Author

P. Rouxel

Abstract

Background: A growing body of evidence shows that social capital may affect the health and well-being of older adults. A number of studies also suggest that social capital is a determinant of oral health. However, the evidence for these claims is weak in terms of causal inference criteria such as temporality because previous studies are mostly based on cross-sectional analysis. Aims: The aims of this thesis were to examine whether social capital is a determinant of oral health among older adults, and whether this association is explained by socio-demographic, socio-economic, health and behavioural factors. Methods: Secondary data from waves 3 (2006-07) and 5 (2010-11) of the English Longitudinal Study of Ageing (ELSA) were analysed with 6,977 adults aged 50 and over in the cross-sectional analysis, and 5,385 and 5,114 older adults in the longitudinal and modelling of change analyses respectively. Four measures of social capital were derived from the ELSA study, reflecting structural (membership in organisations and volunteering) and functional (number of close ties and social support) dimensions of the concept. Oral health outcomes were assessed using measures of self-rated oral health, oral health-related quality of life and edentulousness. Binary and multinomial logistic regression models were used to estimate the odds of poor oral health for different levels of social capital, sequentially adjusted for socio-demographic, socio-economic, health and behavioural factors. Results: There was some evidence that lower levels of social capital were associated with poorer oral health among older adults in the cross-sectional and longitudinal analyses. The size of the statistically significant associations ranged from odds ratios of 1.21 (95%CI:1.01-1.46) to 2.14 (95%CI:1.62-2.84) independent of other dimensions of social capital and several measures of oral health. Poor oral health at baseline (2006-07) also predicted lower levels of social capital 4 years later. There was weaker evidence that positive/negative changes in social capital were associated with improving/worsening oral health. The only consistent finding was the association between low social support and poor self-rated oral health, with odds ratios of 1.36 (95%CI:1.11-1.66) in the cross-sectional analysis, 1.27 (95%CI:1.01-1.60) in the longitudinal analysis, and 1.46 (95%CI:1.13-1.90) in the modelling of change analysis. Conclusions: Overall, the results of the thesis found weak evidence that low social capital is a determinant of poor oral health among older adults. There was some evidence of longitudinal associations between functional dimensions of social capital and subjective oral health, but little evidence for other measures of social capital and oral health. One key area of further research is the mechanisms and interventions by which older adults are able to generate and maintain social support and close ties in later life.