Depression Symptoms and Oral Discomfort in Elderly Adults

To the Editor: One of depression's major consequences is the restriction or inability to perform individual tasks and express behaviors expected in defined social contexts affecting various dimensions of quality of life from self-care and autonomy to performance in family, social, professional, emotional, and religious life,1 including oral health (OH) care. Although OH may have a low priority in the context of mental illness, the effect of mental illness and its treatment on OH must be addressed, because it may lead to deterioration in self-care. Also, risk factors are interrelated and are often barriers to good OH.2 Therefore, this research aimed to identify the relationship between depression symptoms and oral discomfort in elderly adults. This was a quantitative study performed with all elderly adults assisted by two reference centers for social assistance in Fortaleza, Brazil. Centers for social assistance are public spaces offering social assistance follow-up to ensure the welfare of individuals and families in need. Data were individually collected using a questionnaire regarding sociodemographic data (age, sex, marital status, education, and income); oral and general health survey, including general health (self-reported health, systemic diseases, hearing and vision problems), medication use, smoking and alcohol habits, and oral discomfort (dry mouth, difficulty chewing and swallowing food, taste, burning mouth, sore mouth for no apparent reason, edema); and application of the 15-item Geriatric Depression Scale (GDS-15).3, 4 One hundred fifty elderly adults (aged 60–91, mean 69.4 ± 7.2) were examined; 66 (44.0%) were widowed, 43 (28.7%) married, 24 (16.0%) divorced, and 17 (11.3%) single. One hundred sixteen were women (77.3%) and 99 were retired (66.0%). One hundred three (68.7%) had fewer than 4 years of education, and 111 (74.0%) were receiving less than the minimum wage (~US$250 per month). Concerning general health, 47 (31.3%) considered their health to be excellent, 81 (54.0%) fair, and 22 (14.7%) poor. When comparing their health at the time of the research with that in the past year, 47 (31.3%) reported being better, 77 (51.4%) remaining the same, and 26 (17.3%) being worse. The GDS showed that 47 (31.3%) presented symptoms of mild depression and three (2.0%) symptoms of severe depression. Sixteen (10.7%) were smokers, and 13 (8.7%) used alcohol; 111(74.0%) used dental prosthesis, 135 (90.0%) had a toothbrush, 136 (90.7%) used toothpaste, and 30 (20.0%) had had dental visits in the past year. Bivariate analysis showed risk factors for depression (Table 1). Odds ratios for depression according to sex and age group were also determined. The effects of osteoporosis, smoking, dry mouth, pain without apparent reason, and mouth swelling were statistically significant (P < .05). Osteoporosis, dry mouth, and pain without apparent reason were more likely to be associated with depression in men, and hearing problems and mouth swelling were more likely to be associated with depression in women. Individuals aged 70–92 with osteoporosis, hearing problems, dry mouth, and mouth swelling were more likely to be depressed than those aged 60–69 with those conditions. No participants reported depression when asked about their health or disease status, but the GDS showed that 50 (33.3%) elderly adults had symptoms of mild or severe depression. Another study of OH and depression in elderly adults found that 20% had symptoms of depression. This study also found an association between the GDS and the Geriatric Oral Health Assessment Index.5 Depression is a mental condition that is not always diagnosed but can aggravate various serious organic diseases, increasing morbidity.6 Individuals with depression have feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be followed by physical symptoms.7 The psychological effect of oral diseases also reduces quality of life,8 as do hearing problems.9 Accommodation for health problems commonly associated with “old age” (e.g., tooth loss, walking difficulties) may be responsible for the high rate of anxiety disorders in elderly adults, being related to lower satisfaction with life and poor quality of life.10 Oral health, in combination with other co-variants such as socioeconomic status and socialization, may influence the presence and severity of depression but, more importantly influences self-care, which includes OH care and may therefore contribute to poor OH. This may damage self-esteem, influencing the individual's ability to perform tasks and express behaviors expected in defined social contexts,1 which may, in turn, deepen depression, which may affect OH. Therefore, health professionals should further explore and consider depression and OH, using greater interdisciplinary performance in the health care of elderly adults. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Maria Vieira de Lima Saintrain devised the research project, performed data collection and analysis, and composed the letter. Viviane Almeida Honório and Ana Virgínia Parente Guimarães performed the literature review, collected data, and helped in writing the letter. Paulo César de Almeida and Anya Pimentel Gomes Fernandes Vieira helped develop the research project and helped with data analysis and final revision of the letter. Sponsor's Role: None.