Journal of Oral Rehabilitation 2006 33; 330–334
Chewing ability and quality of life in an 80-year-old
population
Y . T A K A T A * , T . A N S A I †, S . A W A N O †, M . F U K U H A R A * , K . S O N O K I * , M . W A K I S A K A * ,
K . F U J I S A W A * , S . A K I F U S A † & T . T A K E H A R A † *Divisions of General Internal Medicine and †Community
Oral Health Science, Department of Health Promotion, Kyushu Dental College, Kitakyushu, Japan
SUMMARY As quality of life (QOL) could be influ-
enced by oral status in the elderly, we examined
whether chewing ability or number of teeth affec-
ted QOL in 80-year olds. A cross-sectional survey
included dental examination, chewing self-assess-
ment, and a QOL questionnaire. A total of 823
people who were 80 years old participated in this
study. QOL was assessed in terms of satisfaction
with physical condition, meals, daily living and
social interactions, and with face-scale scores.
After adjustment for gender, spouse and activities
of daily living, dissatisfaction with social interac-
tions was 3Æ9 times more prevalent in individuals
Introduction
Tooth loss commonly occurs in association with ageing,
compromising mastication of food (1–4). Impaired
chewing ability may adversely affect nutritional status
(5–10) and undermine general well-being (4, 8, 10–12).
In a longitudinal study where subjects were followed
up between age 75 and 80 years, a relationship
between chewing problems and general functional
limitations was evident (9).
Quality of life (QOL), defined as a person’s sense of
well-being derived from satisfaction with daily living,
was reported to be closely related to chewing ability in
elderly persons residing in a rural community in Japan
(13). Better QOL was seen more often in dentulous
than edentulous individuals aged ‡70 years (11). Simi-
larly, in an Italian population aged 70–75 years, func-
tional dental status was shown to be associated with
several QOL domains and the authors encouraged
ª 2006 Blackwell Publishing Ltd
able to chew four foods or fewer than in those
chewing 15. Dissatisfaction with physical condi-
tion, meals and daily living, and poor face-scale
scores, were 2Æ7, 2Æ4, 3Æ4, and 2Æ4 times more
prevalent, respectively, in subjects chewing four
foods or fewer. The number of teeth showed little
effect. In conclusion, self-assessed chewing ability
but not number of teeth was associated with QOL
in 80-year-old subjects.
KEYWORDS: elderly populations, quality of life, chew-
ing ability, number of teeth
Accepted for publication 29 July 2005
extensive use of dentures (14). In subjects with a mean
age of 83 years, Canadian investigators (15) found a
significant effect of oral disorders on well-being and life
satisfaction. Although several studies suggest a rela-
tionship between chewing ability and QOL in the
elderly as mentioned above, such an association has not
yet been broadly established.
We concluded from observations in an 80-year-old
Japanese population that decreased physical capacity
associated with tooth loss could be improved by the use
of dentures (16), and that a positive relationship existed
between chewing ability and physical activity (17).
More recently, we found an association between
activities of daily living (ADL) scores and chewing
ability in an 80-year-old population (18). In the present
study, we therefore examined relationships of QOL
status in 80-year olds to chewing ability as well as to
number of teeth. The number of foods that the subjects
could chew was used as an indicator of chewing ability.
doi: 10.1111/j.1365-2842.2005.01567.x

