摘要：Objectives. We sought to investigate the relationship between varying levels of cognitive function and dental care utilization. Methods. Using data obtained from the National Health and Nutrition Examination Survey (1999–2002), we performed weighted descriptive and multivariate logistic regression analyses on 1984 individuals with at least 1 tooth and who were 60 years and older. Results. Multivariate analyses suggested that level of cognitive function was associated with dental care utilization. At a higher level of cognitive functioning, individuals were more likely to have had more frequent dental visits. In addition, a higher level of socioeconomic status, healthy lifestyle, and worse self-rated oral health–related symptoms were more likely to indicate a higher frequency of dental care utilization. By contrast, poorer oral health status as determined by clinical examinations was negatively associated with frequency of dental visits. Conclusions. The results suggest that community-dwelling older adults with low cognitive function are at risk for less frequent use of dental care. Oral health serves as a mediating factor between cognitive function and dental care utilization. There is a great need to improve oral health awareness and education among older adults, caregivers, and health care professionals. Adults 65 years and older are the fastest growing segment of the population in the United States. The number of older adults will climb from 35 million—12.4% of the US population in 2000—to about 55 million or 16.27% in 2020. 1 An estimated 8% to 10% of older adults have dementia, 2 , 3 and an estimated additional 17% to 19% 4 , 5 have more mild cognitive impairment that does not meet the threshold for dementia. Among the many health care issues that these individuals face, dental care is one that may have serious repercussions if overlooked. Neglect of dental care may lead to tooth decay, pain, tooth loss, and inflammation. More importantly, untreated or delayed dental diseases affect nutrition status, cause oral dysfunction, and ultimately affect an individual’s quality of life. 6 Numerous factors are reportedly associated with lower use of dental care or greater unmet dental care needs: older age, male gender, 7 – 10 lower income, lack of dental insurance, 11 – 13 poorer health status, more chronic conditions, 14 , 15 smoking, 16 , 17 and poorer oral health status. 18 , 19 Limited evidence indicates that, compared with older individuals with no dementia, elderly adults with dementia have poorer oral health and more often do not receive needed dental care. 20 – 22 But even less is known about dental care utilization among those with low cognitive function or mild impairment insufficient to meet the criteria for dementia. One study of a small, regional sample found, through bivariate analyses, that individuals with a greater deficit in cognitive functioning were less likely to have reported getting dental care. 23 A second study, by Walsh et al., found that, after control for respondents’ sociodemographic characteristics and other risk factors, individuals with relatively low or moderate cognitive function were significantly less likely to have dentist visits compared with those with high cognitive function. Walsh et al. used a nationally representative sample from the Asset and Health Dynamics Among the Oldest Old study to examine the impact of cognitive function on dental care. 24 However, because of the limitations of the data, Walsh et al. were not able to include some important variables, such as clinical examinations of oral health status and self-rated oral health–related quality-of-life measures, and dental insurance coverage in the analysis. Without these measures, the effect of cognitive function on dental care utilization might be biased and inaccurate because there is a relationship among cognitive function, oral health, and dental insurance. For our study, we used the National Health and Nutrition Examination Survey (NHANES), which is unique in that it is a large, representative national sample that includes detailed clinical and self-reported measures of oral health, as well as information on cognitive function. With this study, we aimed to fill the gaps in current knowledge by investigating the linkage between cognitive function and dental care utilization while we controlled for many important covariates such as socio-demographic characteristics, physical health, and health behaviors, with the addition of variables that have not previously been studied, such as oral health status and dental insurance. On the basis of previous studies findings, we offer the following hypothesis: a higher level of cognitive function has a positive impact on dental care utilization. After we control for oral health status and other covariates such as sociodemographic characteristics and physical health, a higher level of cognitive function will still have a positive, although smaller, impact.
