Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

Dibello, Vittorio; Lobbezoo, Frank; Lozupone, Madia; Sardone, Rodolfo; Ballini, Andrea; Berardino, Giuseppe; Mollica, Anita; Coelho-Júnior, Hélio José; Pergola, Giovanni De; Stallone, Roberta; Dibello, Antonio; Daniele, Antonio; Petruzzi, Massimo; Santarcangelo, Filippo; Solfrizzi, Vincenzo; Manfredini, Daniele

doi:10.1007/s11357-022-00663-8

Cited by 57 publications

(18 citation statements)

References 139 publications

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“…Oral frailty is defined as an age-related gradual loss of oral function, accompanied by a decline in cognitive and physical functions. It results in major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, loss of quality of life, and reduced hospitalization and falls [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Association between oral frailty and cystatin C-related indices—A questionnaire (OFI-8) study in general internal medicine practice

et al. 2023

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Background Cystatin C-related indices such as the ratio of creatinine to cystatin C (Cr/CysC) and the ratio of estimated glomerular filtration rate by cystatin C (eGFRcys) to creatinine eGFRcre (eGFRcys/eGFRcre) levels have been shown to be associated with muscle mass and strength and can be markers of sarcopenia. Oral frailty is defined as an age-related gradual loss of oral functions, accompanied by a decline in cognitive and physical functions. It results in adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, poor quality of life, and increased hospitalization and falls. Therefore, poor oral health among the elderly is an important health concern due to its association with the pathogenesis of systemic frailty, suggesting it to be a multidimensional geriatric syndrome. The Oral Frailty Index-8 (OFI-8) is a questionnaire that can be used for easy screening of oral frailty. This study aimed to investigate whether cystatin C- related indices are different between patients with low to moderate risk of oral frailty and those at high risk of oral frailty, using the OFI-8 in attending a general internal medicine outpatient clinic. Materials and methods This is a cross-sectional study that included 251 patients with a mean age of 77.7±6.6 years and a median age of 77 years (128 men: mean age, 77.1±7.3 years; median age, 77 years and 123 women: mean age, 78.4±5.7 years; median age, 78 years) attending general internal medicine outpatient clinics. OFI-8 scores were tabulated by gender to determine whether there were differences between patients at low to moderate risk of oral frailty (OFI-8 score ≤3 points) and those at high risk (OFI-8 score ≥4 points) in Cr/CysC, eGFRcys/eGFRcre levels, height, weight, grip strength, etc. were examined. Results The OFI-8 score was higher in women than in men, suggesting that oral frailty is more common in women. Cr/CysC, eGFRcys/eGFRcre and grip strength were significantly lower in both men and women in the high-risk group for oral frailty (OFI-8 score ≥ 4). Height, hemoglobin level, red blood cell count, and serum albumin levels were significantly lower in men with an OFI-8 score ≥4. Receiver operating characteristic curve (ROC) analysis also showed that Cr/CysC and eGFRcys/eGFRcre were significantly associated with an OFI-8 score≥4 in both men and women. Conclusion Cr/CysC and eGFRcys/eGFRcre were significantly lower in the high-risk group for oral frailty on the OFI-8in both men and women. A relationship exists among cystatin C-related indices, which can effectively screen systemic frailty. Similarly, the OFI-8 score can be used to effectively screen oral frailty. Thus, a collaboration that incorporates both systemic and oral frailty from medical and dental perspectives is required.

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Section: Introductionmentioning

confidence: 99%

Association between oral frailty and cystatin C-related indices—A questionnaire (OFI-8) study in general internal medicine practice

et al. 2023

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“…Lack of occlusal support, whether due to periodontal disease, tooth loss, or other factors, is associated with several other primary adverse health-related outcomes in older adults, such as frailty, hospitalization, falls, mortality, functional disability, and quality of life. Dibello et al (2021 , 2023) found a significant association between poor mastication and frailty.…”

Section: Discussionmentioning

confidence: 93%

Association between occlusal support and cognitive impairment in older Chinese adults: a community-based study

Zhang

et al. 2023

Front. Aging Neurosci.