Materials and methods
In 1998, we enrolled 1282 80-year-old individuals
residing in one of three cities (Buzen, Yukuhashi or
Munakata), four towns (Katsuyama, Tikujo, Toyotsu or
Kanda), one village (Shinyoshitomi), or one ward
(Tobata of Kikakyushu City) in the Fukuoka Prefecture
of Japan to participate in the present study. Of the
1282 individuals, 823 participated (309 male and
514 female). As the other 36% of potential subjects
declined to participate, self-selection factors could have
introduced some bias in the present findings. The study
was approved by the Human Investigations Committee
of Kyushu Dental College, and informed consent was
obtained from all participants. The authors performed
dental examination of each subject in the manner
recommended by the World Health Organization (19).
Quality of life status was determined using a prepared
questionnaire with multiple choices for responses.
Queried items included the following: ‘have a spouse’
(1, yes; 2, no); ‘satisfied with physical condition’ (1, yes;
2, no); ‘good mood after a meal’ (1, yes; 2, no); ‘satisfied
with daily life’ (1, yes; 2, no); and ‘satisfied with social
interactions’ (1, yes; 2, no). Face-scale scores (20)
(1, score of 1 or 6; 2, score of 10–20) and ADL status
(1, independent; 2, dependent) were determined by
public health nurses who classified subjects as either
independent or dependent (i.e. requiring day-to-day
assistance) using the guidelines of the Health, Labor,
and Welfare Ministry of Japan.
Oral health-related QOL instruments, such as Geri-
atric Oral Health Assessment Index (GOHAI) (21) and
Oral Health Impact Profile (OHIP) (22), were developed
in 1990 and 1994 respectively. However, the Japanese
versions of these instruments were not established until
2004 for GOHAI (23) and 2002 for OHIP (24). As the
present study was performed in 1998, these instru-
ments for evaluating QOL related to oral health were
not yet established in Japan.
Questionnaires concerning food intake have proven
valuable in epidemiological surveys of masticatory
function in the elderly (3, 25–27). Accordingly, each
subject was asked about his/her ability to chew the
following 15 foods: peanuts, yellow pickled radish, hard
rice cracker, French bread, beefsteak, octopus in
vinegar, pickled shallots, dried scallops, dried cuttlefish,
squid sashimi, konnyaku, a tubular roll of boiled fish
paste, boiled rice, tuna sashimi, and grilled eel. These 15
foods were selected to represent four groups: three
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 330–334
QOL AND CHEWING IN THE ELDERLY 331
foods that are very hard to chew, six foods moderately
hard to chew, three foods slightly hard to chew, and
three foods easy to chew (28). The number of these
foods that a subject could chew was used as an index of
chewing ability, which was assessed as a possible
independent influence on QOL status by logistic
regression analyses. The factors gender, spouse and
ADL were considered as possible influences upon
number of teeth, number of foods reported to be
chewable and QOL. Adjustments were made for these
categorical factors in order to identify independent risk
factors for QOL compromise.
All data are reported as the mean
s.d. Logistic
regression analysis was carried out to evaluate which
factors were related to QOL after adjustment for
confounding variables. All statistical analyses were
performed using StatView 5Æ0*. Results were considered
statistically significant when P-value was below 0Æ05.
Results
The mean number of teeth was 7Æ5
8Æ7, and the mean
number of foods that subjects could chew was
11Æ2
3Æ8. QOL was evaluated in 813 individuals.
The number of subjects satisfied with their health status
was 331 (40Æ7%), while 482 (59Æ3%) were dissatisfied.
While 454 subjects (56Æ2%) felt satisfied after a meal,
354 (43Æ8%) did not. Most subjects (677; 83Æ8%) were
satisfied with their daily life, while 131 (16Æ2%) were
not satisfied. The number of individuals satisfied with
interactions with family or friends was 698 (86Æ7%),
while 107 subjects (13Æ3%) were dissatisfied. Face-scale
groups of 1 and 6 were classified as good QOL (n ¼ 436;
56Æ4%), with those of 10, 15 and 20 representing poor
QOL (n ¼ 337; 43Æ6%).
Subjects were divided into four groups according to
number of foods chewed (0–4, 5–9, 10–14 or 15), which
was used as an index of chewing ability, and also were
classified into four groups by number of teeth (0, 1–9,
10–19 or ‡20). Compared by logistic regression analysis
to findings in subjects who were able to chew 15 foods,
dissatisfaction with physical condition was 2Æ1 times
prevalent in individuals with 5–9 chewable foods and
2Æ9 times prevalent in those chewing 0–4 foods.
Unhappy moods after meals were significantly more
prevalent in subjects who could chew only 10–14, 5–9
or 0–4 foods than in those chewing 15 foods.
*SAS Institute, Cary, NC, USA
332 Y . T A K A T A et al.

