apanese norm-based scoring of 70 - 75 years old subjects (Fukuhara & Suzukamo, 2004) revealed that all subscale and summary scores of our subjects were within the 1-standard-deviation range. Three hundred and fifty-two subjects (77.5%) answered that they were “very satisfied” or “satisfied” with verbal communication. When the gender groups were compared, PCS scores in the male group were significantly higher than those in the female group (P < 0.05). The ratio of subjects with all natural tooth dentition in the male group (20.6%) was significantly higher than that in the female group (8.7%, P < 0.01). Subject in no teeth or denture group was only one (0.2%) subject, so we used the 4 dental status group (all natural tooth, natural tooth with partial denture, denture on upper or lower jaw, and full denture or no tooth) to investigate the association between the dental status and other factors in the later analysis.
Table 1. Age, HRQOL, satisfaction for communication, and dental status in 454 elderly subjects, and comparison those data between the gender group.
ns: not significant; *P < 0.05; **P < 0.01 compared between the gender.
Satisfaction with verbal communication had significantly positive correlations with SF-8 subscores (r = 0.397 in PCS, 0.482 in MCS; P < 0.001). All subscores of SF-8 among subjects who answered that they were “very satisfied” or “satisfied” with verbal communication were significantly higher than those of subjects who answered that they were “neither satisfied nor unsatisfied”, “unsatisfied” or “very unsatisfied” (P < 0.001: Figure 1). The mean age of subjects who were very satisfied with verbal communication was significantly lower than that of subjects in the “neither satisfied nor unsatisfied” group (P < 0.05).
Comparisons of SF-8 scores between age and dentition groups are shown in Table 2. PCS or MCS scores in the full denture or no teeth groups were significantly lower than those in the other three groups (P < 0.05). We compared the satisfaction with verbal communication between the groups with natural teeth present. The proportion who were “very satisfied” and “satisfied” among the subjects with natural teeth (all natural teeth, natural teeth with partial denture, or denture on upper or lower jaw) was higher than in those of the subjects with no natural teeth (full denture or no teeth or denture; 80.7% in the subjects with natural teeth, and 67.9% in the subjects with no natural teeth, P < 0.001).
The results of multiple regression analysis are shown in Table 3. Age, gender (male = 1 and female = 0), subjective satisfaction with verbal communication (“very satisfied” or “satisfied” = 1, others = 0), and presence of natural teeth (full denture or no teeth = 0 and others = 1) were entered as independent variables of PCS or MCS scores. Younger age, male gender, and good subjective satisfaction with verbal communication were independent predictors of higher PCS (adjusted R2 = 0.248, P < 0.001). Younger age and good subjective satisfaction with verbal communication were also independent predictors of higher MCS (adjusted R2 = 0.235, P < 0.001).
The model of covariance structure analysis is shown in Figure 2. The model fit was GFI = 0.997, AGFI = 0.977, CFI = 0.995 and RMSEA = 0.034. There was a significant positive correlation between subjective satisfaction with verbal communication and PCS (r = 0.307, P < 0.001) or MCS (r = 0.435, P < 0.001). Age had significant negative correlations with PCS (r = −0.315, P < 0.001) and MCS (r = −0.132, P < 0.01) and male gender had a significant positive correlation with PCS (r = 0.091, P < 0.05). The presence of natural teeth was significantly negatively correlated with age (r = −0.355, P < 0.001) and was positively correlated with male gender (r = 0.141, P < 0.01). However, no significant correlation was shown between the presence of natural teeth and subjective satisfaction with verbal communication or HRQOL.
**P < 0.01; ***P < 0.001.
Figure 1. Comparison of PCS (left) and MCS (right) scores between the satisfactions with verbal communication groups.
*P < 0.05; **P < 0.01; ***P < 0.001.
Figure 2. Model of the HRQOL-related factors by covariate structure analysis: GFI = 0.997; AGFI = 0.977; CFI = 0.995; RMSEA = 0.034.
Table 2. Comparison of age and HRQOL between the dental status groups.
Score (SD). *P < 0.05 **P < 0.01 ***P < 0.001 vs. full denture or no teeth group.
Table 3. Determinants to the good HRQOL analyzed by multiple regression analysis¶.
