Oral Health-Related Quality of Life in Geriatric Patients with Dementia in Nigeria: Evidence, Context, Measurement Challenges, and Implications for Care

Background: Oral health-related quality of life (OHRQoL) is a multidimensional construct that expresses the influence of oral diseases on physical comfort, psychological functioning, and social involvement. In older individuals with dementia, diminished self-care ability, communication difficulties, and caretaker dependence add to an existing high prevalence of oral disease in old age. Nigeria has such an aging population, which is rapidly increasing – 9 million people aged 60 and older in 2016; increasing to 26 million by 2050 based on United Nations estimates [14] – and also has serious structural shortfalls in geriatric oral health services. Aim: To review and interpret available evidence on the effect of oral health on OHRQoL in elderly with dementia in Nigeria. Broad evidence is integrated where relevant, and used with appropriate caution, where Nigeria-specific dementia data is limited. Methods: Thematic synthesis of a narrative review was carried out with four electronic databases: PubMed, Scopus, African Journals Online (AJOL), and Google Scholar. A literature search of selected articles was undertaken by hand to get to the reference lists of selected articles. Evidence was collated as Nigeria-specific oral health data on older adults, international oral health evidence for dementia, and Nigeria-specific literature on access and use for contextual analysis. Results: The findings point to a substantial burden of dental caries, periodontal disease, edentulism, and xerostomia that burden older Nigerians, compounded by predominantly reactive, extraction-oriented care seeking among such communities as well. Dementia increases oral health risk through reduced self-care ability, difficulty in communication, and behavioural resistance to care. Caregivers act as an important mediating variable albeit often ill-prepared. Rigorous system barriers in Nigeria, including high out-of-pocket costs, geographic inaccessibility, mobility issues, and the sociocultural mainstreaming of tooth loss, increase risk, particularly in persons with cognitive impairments. The direct evidence for dementia in Nigerian patients remains very limited. Conclusions: There is compelling evidence that OHRQoL is particularly impaired in older Nigerians with dementia because of physical, psychological, and situational factors. Some priority should be to incorporate oral healthcare in both dementia and geriatric services; improve caregiver training; and to conduct more research in Nigeria specifically for this group.