Keywords
knowledge - self-awareness - elderly - oral mucosal health
Introduction
Aging as a physiologic process of human beings is a complex biological phenomenon
resulting from genetic and environmental factors.[1] According to the World Health Organization (WHO), the worldwide population is increasing
at an annual rate of 1.7%, while the population aged 65 years or older is increasing
more rapidly at a rate of 2.5%.[2]
[3] Globally, it is predicted the number of elderly aged 60 years or older will be 2
billion in 2050, two times greater than the population in 2019.[4] This population aging is influenced by many factors, including improvement in public
health and advances in medicine.[5]
With global changes in life expectancy, the elderly population has increased in number,
especially in developed countries.[6] Indonesia, one of the developed countries, is the fourth most populous country in
the world and is heading toward an aging population.[5]
[7] In 2017, there were approximately 22 million elderly in Indonesia. This number is
estimated to increase to 48 million by 2035 with the elderly population accounting
for 16% of the total.[7] Increases in this population need special attention, especially regarding the improvement
of hygiene and health. WHO states that health includes physical, mental, and social
well-being. It is, therefore, important to improve health not only in life-saving
aspects but also in quality of life.[8]
Dental and oral health contribute physically and psychologically to quality of life.[9] Elderly populations face many obstacles to receiving oral health care, such as low
education levels, low-income levels, lack of dental insurance, poor health, and their
belief that they do not need any oral treatment.[10] Less self-awareness about oral health problems can lead to nescience that those
problems can be prevented or treated.[11] Therefore, it is important to assess elderly knowledge related to oral health.
Public health centers seek to overcome the oral health problems of the elderly through
health promotion programs. Community empowerment is a type of health promotion program
that takes the form of counseling and providing knowledge about oral health to the
elderly.[12] Community empowerment is a process to increase the community's capacity to utilize
both human and natural resources for their welfare.[13]
As an inevitable part of the lifecycle, every elderly person should prepare for the
aging process and aging-related problems, especially in the oral cavity. If oral health
of the elderly can be maintained properly, it can support general health and improve
quality of life so that demographic bonuses can be utilized maximally.[4] Therefore, this research aims to assess whether community empowerment as a health
promotion program can improve elderly knowledge and develop self-awareness about oral
health and aging-related oral health problems.
Materials and Methods
This study was a quasi-experimental study with a one-group pretest–posttest design
conducted in the Lestari and Flamboyan Geriatric Communities fostered by the Jagir
Public Health Center, Surabaya, Indonesia. This study was conducted in September 2021,
in the form of a community empowerment program to share knowledge about oral health
and aging-related oral health problems. The Jagir Public Health Center had previously
collaborated with the Universitas Airlangga Faculty of Dental Medicine on several
oral health programs including education, research, and community development.
Participants of this study were elderly aged 60 years or older from the geriatric
community mentioned above. The community empowerment target to be achieved was an
increase in awareness, understanding, and knowledge about the importance of maintaining
oral health and hygiene in the elderly. To achieve this target, the authors composed
counseling material in the form of an educative booklet distributed to all elderly
who participated in the program. The drafting process was done by an oral medicine
specialist from the Faculty of Dental Medicine at Universitas Airlangga and involved
dentists from the Jagir Public Health Center.
Counseling was done by an oral medicine specialist and resident from the Faculty of
Dental Medicine at Universitas Airlangga. Evaluation of elderly knowledge and improvement
was conducted pretest and posttest in a written questionnaire consisting of 10 questions
related to material from counseling and the educative booklet. Elderly patients who
needed help in filling in the questionnaire were assisted by an oral medicine resident.
Data collection procedures for this study were the scoring of pretest and posttest
questionnaires. Data obtained will be presented descriptively in number and analyzed
statistically to compare the score between pretest and posttest using IBM SPSS version
26. Data normality was tested using the Shapiro–Wilk test with the result that the
data was not normally distributed (p < 0.05), therefore follow-up analysis was done using a nonparametric test. Then,
the Wilcoxon test was performed to determine if there was a statistically significant
difference between pretest and posttest scores.
Results
A total of 50 participants from two geriatric communities joined this counseling program.
Of those, 12 participants were excluded from the study because they were under 60
years old. Therefore, a total of 38 elderly aged 60 years or older were included in
this study. The demographic profile of the elderly included in data analysis is presented
in [Table 1].
