A 5‐year longitudinal study of association of maximum bite force with development of frailty in community‐dwelling older adults

Abstract

SummaryTo determine whether maximum bite force (MBF), an objective measure of oral function, is associated with development of frailty in community-dwelling older adults. This prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Baseline MBF was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up examinations, including physical fitness and anthropometric evaluation and structured questionnaires, were administered annually over a 5-year period to determine the incidence of frailty, which was defined by the presence of 3 or more of the following 5 components derived from the Cardiovascular Health Study: low level of mobility, low physical activity level, weakness, shrinking and poor endurance and energy. Adjusted hazard ratios (HRs) of incidence of frailty according to sex-stratified tertiles of baseline MBF were calculated using Cox proportional hazards regression models. During the follow-up, 49 participants (15.2%) developed frailty. Participants in the lower tertile of MBF exhibited a significantly greater risk of frailty than those in the upper tertile. After adjustment for sex, depression, diabetes and Eichner index, the adjusted HRs for frailty in the upper through lower tertiles of MBF were 1.00 (reference), 1.27 (95% confidence interval [CI]: 0.50-3.20) and 2.78 (95% CI: 1.15-6.72), respectively (P for trend = .01). Poor oral function, as indicated by low MBF, increases the risk of development of frailty among elderly men and women. K E Y W O R D Scohort studies, dental occlusion, epidemiology, frail elderly, muscle strength, oral health | BACKGROUNDFrailty is a state of increased vulnerability to stressors, which develops as a consequence of age-related decline in multiple physiological systems.

Association between oral health and frailty: A systematic review of longitudinal studies

“…The characteristics of the included studies are presented in Table . Five studies provided data from a combined population of 3086 subjects in 3 countries Mexico, Japan, and UK . The number of participants ranged from 322 to 1151.…”

“…Furthermore, all the studies indicated the exclusion of individuals with frailty at baseline of the study from the analysis. Four studies accounted for age, sex, chronic diseases (mostly diabetes) and socio‐economic status, except for one study that accounted for all these factors but not socio‐economic status . In terms of the outcome, all the studies had long follow‐up periods (2‐5 years).…”

“…In terms of the outcome, all the studies had long follow‐up periods (2‐5 years). Only 2 studies had an attrition rate of <20% . Finally, all the studies did not provide any description of blind assessment of frailty.…”

“…The first study used functional dentition defined by the presence of 20 teeth or more with nine or more occluding pairs, which was associated with a reduction in the risk of 5 years incident frailty . On the other hand, the other oral function indicator was low maximum bite force (MBF) which was associated with an increase in 5‐year incidence frailty …”

Chapter 2 Frailty concepts

“…16 The study also reported that the need for dental prostheses was associated with a higher likelihood of frailty (OR 1.84, 95% CI 1.13-3.00). 21,22 These studies provide further evidence that oral and dental health might be closely related to frailty, as well as to the risk factors for frailty. Thus, the study suggests that there might be an association between oral health problems and frailty, but that this is not conclusive.…”