Severe Periodontitis Increases the Risk of Oral Frailty: A Six-Year Follow-Up Study from Kashiwa Cohort Study

The symptom network of oral health conditions in older populations with oral frailty: a cross-sectional study

BACKGROUND

Population aging is increasing globally, with oral frailty affecting 24% of the older population. Previous studies have demonstrated the relationship between oral frailty and poor oral health symptoms but the interactions and core symptoms among these oral symptoms remain vague.

OBJECTIVE

To clarify the relationship between oral frailty and oral symptoms, explore the intrinsic connections between these symptoms, and identify core symptoms to provide more effective management and treatment strategies for oral frailty and related health issues.

METHODS

The study conducted a cross-sectional study from January 2024 to April 2024, included 547 participants using a convenient sampling method. The study adopted the Geriatric Self-Efficacy Scale for Oral Health (GSEOH), Oral Frailty Index-8, FRAIL scale, and oral symptoms, including the simplified oral hygiene index score (OHI-S), plaque index, periodontal pocket depth and gingival index, teeth numbers and tooth mobility index. T-test, Chi-Square test, Mann-Whitney test and binary logistic regression were used to explore the relationship between oral symptoms and oral frailty, and symptom network analysis and subgroup network analysis were used to explore the intrinsic connections between oral symptoms and identify core symptoms.

RESULTS

The study found that while teeth number and GSEOH were significantly associated with oral frailty (teeth number: β = -0.262, P = 0.013) (GSEOH: β = -0.056, P = 0.000), the centrality of teeth number and GSEOH was the lowest compared to other oral symptoms. oral hygiene status (CI-S and plaque index), and gingival index were the core symptoms in older adults, and gingival index was the strongest bridge node.

CONCLUSION

The study explored the relationship between oral symptoms and oral frailty using network analysis. The study recommended that communities implement routine oral functional assessments to increase the denture restoration rate and identify oral frailty at an early stage, as well as educational and promotional programs aimed at maintaining oral hygiene and function. Future research should further analyze the causal relationships between oral symptoms, particularly periodontal pocket depth, oral frailty, and overall frailty.

The current status and influencing factors of oral frailty in elderly populations: A scoping review

AIM

In order to serve as a reference for future studies on oral frailty interventions, this scoping review aims to provide an analysis of the factors influencing oral frailty in elderly group.

DESIGN

A scoping review based on the principles of participants, concept and context (PCC) and a theoretical framework of the Health Ecology Model (HEM).

REVIEW METHODS

Based on the principle of PCC, this study reviews the prevalence and influencing factors of oral frailty.

DATA SOURCES

A systematic search was conducted across eight Chinese and English databases with time ranged from their foundation to March 10, 2024, using a combination of subject terms and free words. For the English database Web of Science, the search formula was: #1: TI = (aged OR elder OR elderly people), #2: TI = (Oral frail* OR Oral frailty OR oral weakness), #3: #1 AND #2. And manual searches were conducted using literature tracing methods for retrospective queries.

RESULTS

A total of 25 papers were included, reporting a prevalence of oral frailty ranging from 9.5% to 59.2%. These papers identified 34 influencing factors categorized into four levels: individual characteristics level (such as age, gender, number of teeth, number of dentures, masticatory ability, swallowing ability, oral health, tongue pressure, dry mouth, periodontitis, medications, cognitive ability, physical frailty, nutrition, type of chronic diseases, cardiovascular disease, diabetes, cancer history, hemoglobin, albumin, BMI, Cystatin C), psycho-behavioral and lifestyle level (including depression, sleep quality, dietary habits, physical activity, smoking, alcohol, and oral health-related self-efficacy), interpersonal network level (social support, social isolation), and work and living level (income status, educational level, and type of residence).

CONCLUSIONS

The high prevalence of oral frailty in the elderly group worldwide is influenced by 34 factors, highlighting the importance of considering the synergistic effects of multiple influences. Meanwhile, the OFI-6 and OFI-8 are commonly used assessment tools for oral frailty research in the elderly, and each plays an important role. OFI-8 is a self-reported and subjective assessment scale that does not require specialized oral examination tool compared to OFI-6. As a result, it is better suited for rapid screening in community and outpatient settings than the OFI-6.

IMPACT

Generalizing the influencing factors of oral frailty facilitates a deeper understanding of its pathogenesis, enables the identification of high-risk groups, and provides a theoretical foundation for developing interventions aimed at preventing and mitigating oral frailty among the elderly.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

Systematic review and meta-analysis on the prevalence and risk factors of oral frailty among older adults

Objectives

The present study aim to systematically review the prevalence and influencing factors of oral frailty in older people.

