Background Poor nutritional status is a risk factor for the development of frailty. Likewise, oral health is independently associated with nutrition. The potential association between oral health and frailty in hospitalised elderly adults has, however, not previously been investigated. Objective To investigate the relationship between oral health and frailty in hospitalised elderly adults and to identify the predictors of frailty. Method A cross‐sectional study of 168 geriatric inpatients >65 years old was performed from August to December 2016. Patients of non‐English speaking background, with impaired cognition (MMSE <24), severe hearing or visual impairment or active delirium were excluded. Oral health, nutrition and frailty were assessed using previously validated tools, namely the Geriatric Oral Health Assessment Index (GOHAI), Mini Nutrition Assessment (MNA) and Reported Edmonton Frailty Scale (REFS). Other data collected included demographics, co‐morbidities, level of education and smoking/alcohol history. Results On univariate analysis, the REFS score decreased with better nutritional status/higher MNA (P < 0.001) and better self‐reported oral health/higher GOHAI (P = 0.023). Nutritional status accounted for 17% of variability in frailty assessment. On multivariate analysis, co‐morbidities (P < 0.001), MNA (P < 0.001) and living in residential care (P < 0.001) were independent predictors of frailty. After adjusting for nutrition and co‐morbidities, self‐reported oral health was found to have an independent negative association with frailty (P = 0.019). Conclusion Poor self‐reported oral health was found to be independently associated with frailty. Further research should be directed at whether interventions to maintain good oral health can prevent or slow the progression of frailty.

Background Poor oral health is known to be associated with frailty in geriatric populations. Recent exposure to anticholinergic medications is responsible for features of poor oral health. Anticholinergic medications pose a cumulative risk for frailty. Methods We studied 115 geriatric inpatients (aged >65 years and recruited over a 3‐month period from October to December 2017). Patients who were severely agitated, cognitively impaired, from a non‐English speaking background and with severe sensory impairment were excluded. Frailty and oral health were assessed using the Reported Edmonton Frailty Scale and the Oral Health Assessment Test, respectively. Exposure to anticholinergic medications was assessed using the Anticholinergic Burden Scale. Results The mean age was 80 (range from 66 to 101). Only 44 patients (38.3%) were not exposed to any anticholinergic medication. Nearly two‐thirds of patients were taking anticholinergic medications, with 25% classified as having a high anticholinergic burden (ACB ≥ 4). Approximately one‐third of severely frail patients were exposed to a high anticholinergic burden. Patients with a high anticholinergic burden were more than twice as likely to have severe frailty (OR 2.21; 95% confidence interval 1.05–4.6). Poor oral health was associated with frailty (OR 1.24; 95% CI 1.02–1.49). Conclusion High anticholinergic burden was found to be a risk marker for severe frailty independent of its effect on oral health. Poor oral health was associated with all levels of frailty. This study highlights a need for a review of medications with anticholinergic properties in older patients. Further research should be directed at whether deprescribing could prevent poor oral health or slow the progression of frailty.

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