title: Correlates of change in self-perceived oral health among older adults in Brazil: findings from the Health, Well-Being and Aging Study.
abstract: BACKGROUND
  Identifying changes in the oral health status of older populations, and their predictors and explanations, is necessary for public health planning. The authors assessed patterns of change in oral health-related quality of life in a large cohort of older adults in Brazil during a five-year period and evaluated associations between baseline characteristics and those changes.
  
  
  METHODS
  The sample consisted of 747 older people enrolled in a Brazilian cohort study called the Health, Well-Being and Aging (Saúde, Bem-estar e Envelhecimento [SABE]) Study. Trained examiners measured participants' self-perceived oral health by using the General Oral Health Assessment Index (GOHAI). The authors calculated changes in the overall GOHAI score and in the scores for each of the GOHAI's three dimensions individually by subtracting the baseline score from the score at follow-up. A positive difference indicated improvement in oral health, a negative difference indicated a decline and a difference of zero indicated no change.
  
  
  RESULTS
  The authors found that 48.56 percent of the participants experienced a decline in oral health and 33.48 percent experienced an improvement. Participants with 16 or more missing teeth and eight or more years of education were more likely to have an improvement in total GOHAI score. Deterioration was more likely to occur among those with two or more diseases. Improvement and decline in GOHAI functional scores were related to the number of missing teeth. The authors found no significant model for the change in the psychosocial score, and self-rated general health was the only variable related to both improvement and decline in pain or discomfort scores.
  
  
  CONCLUSIONS
  The authors observed a bidirectional change in self-perceived oral health, with deterioration predominating. The strongest predictor of improvement in the total GOHAI score was the number of missing teeth, whereas the number of diseases was the strongest predictor of deterioration.
  
  
  CONCLUSIONS
  Dental professionals and policymakers need to know the directions of change in older adults' oral health to establish treatment priorities and evaluate the impact of services directed at this population.
authors.affiliation: Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil. fabiolabof@yahoo.com.br
authors.forename: Fabíola Bof
authors.initials: FB
authors.lastname: de Andrade
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Lebrão
authors.forename: Jair Licio Ferreira
authors.initials: JL
authors.lastname: Santos
authors.forename: Yeda Aparecida de Oliveira
authors.initials: YA
authors.lastname: Duarte
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology; D000704:Analysis of Variance; D001938:Brazil; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016321:Dental Care for Aged; D003753:Dental Health Surveys; D018450:Disease Progression; D004498:Education, Dental, Continuing; D005260:Female; D015577:Geriatric Assessment; D005850:Geriatric Dentistry / Q000193:education; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D011788:Quality of Life; D012647:Self-Assessment; D018434:Sickness Impact Profile; D012959:Socioeconomic Factors; D016388:Tooth Loss / Q000523:psychology