analyzing factors influencing OHRQoL among older adults living alone, using a large, nationally representative sample. The robust KLoSA dataset enhances the generalizability of the findings, providing a strong foundation for developing nursing interventions and policy recommendations aimed at improving the OHRQoL of this vulnerable population, particularly by addressing psychological health, managing disabilities, and enhancing preventive care.
CONCLUSION
This study explores the impact of oral health and general health factors on the OHRQoL of community-dwelling older adults living alone, providing a foundation for tailored nursing interventions. Nurses play a critical role in preventive care, such as regular dental check-ups, oral hygiene education, and mental health support, especially for issues like depression. Furthermore, nursing interventions must address the specific needs of older adults with visual and hearing impairments.
From a policy perspective, a multidisciplinary approach is essential in managing the oral health of older adults in the community. Nurses can collaborate with other healthcare professionals to deliver oral health education and preventive care through mobile dental clinics or home-based programs for those with mobility limitations. Additionally, nurses are central to community-wide education campaigns that promote the connection between oral health and overall well-being. Future research should in-corporate psychological factors, such as self-esteem and stress, into a broader multidisciplinary approach.
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