Prevalence of dissatisfaction with daily life was 3Æ7
times greater in individuals able to chew £4 foods than
in those who could chew 15 foods; such dissatisfaction
was 2Æ1 times as prevalent in those who had 10–19
teeth than in those with ‡20 teeth. Dissatisfaction with
interactions with family or friends also was more
prevalent in individuals with £9 chewable foods.
A face-scale of 10–20, indicating negative mood, was
more prevalent in individuals with £4 chewable foods
and in those with 10–19 teeth.
Similarly, subjects were divided into four groups
according to chewing ability using the number of
chewable foods. Logistic regression analysis after adjust-
ment for gender difference, spouse status, and ADL
status revealed odds ratios (OR) and 95% confidence
intervals (CI) for a poor QOL (Table 1). These three
potential confounders were included in aggregate in the
logistic regression analysis. Compared with individuals
able to chew 15 foods, dissatisfaction with physical
condition was significantly more prevalent among
individuals able to chew only 5–9 foods, or £4 foods
(Table 1). Prevalence of unhappiness after a meal in
individuals able to chew 10–14, 5–9 and £4 foods was
1Æ7, 2Æ2 and 2Æ4 times higher, respectively, than those
chewing 15 foods. Dissatisfaction with daily life in
subjects able to chew £4 foods was 3Æ4 times more likely
than in those chewing 15 foods. Dissatisfaction with
interactions involving family or friends also was pre-
valent in individuals with 5–9 chewable foods or those
with £4 foods. Similarly, a face-scale score indicating a
negative mood, was more prevalent in individuals with
£4 chewable foods. Compared with individuals able to
chew 15 foods, those with a reduced number of
chewable foods showed more dissatisfaction according
to all scales used (Table 1). In contrast, no consistent
difference in prevalence of poor QOL status was found
between four groups defined by remaining numbers of
teeth, using logistic regression analysis with adjust-
ment. However, dissatisfaction with daily life was more
prevalent in groups with 10–19 teeth, and an unfa-
vourable face-scale score was more prevalent in indi-
viduals with 10–19 teeth or no teeth than in subjects
with ‡20 teeth. Dissatisfaction with daily life or with
social interactions was significantly more prevalent in
dependent subjects than in independent subjects. Gen-
der difference was also slightly observed in satisfaction
with daily life or social interactions (Table 1).
Discussion
In the present study, we found a relationship between
poor chewing ability and poor QOL status in 80-year-
old subjects. The relationship was confirmed by logistic
regression analysis with adjustment for confounding
factors. No consistent significant relationship was found
between number of teeth and QOL status. Thus,

Table 1. Logistic regression analysis of prevalence of poor QOL, adjusted for various confounding factors, in relation to number of
chewable foods or number of teeth

Satisfaction with Mood after Satisfaction with Satisfaction with Face-scale

physical condition a meal daily life social interactions score

Number of chewable foods

15 1 1 1 1 1
10 to 14 1Æ2 (0Æ9–1Æ8) 1Æ7 (1Æ2–2Æ4)** 1Æ1 (0Æ7–1Æ9) 1Æ4 (0Æ8–2Æ6) 1Æ3 (0Æ9–1Æ9)
5 to 9 2Æ1 (1Æ3–3Æ2)** 2Æ2 (1Æ4–3Æ3)*** 1Æ6 (0Æ9–2Æ9) 3Æ8 (2Æ0–7Æ2)*** 1Æ2 (0Æ8–1Æ9)
0 to 4 2Æ7 (1Æ4–5Æ4)** 2Æ4 (1Æ3–4Æ5)** 3Æ4 (1Æ6–7Æ0)*** 3Æ9 (1Æ7–8Æ9)** 2Æ4 (0Æ3–4Æ6)**
Gender difference 1Æ0 (0Æ7–1Æ5) 0Æ9 (0Æ6–1Æ2) 0Æ6 (0Æ4–1Æ0)* 0Æ5 (0Æ3–0Æ9)* 0Æ9 (0Æ6–1Æ3)
Spouse status 1Æ1 (0Æ7–1Æ5) 1Æ0 (0Æ7–1Æ4) 1Æ5 (0Æ9–2Æ4) 0Æ9 (0Æ5–1Æ6) 0Æ8 (0Æ5–1Æ1)
ADL status 1Æ0 (0Æ6–1Æ7) 1Æ2 (0Æ7–2Æ0) 2Æ0 (1Æ1–3Æ5)* 2Æ4 (1Æ3–4Æ3)** 1Æ2 (0Æ7–2Æ1)
Number of teeth
‡20 1 1 1 1 1
10 to 19 1Æ0 (0Æ6–1Æ6) 1Æ4 (0Æ8–2Æ3) 2Æ3 (1Æ1–4Æ7)* 1Æ4 (0Æ7–3Æ0) 1Æ9 (1Æ2–3Æ2)*
1 to 9 0Æ9 (0Æ5–1Æ4) 1Æ5 (1Æ0–2Æ5) 1Æ5 (0Æ8–3Æ1) 1Æ2 (0Æ6–2Æ6) 1Æ5 (0Æ9–2Æ4)
0 0Æ9 (0Æ6–1Æ4) 1Æ6 (1Æ0–2Æ5) 1Æ4 (0Æ7–2Æ7) 1Æ4 (0Æ7–2Æ8) 1Æ6 (1Æ0–2Æ6)*
Gender difference 1Æ1 (0Æ8–1Æ6) 0Æ9 (0Æ6–1Æ3) 0Æ7 (0Æ4–1Æ1) 0Æ6 (0Æ4–1Æ0) 0Æ9 (0Æ6–1Æ2)
Spouse status 1Æ0 (0Æ7–1Æ5) 1Æ0 (0Æ7–1Æ4) 1Æ4 (0Æ9–2Æ3) 1Æ0 (0Æ6–1Æ6) 0Æ8 (0Æ5–1Æ1)
ADL status 1Æ2 (0Æ8–2Æ0) 1Æ4 (0Æ9–2Æ3) 2Æ7 (1Æ6–4Æ5)*** 2Æ9 (1Æ7–5Æ1)*** 1Æ3 (0Æ8–2Æ2)

