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dc.contributor.authorGülcan, Ferda
dc.date.accessioned2017-03-16T11:58:52Z
dc.date.available2017-03-16T11:58:52Z
dc.date.issued2017-03-10
dc.identifier.isbn978-82-308-3106-9
dc.identifier.urihttp://hdl.handle.net/1956/15596
dc.description.abstract<p>Background: Globally, the proportion of older people is increasing. There is a need to address issues related to oral health and oral health-related quality of life of elderly. There is scarce information on how oral health and dental care utilization as well as the social distribution of those oral indicators develop across time and by ageing in Norway and Sweden. The overall aim was to provide new information about oral health, dental care utilization and associated life-course factors among older people using comparative data generated by Norwegian and Swedish 1942 birth cohorts of elderly.</p> <p>Methods: The thesis is based on data from two cohort studies. All persons born in 1942 in three counties of Norway and two counties of Sweden were defined as the study cohorts. The 2007 and 2012 waves were used in the present thesis. In Norway, the response rates were 58.0% (n=4211) in 2007 and 54.5% (n=3733) in 2012. A total of 2947 (follow-up rate of 70.0%) participated in both waves. The corresponding rates in Sweden were 73.1% (n=6078) and 72.2% (n=5697), respectively. A total of 4862 (follow-up rate of 80.0%) participated in 2007 and 2012. Data were collected using self-administered questionnaire and analysed separately by country.</p> <p>Results: The prevalence of reporting any oral impacts (OIDP&gt;0) was 29.0% in 2007 and 28.4% in 2012 in Norway, whereas corresponding figures in Sweden were 27.3% in 2007 and 20.4% in 2012. Altogether, 63.6% of the Norwegian and 68.1% of the Swedish participants reported no change regarding OIDP (Oral Impacts on Daily Performances) scores across time. The percentage of persons reporting tooth loss (defined as extensive tooth loss or being edentulous) increased from 21.8% to 23.2% in Norway and from 25.9% to 27.3% in Sweden. Less frequent dental attendance decreased from 14.5% to 12.2% in Norway and from 13.6% to 12.9% in Sweden. Early and later life social conditions contributed independently on tooth loss and OIDP. Participants in socially disadvantaged groups were more likely to report oral impacts (OIDP), tooth loss and less frequent dental attendance. Marginal and random intercept models were applied to take account into clustered structure of data due to repeated observations. Using Andersen&rsquo;s behavioural model, predisposing, enabling, and need related factors and dental care utilization indicators were associated with OIDP.</p> <p>Conclusions: The OIDP frequency inventory demonstrated acceptable longitudinal validity, reproducibility and responsiveness. OIDP (reporting any oral impacts) and less frequent dental attendance declined while tooth loss increased from age 65 to 70 in both countries investigated. Social inequalities were confirmed and shown to be persistent in Norwegian and Swedish older people from age 65 to 70 years. Support for the latent effect life-course model was obtained. This thesis provides support to Andersen&rsquo;s model as a satisfactory model to explain oral health in older people.</p>eng
dc.description.abstract<p>Bakgrunn: Andelen av eldre &oslash;ker p&aring; verdensbasis. Det er behov for &aring; ta opp sp&oslash;rsm&aring;l knyttet til oral helse og oral helse-relatert livskvalitet for eldre. Det er lite informasjon om hvordan oral helse og bruk av tannhelsetjenester samt den sosiale fordelingen av disse indikatorer forandrer seg over tid og ved aldring i Norge og Sverige. Det overordnede m&aring;let var &aring; skaffe ny informasjon om oral helse, bruk av tannhelsetjenester og tilh&oslash;rende livsl&oslash;psfaktorer blant eldre mennesker ved hjelp av &aring; bruke komparative data i norske og svenske 1942 f&oslash;dselskohorter av eldre.