Testing the applicability of a conceptual model of oral health in housebound edentulous older people

Objectives: The aim of the study was to test prospectively Wilson and Cleary's (1) conceptual model of the direct and mediated pathways between symptom burden, functional status and health perceptions in relation to the oral health of housebound elderly edentulous people. Methods: The data were collected as part of a community based randomized control trial of a domiciliary denture service for older people. Measures of self-reported symptoms, functional status and global oral and general health perceptions were collected from 133 participants prior to treatment and at 3-month follow-up. Results: The results indicated support for the dominant direct and indirect pathways within the model; worse patient reported symptoms predicted a lower functional status; worse daily functioning predicted lower global oral health perceptions. In addition, the impact of symptom status on oral health perceptions was mediated by patient reported functioning. The treatment (domiciliary denture service) significantly improved functional status and global oral health perceptions. All relationships were significant prospectively that is, from baseline, prior to the intervention, to 3-month follow-up, with the exception of between symptoms functioning. Conclusion: The results support Wilson and Cleary's conceptual model of patient outcomes as applied to elderly edentulous people. They highlight the importance of assessing a range of patient-orientated variables in order to help gain a greater understanding of how oral health impacts on individuals' daily lives and well-being. Further conceptual development of the model is discussed, particularly the role of individual difference factors.