Methods

A search strategy was developed and implemented to systematically review literature across PubMed, Embase, Web of Science, MEDLINE (via EBSCOhost), CINAHL, the Cochrane Library, Scopus, China Knowledge Resource Integrated Database (CNKI), Wanfang Data, Chinese Biomedical Database (CBM), and Weipu Database (VIP), in accordance with the PRISMA 2020 guidelines. Our search encompassed studies published up to June 28, 2024, that investigated the prevalence or risk factors of oral frailty among older adults. Literature screening, data extraction, and quality assessment were independently performed by two researchers, followed by data analysis using Stata 17 software. This study has been registered with PROSPERO.

Results

A total of 35 studies involving 202,864 participants were analyzed. The overall prevalence of oral frailty among older adults was 34.0% (95% CI: 27.9-40.1%, I 2 = 99.7%, p < 0.001). Subgroup analyses revealed statistically significant differences in the prevalence of oral frailty among different assessment tools and age groups (p < 0.05). Univariate meta-regression analysis indicated that the age was related to heterogeneity in the study (p < 0.05). Factors such as age, gender, physical frailty, pre-frailty, and unattached were identified as key risk factors for oral frailty in older adults (all p < 0.05).

Conclusion

The incidence of oral frailty among older adults is notably high and influenced by a variety of factors. Healthcare professionals are encouraged to actively implement preventive and treatment measures addressing the controllable factors associated with oral frailty. Such proactive efforts are essential for early identification of high-risk individuals, which can help reduce the prevalence of oral frailty among older adults and enhance their quality of life.

Systematic Review Registration

PROSPERO (CRD42023488653: https://www.crd.york.ac.uk/prospero/).

Prevalence and unfavourable outcome of oral frailty in older adult: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Oral frailty (OF) refers to a decline in oral function amongst older adult that often occurs alongside declines in cognitive and physical abilities. We conducted a study to determine the prevalence and unfavourable outcomes of OF in the older adult population to provide medical staff with valuable insights into the associated disease burden.

METHODS

From inception to March 2024, we systematically searched six key electronic databases: PubMed, Web of Science, Embase, Cochrane Library, Scopus, and CINAHL to identify potential studies that reported the prevalence or unfavourable outcomes of OF amongst older adult. Studies that did not have accessible data were excluded. Two researchers worked independently to retrieve the literature, collect data, and evaluate the quality of the included studies. Data analysis was conducted using R Project 4.1.1 and Review Manager 5.3 software.

RESULTS

We identified 28 studies that met the inclusion criteria, including 27,927 older adult. The pooled prevalence of OF amongst older adult was 32% (95% confidence interval (CI): 0.24, 0.41). Subgroup analyses indicated that the setting, sample, design of studies, and assessment instruments influence the prevalence of OF. In addition, OF was associated with a high risk of physical frailty (odds ratio (OR) = 1.67; 95% CI: 1.38, 2.02), malnutrition (OR = 2.27; 95% CI: 1.75, 2.96), low dietary variety (OR = 1.98, 95% CI: 1.15, 3.39), and social withdrawal (OR = 1.42; 95% CI: 1.18, 1.71).

CONCLUSION

This systematic review and meta-analysis revealed that OF is prevalent amongst older adult. OF may affect the prognosis of older adult and thus necessitates comprehensive assessment and management as part of an integrated approach.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=537884.

Prevalence and influencing factors of oral frailty in older adults: a systematic review and meta-analysis

Objective

This study aimed to conduct a systematic review and meta-analysis, assessing the pooled prevalence and influencing factors of oral frailty in older people to assist healthcare professionals in enhancing their understanding of this condition and formulating efficient interventions.

Methods

This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) guidelines. We searched PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, ProQuest, the National Knowledge Infrastructure (CNKI), WAN FANG DATA, VIP Information, SinoMed and Scopus for literature published in English or Chinese from inception to June 19, 2024. Subsequently, we evaluated the potential for bias in the cross-sectional studies that met our criteria through the Agency for Healthcare Research and Quality (AHRQ) tool. In contrast, we utilized the robust Newcastle-Ottawa scale for cohort and case-control studies. We performed statistical analyses using STATA 17 software. Prevalence was studied using a meta-analysis of a single proportion. For influencing factors, dichotomous variables were expressed as odds ratios (ORs) and 95% confidence intervals (Cls), and continuous variables were expressed as weighted mean differences (WMDs) and 95% confidence intervals (Cls).

Results

Investigation into 17 studies encompassing 24,983 participants discovered a striking 28% overall prevalence rate for oral frailty among older individuals (95% CI 20-36%, p < 0.001). Upon assessing the literature's quality, nine articles acquired high ratings; all others received medium ratings. These findings imply a complex interplay among biological, socio-economic, lifestyle, and disease-pharmacological factors in the manifestation of oral frailty in older adults.

Conclusion

Oral frailty is prevalent in older adults and is impacted by diverse factors. Enhanced surveillance and effective interventions for oral frailty are required in older cohorts.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024544552, identifier CRD42024544552.

Oral Function, Loneliness, Depression, and Social Participation Among Physically Disabled Middle-Aged and Older Adult Individuals: Insights from a Japanese Cross-Sectional Study

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000-0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals.