</p> <p>Metoder: Denne avhandlingen er basert p&aring; data fra to kohortstudier. Alle personer f&oslash;dt i 1942 i tre fylker i Norge og to fylker i Sverige ble definert som studiekohorter. Data fra 2007 og 2012 ble brukt. I Norge var responsraten 58,0 % (n = 4211) i 2007 og 54,5 % (n = 3733) i 2012. I alt 2947 (oppf&oslash;lging rate 70,0 %) deltok i begge &aring;rene. De tilsvarende tallene i Sverige var henholdsvis 73,1 % (n = 6078) og 72,2 % (n = 5697). Totalt 4862 (oppf&oslash;lging rate 80,0 %) deltok i 2007 og 2012. Data ble samlet inn ved hjelp av selvadministrert sp&oslash;rreskjema og analysene ble gjort separat p&aring; hvert land.</p> <p>Resultater: Forekomsten av redusert livskvalitet (OIDP&gt;0) var 29,0 % i 2007 og 28,4 % i 2012 i Norge, mens tilsvarende tall i Sverige var 27,3 % i 2007 og 20,4 % i 2012. Til sammen 63,6 % av norske og 68,1 % av svenske deltakere rapporterte ingen endring av OIDP (Oral Impacts on Daily Performances) sk&aring;r over tid. Andelen av personer som rapporterte tanntap (definert som omfattende tanntap eller &aring; v&aelig;re tannl&oslash;s) &oslash;kte fra 21,8 % til 23,2 % i Norge og fra 25,9 % til 27,3 % i Sverige. Sjeldent bruk av tannhelsetjenester ble redusert fra 14,5 % til 12,2 % i Norge og fra 13,6 % til 12,9 % i Sverige. Livsl&oslash;psperspektiv modellen (the latent effect life-course model) ble bekreftet at tidlige og senere livsl&oslash;psfaktorer hadde en uavhengig effekt p&aring; tanntap og OIDP. Deltakere med minst sosiale ressurser var mer sannsynlig &aring; rapportere redusert livskvalitet (OIDP), tanntap og sjeldnere bruk av tannhelsetjenester. Ulike statistiske metoder ble anvendt for &aring; ta hensyn til den &laquo;cluster&raquo; strukturen av data p&aring; grunn av repeterte m&aring;linger. Ved hjelp av Andersens atferds modell, disponerende-, muliggj&oslash;rende-, og behovs- relaterte faktorer og bruk av tannhelsetjenester var assosiert med OIDP.</p> <p>Konklusjon: OIDP instrument demonstrerte akseptabelt longitudinell validitet, reproduserbarhet og respons. Redusert livskvalitet og sjeldnere bruk av tannhelsetjenester ble redusert mens tanntap &oslash;kte fra 65 &aring;r til 70 i begge landene. Sosiale ulikheter ble bekreftet og viste seg &aring; v&aelig;re vedvarende hos den norske og svenske eldre populasjonen fra alderen 65 til 70 &aring;r. Denne avhandlingen gir st&oslash;tte til Andersens modell som en tilfredsstillende modell for &aring; forklare oral helse hos eldre. St&oslash;tte for den livsl&oslash;psperspektiv modellen ble ogs&aring; oppn&aring;dd.</p>eng
dc.language.isoengeng
dc.publisherThe University of Bergeneng
dc.relation.haspartPaper I: Gulcan F, Nasir E, Ekback G, Ordell S, Astrom AN. Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden. BMC Oral Health 2014, 14:59. The article included an erratum is available at: <a href="http://hdl.handle.net/1956/8469" target="blank">http://hdl.handle.net/1956/8469</a>eng
dc.relation.haspartPaper II: Gulcan F, Ekback G, Ordell S, Lie SA, Astrom AN. Inequality in oral health related to early and later life social conditions: a study of elderly in Norway and Sweden. BMC Oral Health 2015, 15:20. The article is available at: <a href="http://hdl.handle.net/1956/10749" target="blank">http://hdl.handle.net/1956/10749</a>eng
dc.relation.haspartPaper III: Gulcan F, Ekback G, Ordell S, Lie SA, Astrom AN. Social predictors of less frequent dental attendance over time among older people: population-averaged and person-specific estimates. Community Dent Oral Epidemiol 2016, 44(3):263-273. The article is available in the main thesis. The article is also available at: <a href="http://dx.doi.org/10.1111/cdoe.12214" target="blank">http://dx.doi.org/10.1111/cdoe.12214</a>eng
dc.relation.haspartPaper IV: Gulcan F, Ekback G, Ordell S, Klock KS, Lie SA, Astrom AN. Exploring associations of dental care utilization on oral impacts on daily performances using Andersen’s behavioural model – a prospective cohort study of older people in Norway and Sweden. Full text not available in BORA.eng
dc.titleOral health-related quality of life, tooth loss and utilization of dental services among older people in Norway and Sweden. A prospective and comparative perspectiveeng
dc.typeDoctoral thesiseng
dc.rights.holderCopyright the Author. All rights reservedeng
bora.peerreviewedNot peer reviewedeng
dc.identifier.cristinID1456889
dcterms.hasParthttp://hdl.handle.net/1956/10749eng
dcterms.hasParthttp://hdl.handle.net/1956/8469eng


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