*P < 0.05; **P < 0.01; ***P < 0.001. ¶Analyzed by related factors below: age, sex (male = 1), satisfaction in conversation (“very satisfied” or “satisfied” = 1, others = 0), and presence of natural tooth (“natural tooth” = 1, others = 0).
Our findings indicate that good subjective satisfaction with verbal communication is associated with an improved HRQOL among community-dwelling elderly individuals. In Japan, oral health programs for the elderly are one of the interventions that aim to prevent the need for nursing care. The program may play an important role in patients’ oral functional status by reducing the risk of oral functional problems, maintaining or improving oral function, and enabling patients to enjoy a healthy daily life. The report of a study that investigated the association between social communication and QOL in Japanese elderly (Tanno, 2010) concluded that self-disclo- sure in social communication situations promoted daily comfort. Our findings also suggest that a program designed to establish situations involving friendly exchanges and an increase in friendship through communication with all elderly participants, has the potential to maintain or increase each participant’s HRQOL and health status.
Higher PCS scores were significantly associated with gender in the present study. In our previous study (Hara, Miura, & Yamasaki, 2013) , we investigated oral diadochokinesis (OD) in community-dwelling subjects and compared age groups and gender groups. We found that OD tends to decrease from age 65, with the decline in OD clearly beginning earlier in women than in men. OD is used to evaluate the speed and regularity of reciprocal movement of the jaw, lips, and anterior or posterior tongue and hence, this measurement also provides an assessment of the articulatory movement (Duffy, 2005) . Our present study suggests that the decline in articulatory ability in women caused reduced satisfaction with verbal communication and was related to the lower physical HRQOL. Sakayori et al. (2013) reported that a 3-month intervention, which included oral physical exercises, singing, and pronunciation exercises, effected an improvement in the OD score for high-risk elderly patients. Our results indicate that exercises, including pronunciation or singing, may improve the articulatory ability, maintain a better level of satisfaction with verbal communication, and result in a better HRQOL.
In our present study, we found a significant association between the subjective satisfaction of communication and dental state, or HRQOL in bivariate analysis. Multiple regression analysis was conducted to investigate the association of the above factors adjusted for age and gender. Covariate structural analysis and path model analysis were also conducted to clarify the mutual relationship between these factors. Satisfaction with verbal communication was a significant determinant of higher HRQOL; however, no significant association was shown between dental state and communication, or HRQOL in both analyses. We evaluated the dentition only by the questionnaire; we were not able to investigate the details of the dental status, for example, presence of missing teeth, bridges, and dental implant. We need to survey the association between above factors and satisfaction with verbal communication, or HRQOL. Furthermore, in previous studies, intraoral state, including factors such as the suitability of a denture ( Knipfer et al., 2014 ; Broka et al., 2013 ; Adaki, Meshram, & Adaki, 2013 ), hyposalivation (Samnieng et al., 2012) , gingival abscesses (Holtzclaw & Toscano, 2008) , and mastication and swallowing function (Sapir, Ramig, & Fox, 2008; Vogel et al., 2014) , may be associated with communicational status and satisfaction. Therefore, further studies, which investigate the above factors, are necessary to examine whether there is any association between subjective communicational satisfaction and HRQOL.
Our present study was also a cross-sectional study. Hence, further prospective studies are needed to investigate any correlation between subjective satisfaction with verbal communication and HRQOL among participants of a long-term care-prevention program. It will also be necessary to carry out additional studies of a subjects’ health-care behavior to investigate whether other health activities or programs improve satisfaction with verbal communication as well as HRQOL.
In conclusion, satisfaction with verbal communication improves HRQOL among Japanese community-dwel- ling elderly individuals. Therefore, programs for the elderly, which include exchanges involving communication, may play an important role in improving their HRQOL.
This work was supported by Grants-in-Aid for Scientific Research (C) No. 23593115 (Hara S., Miura H., and Yamasaki K.) and No. 22500688 (Miura H., Hara S., and Yamasaki K.) from the Japan Society for the Promotion of Science and Grants-in-Aid for Scientific Research No. 22110101 (Osaka K.) from the Ministry of Health, Labor and Welfare. The authors thank all those who responded to our questionnaire. We also thank the public health nurses in the northern area of Miyazaki prefecture for distributing and collecting the questionnaire. Part of this study was previously presented at the 20th IAGG World Congress of Gerontology and Geriatrics (June 26, Seoul, Korea).
No potential conflicts of interest were disclosed.