Table 1
Demographic profiles from the elderly included in this study
|
Demographic aspect
|
Number of subjects
|
Percentage
|
|
Sex
|
|
Male
|
7
|
18.42
|
|
Female
|
31
|
81.58
|
|
Age
|
|
60–74 years old
75–90 years old
|
29
9
|
76.32
23.68
|
|
> 90 years old
|
0
|
0
|
|
Geriatric community
|
|
Lestari
|
27
|
71.05
|
|
Flamboyan
|
11
|
28.95
|
|
Total subjects
|
38
|
|
The results of the pretest and posttest are listed in [Table 2], showing that 29 (76.32%) elderly showed an improvement in knowledge after being
given counseling about oral health. Only two (5.26%) elderly had a lower posttest
score and seven (18.42%) elderly showed no score improvement. Statistical comparison
showed that there was a significant difference between participants' pretest and posttest
scores (p = 0.000).
Table 2
Pretest and posttest results from study participants
|
Ranks
|
Number of subjects
|
p-Value
|
|
Positive ranks[a]
|
29 (76.32%)
|
0.000
|
|
Negative ranks[b]
|
2 (5.26%)
|
|
Ties[c]
|
7 (18.42%)
|
|
Total subjects
|
38 (100%)
|
|
a Posttest > pretest.
b Posttest < pretest.
c Posttest = pretest.
Discussion
The aging process is an inevitable part of human life; it will occur in every individual
in the global population and life expectancy will increase significantly.[14]
[15] Elderly are people aged 60 years or older. They are considered “elderly” because
this stage of the aging process causes a decline in physical and physiological abilities.[16] Those declined abilities cause limitations in maintaining personal hygiene. Furthermore,
personal, social, and cultural factors also play a vital role in personal hygiene
behavior, including oral care. If oral care is not done properly, it will cause oral
mucosal disorders and other oral-related diseases.[8]
Oral health in the elderly is considered a basic need that is increasingly neglected
with advancing age, debilitation, and limited mobility.[2] A study by Thalib et al showed that there was a significant relationship between
oral hygiene status and individual knowledge about oral hygiene. A healthy way of
life in maintaining oral health was formed from a good education. Even adequate knowledge
will lead to good oral health status so that the risk of developing caries and mucosal
disease can be suppressed.[9] A survey study conducted by Abdat and Jernita found that the elderly still possess
poor knowledge about oral health and that this level of knowledge has a strong correlation
with poor oral health status.[17] Therefore, improving knowledge about oral health in the elderly becomes an important
aspect to be developed in the aging population.
In this study, a community empowerment program on oral health education was conducted
with 38 elderly from two geriatric communities. The success indicator of this program
was the increasing knowledge of the elderly, measured through pretest and posttest
questionnaires. During the implementation of the program, educational counseling was
conducted with a demonstration method by two speakers, which participants could follow
with guidance from the booklet given to them before. Participants gave positive feedback
and actively asked questions of the speaker. These indicated that participants followed
the program well.
The result of this study was that 29 elderly (76.32%) had an improvement in their
posttest score compared with their pretest score (p = 0.000). This can be interpreted as showing how community empowerment done in counseling
methods can significantly improve elderly knowledge about oral health. This study
is in line with a study from Berniyanti et al that dental and oral health education
plays a significant role in improving elderly knowledge about tooth brushing methods.[12] Both studies included the elderly and used the same method in transferring knowledge
from speakers to participants. The only difference was the topics and outcomes of
the study.
Research on the effect of educational interventions on improving the quality of life
of the elderly has now been performed extensively. Each study is different from other
studies so it is difficult to do a direct comparison; nevertheless, each study can
support others in terms of outcomes. One study from Shokouhi et al was conducted to
determine the impact of educational intervention on oral health-related quality of
life of the elderly using a randomized controlled trial study design. The results
showed that the educational program alongside therapeutic interventions had a positive
impact, which improved the oral health-related quality of life in the elderly (p < 0.001).[18]
Oral health education is a part of health promotion programs in public health centers,
which include various targets for different age groups. Health promotion strategies
for the elderly have three basic outcomes: maintaining and increasing functional capacity,
improving self-care, and stimulating individual social networks.[13]
[19]
[20] The limitation of this study is the small number of participants and evaluation
method. This study only used pretest and posttest methods to assess knowledge improvement
while other factors may influence the knowledge status of each elderly person. It
is also not possible to measure the development of self-awareness. For further research,
the authors suggest thorough research involving all variables affecting elderly knowledge.
Overall, despite the existing limitations, this study concludes that educational counseling
in empowerment programs can help the elderly improve their knowledge about oral health
so that improvements can be expected to be followed by the development of self-awareness
in the future.