[Research Progress on the Correlation Between Oral Frailty and Dietary Intake in Older Adults]

With the increase in age, the oral function of older adults shows an age-related decline, which limits the types, quantity, and quality of their diet. Limited dietary intake can lead to a lack of basic nutrients needed for maintaining oral health, induce a series of oral diseases, and further aggravate the deterioration of oral functions. Oral frailty is the accumulation of mild oral function decline and is an emerging concept in the field of oral health. Currently, research on oral frailty and dietary intake mostly focuses on the impact of single-dimensional oral function decline on the dietary intake, dietary structure, and dietary satisfaction of older adults, as well as the impact of different dietary structures on the status of oral health among older adults. There is still a lack of large-sample, high-quality research on the relationship between comprehensive oral function decline and dietary intake. In addition, existing oral frailty intervention measures often place a narrow emphasis on the exercise and recovery of oral function without considering the impact of dietary intake and nutritional status on the development of oral frailty. Relevant research on taking dietary intake as an entry point or using it as a comprehensive intervention method also needs to be further explored by researchers. In the future, specialized assessment and screening of dietary status may be introduced in the routine health management practices for older adults. Furthermore, targeted intervention programs could also be proposed based on the characteristics of the oral status and the dietary intake habits of older adults, so as to prevent the functional decline related to dietary intake and nutritional supplementation. Herein, we reviewed the correlation between dietary intake and oral frailty to provide new ideas and directions for formulating comprehensive management strategies for oral frailty.

The prevalence of oral frailty among older adults: a systematic review and meta‑analysis

BACKGROUND

In recent years, oral frailty was proposed as a new concept regarding dental and oral health in older adults. Poor oral health is linked to preserving general health and has become a geriatric public health problem that deeply affects healthy aging. While in present, evidence on the prevalence associated with oral frailty in older adults remains unclear.

OBJECTIVE

To systematically evaluate the prevalence of oral frailty among older adults, stratified by relevant factors such as gender, source, study design, region, and the evaluation scales for oral frailty and provide an evidence-based foundation for healthcare professionals and policymakers to formulate relevant measures.

METHODS

Ten electronic databases were systematically searched from inception to September 2023, including PubMed, Web of Science, Embase, PsycINFO, The Cochrane Library, CINAHL, China National Knowledge Infrastructure Database (CNKI), Chinese Biomedical Database (Sinomed), Weipu Database, and Wanfang database. Based on the Stata 15.0 software package, a random effect model was used to calculate the pooled prevalence of oral frailty among older adults. In addition, sensitivity analysis, subgroup analysis, and meta-regression were conducted based on different study characteristics to detect heterogeneity sources. Funnel plots, Begg's and Egger's tests were used to evaluate the publication bias.

RESULTS

Eighteen studies with a total of 12,932 older adults were included for meta-analysis. The pooled prevalence of oral frailty and oral pre-frailty was 24% (95% CI: 20-28%) and 57% (95% CI: 52-61%) respectively. Based on different assessment tools of oral frailty, the pooled prevalence of oral frailty was higher when using the OFI-8 scale (44.1%; 95% CI: 35.4-52.8%) than the OFI-6 scale (18.3%; 95% CI: 15.8-20.8%) or OF checklist (22.1%; 95% CI: 17.4-26.7%). The prevalence of oral frailty was higher among older adults in females (23.8%; 95% CI: 18.4-29.2%), hospital settings (31%, 95% CI: 16.6-45.5%), cross-sectional design (26.7%, 95% CI: 19.2-34.2%), and China (45.9%, 95% CI: 34.4-57.3%).

CONCLUSIONS

Our study showed that oral frailty was common among older adults and various characteristics may affect its prevalence. Thus, healthcare professionals and policymakers should take oral frailty seriously in clinical practice and program planning and develop more preventive measures for oral frailty among older adults.

Oral frailty: a concept analysis

BACKGROUND

Oral frailty has become a worldwide problem among older adults. Although researchers have conducted various studies on oral frailty, its definition remains controversial.

PURPOSE

To clarify the concept of oral frailty.

METHODS

Online databases PubMed, Web of Science, CINAHL, Cochrane Library, ProQuest, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang database were searched from inception to September 20, 2023. The reference lists of relevant studies were searched manually. Eligible articles, theses, and books were analyzed using Walker & Avant's concept analysis model.

RESULTS

The attributes of oral frailty were abnormal oral structure and/or decline in multi-faceted oral function and coexisting decline in physical, cognitive and social functions. Its antecedents were aging, social frailty, and severe periodontitis, whereas its consequences were decline in physical health and mental health, social withdrawal, lower quality of life and systemic frailty.

CONCLUSION

Oral frailty could result in worse conditions among older adults physically, psychologically and socially. Tools based on the concept analysis need to be developed to comprehensively assess oral frailty.