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Is frailty in the elderly associated with poor oral health?


This summary is based on the article Association between oral health and frailty: A systematic review of longitudinal studies published in Gerodontology, September 2019

Frailty and poor oral health are common among ageing populations; however,  there's no evidence of this association over short or long periods of time. Longitudinal studies to observe this phenomenon are scare and the authors of a systematic review attempted to find the few studies that could shed more light on the impact of poor oral health on the onset or progression of frailty in the elderly.

Five longitudinal studies from three countries (Mexico, Japan, and UK) were identified. The studies examined the association between oral health and frailty in the elderly. All studies used Fried's frailty phenotype criteria for measuring frailty. Oral health indicators were number of teeth, periodontal disease, oral functions (functional dentition with occluding pairs and maximum bite force), use of removable dentures, accumulation of oral health problems and dry mouth symptoms.

The frailty phenotype, as described by Fried and colleagues, is based on five pre-defined physical frailty criteria: weight loss, exhaustion, low physical activity, slowness and weakness. The sum score of these five criteria classifies people into one of three frailty stages (or groups): not frail (score 0), pre-frail (score 1–2) and frail (score 3–5).

Frailty is defined as a state characterised by reduced physiological reserve and higher vulnerability to stressors which leads to adverse health outcomes including dependency functional impairment, cognitive decline and death. Furthermore, it leads to adverse outcomes and affects the quality of life of older adults.

The studies showed significant association of number of teeth (two studies), oral functions (two studies), accumulation of oral health problems and number of dry mouth symptoms with frailty incidence, whereas periodontal disease showed inconsistent associations.

The systematic review identified significant longitudinal associations between oral health and frailty. These associations highlight the importance of oral health as a predictor of frailty in older age.

Pathways of Associations Between Poor Oral Health and Frailty

The evidence indicates that malnutrition is a significant risk factor for the development of frailty. The Number of teeth consistently showed significant association with frailty in this review. This could be attributed to chewing problems, changes in the quality and quantity of food and ultimately malnutrition.

There were also significant associations between functional dentition (occluding pairs and maximum bite force) and the incidence of frailty. These could also be attributed to the impact of oral function on nutrition which in turn can affect general health and frailty.

On the other hand, the link between oral function and frailty could also be attributed to common risk factors associated with the decline of oral function and musculoskeletal dysfunction at old age.

An important factor that could explain this association is the role of socio-economic factors in both frailty and oral health. Previous
studies found that older adults with less education were more frail compared to those with better education. Despite the temporal relationship between oral health and incidence of frailty observed in the longitudinal studies included in the review, poorer socioeconomic factors could be one of the underpinning determinants of both poor oral health and frailty.

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Until next time!
CDA Oasis Team

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