Values are given as OR (95% CI). * P < 0.05, ** P < 0.01, *** P < 0.001.

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 330–334


chewing ability, but not number of teeth, may contrib-
ute to QOL status in very elderly individuals. Similarly,
QOL in centenarians was associated with preservation
of masticating ability (29). Locker et al. (15) also found a
negative impact of oral disorders upon well-being and
life satisfaction in elderly people with a mean age of
83 years. Although the association of chewing ability
but not number of teeth with QOL measures in the
present study might appear paradoxical, it could be
explained by drawing the distinction that functional
teeth related to chewing ability may improve QOL in
octogenarians. It might also be possible that simply
counting teeth is not enough to evaluate an oral status.
Some attempt to estimate the function of teeth is
probably necessary. The simplest way would be to
count the occluding pairs of teeth or using a functional
index such as the Eichner index, often used in Euro-
pean studies. In our previous studies, impaired physical
activity associated with tooth loss was found to be
improved by use of dentures (16). Furthermore, elec-
trocardiographic ST segment (the segment between the
end of the QRS complex and the beginning of the T
wave) depression indicative of myocardial ischaemia
was linked with poor dentition status in elderly subjects
(30). We also found an association between chewing
ability and physical ability (17) or ADL (18) in an
80-year-old population. Heydecke et al. (31) found that
mandibular overdentures retained by two implants
provided elderly patients with improved oral health-
related QOL, and also detected that general health-
related QOL may be improved in the implant group.
Although the reason why chewing ability and number
of teeth differed in importance was not established in
the present study, our present and previous findings
together with Heydecke’s observations suggest that
QOL status might be improved in elderly patients by
enhancing chewing ability using appropriate dentures.
However, as no Japanese oral health-related QOL
measures existed at the time of this study, some
concerns remained about the instrument for evaluating
QOL. It also is possible that a cross cultural validity of
the chewing ability scale might be questionable. These
could be a limitation for the present study.
An ‘80/20 movement’ recently was set as a goal in
Japan, referring to retention of ‡20 teeth at age
80 years (32). This 80/20 movement includes nation-
wide surveys concerning relationships between general
and oral conditions in 80-year-old subjects; the present
study was performed as part of this initiative. Precision
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 330–334
QOL AND CHEWING IN THE ELDERLY 333
of analysis presumably was enhanced in our survey by
limiting subject age to 80 years, as an influence of age
could be completely excluded in statistical analysis. As
chewing ability reflects the subjects self-perceived
ability to chew different foods, it may be closer related
to the subject’s overall satisfaction with his/her daily
life, social interactions, and other quality of life meas-
ures than a more hard measure as number of teeth.
Furthermore, as functional status is a key domain of
QOL, and chewing ability is intrinsically linked to
functional status, the finding that chewing ability is
closely related to QOL may appear tautological in a
sense. Yet, it has the important implication that QOL
status may be promoted by oral care.
In conclusion, self-assessed chewing ability but not
number of teeth was associated with QOL in 80-year-
old subjects.
Acknowledgments
This work was supported in part by Grants-in-Aid for
Scientific Research (B) 15390655, (C) 15592194, and
(C) 16592092 from Japan Society for the Promotion of
Science.
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Correspondence: Dr. Yutaka Takata, Division of General Internal
Medicine, Department of Health Promotion, Kyushu Dental College,
Manazuru 2-6-1, Kokurakita-ku, Kitakyushu City, 803-8580, Japan.
E-mail: yutaka@kyu-dent.ac.jp