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IntroductionThe loss of occlusal support due to tooth loss is associated with systemic diseases. However, there was little about the association between occlusal support and cognitive impairment. The cross-sectional study aimed to investigate their association.MethodsCognitive function was assessed and diagnosed in 1,225 community-dwelling adults aged 60 years or older in Jing’an District, Shanghai. Participants were diagnosed with mild cognitive impairment (MCI) by Peterson’s criteria, or dementia, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. We determined the number of functional occlusal supporting areas according to Eichner classifications. We used multivariate logistic regression models to analyze the relationship between occlusal support and cognitive impairment and mediation effect models to analyze the mediation effect of age.ResultsSix hundred sixty participants were diagnosed with cognitive impairment, averaging 79.92 years old. After adjusting age, sex, education level, cigarette smoking, alcohol drinking, cardiovascular disease, and diabetes, individuals with poor occlusal support had an OR of 3.674 (95%CI 1.141–11.829) for cognitive impairment compared to those with good occlusal support. Age mediated 66.53% of the association between the number of functional occlusal supporting areas and cognitive impairment.DiscussionIn this study, cognitive impairment was significantly associated with the number of missing teeth, functional occlusal areas, and Eichner classifications with older community residents. Occlusal support should be a significant concern for people with cognitive impairment.

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“…2 Dental and oral overlapping impairments of dental and oral functions as oral frailty that might be risk factors for physical frailty, and reported their association with adverse health outcomes, including mortality. [3][4][5][6][7] The Japanese Society of Geriatric Dentistry has proposed oral hypofunction, which allows dental healthcare professionals to comprehensively assess, manage and intervene in the dental and oral functions of older adults. 8 Importantly, factors related to oral frailty in old age, including nutritional status and social aspects, are complex.…”

Section: Introductionmentioning

confidence: 99%

“…Frailty is associated with decreased physical status and activity, and increased vulnerability to adverse health outcomes 2 . Dental and oral functions in old age are attracting attention as a predictor of physical frailty and loss of independence 3–6 . We previously identified overlapping impairments of dental and oral functions as oral frailty that might be risk factors for physical frailty, and reported their association with adverse health outcomes, including mortality 3–7 .…”

Section: Introductionmentioning

confidence: 99%

“…Dental and oral functions in old age are attracting attention as a predictor of physical frailty and loss of independence 3–6 . We previously identified overlapping impairments of dental and oral functions as oral frailty that might be risk factors for physical frailty, and reported their association with adverse health outcomes, including mortality 3–7 . The Japanese Society of Geriatric Dentistry has proposed oral hypofunction, which allows dental healthcare professionals to comprehensively assess, manage and intervene in the dental and oral functions of older adults 8 .…”

Section: Introductionmentioning

confidence: 99%

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Oral frailty five‐item checklist to predict adverse health outcomes in community‐dwelling older adults: A Kashiwa cohort study

Tanaka

Hirano

Ikebe

et al. 2023

Geriatrics Gerontology Int

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AimTo enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five‐item checklist (OF‐5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community‐dwelling older adults.MethodsThis population‐based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long‐term care needs. Baseline data were collected in 2012, and follow‐up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF‐5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long‐term care insurance receipt database were followed for 9 years.ResultsOf 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF‐5 points had significantly increased prevalence and new‐onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF‐5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14–1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11–1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty.ConclusionsThe OF‐5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; ••: ••–••.

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Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

Cited by 57 publications

References 139 publications

Association between oral frailty and cystatin C-related indices—A questionnaire (OFI-8) study in general internal medicine practice

Association between oral frailty and cystatin C-related indices—A questionnaire (OFI-8) study in general internal medicine practice

Association between occlusal support and cognitive impairment in older Chinese adults: a community-based study

Oral frailty five‐item checklist to predict adverse health outcomes in community‐dwelling older adults: A Kashiwa cohort study

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