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Xia X, Yang Z, Xu Z, Tang J, Zhang G, Dong B, Liu X. Nutrition Status Plays a Partial Mediation Role in the Relationship between Number of Teeth and Frailty: A Cross-Sectional Multicenter Study. Gerontology 2024; 70:572-584. [PMID: 38461811 DOI: 10.1159/000538181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Although the relationship between the number of teeth and frailty has been extensively studied, the mediating role of nutrition status in the association between the number of teeth and frailty remains to be clarified. METHODS A number of 6,664 participants lived in the communities of West China were analyzed in our study. Physical frailty was determined based on the phenotype established by Fried. Nutrition status was evaluated using the Mini Nutrition Assessment-Short Form (MNA-SF) scale. Multiple linear regression was employed to evaluate the direct relationships between the number of teeth, nutrition, and frailty. Mediation models and structural equation model (SEM) pathway analysis were used to test the mediating role of nutrition status in the relationship between the number of teeth and frailty. RESULTS Among the 6,664 participants aged over 50 years old, the prevalence of frailty was 6.2%. Multiple linear regression analysis showed a significant total relationship between the number of teeth (β = -0.359, 95% CI: -0.473 to -0.244, p < 0.001) and frailty. After adjusting for MNA-SF scores, the relationship between the number of teeth and frailty remained significant (β = -0.327, 95% CI: -0.443 to -0.211, p < 0.001), indicating a partial mediating effect of nutrition. Mediation analysis verified that nutrition partially mediated the relationship between the number of teeth and frailty (indirect effect estimate = -0.0121, bootstrap 95% CI: -0.0151 to -0.0092; direct effect estimate = -0.0874, bootstrap 95% CI: -0.1086 to -0.0678) in the fully adjusted model. This mediating effect occurred through influencing weight loss, low level of physical activity, and debility. SEM framework pathway analysis confirmed the association between the number of teeth, nutrition, and frailty. CONCLUSIONS Our findings demonstrated that frailty was correlated with the number of teeth and poorer nutritional status, with nutrition partially mediating the correlation between the number of teeth and frailty. Our results supported early nutritional evaluation and intervention in oral health to decrease the risk of frailty.
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Affiliation(s)
- Xin Xia
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Zhongli Yang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Zhigang Xu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Jingyi Tang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Department of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Gongchang Zhang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
| | - Xiaolei Liu
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Geriatric Health Care and Medical Research Center, Sichuan University, Chengdu, China
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de Vasconcellos NBT, Fagundes MLB, Menegazzo GR, do Amaral Júnior OL, Hilgert JB, do Amaral Giordani JM. Association between frailty and oral health services use in Brazilian older adults. Gerodontology 2024; 41:46-53. [PMID: 37750043 DOI: 10.1111/ger.12716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES To assess the association between frailty and oral health services use in Brazilian older adults. METHODS This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.
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Affiliation(s)
| | | | | | | | - Juliana Balbinot Hilgert
- Departament of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Luong R, Ribeiro R, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Cross-sectional and longitudinal associations between empirically derived dietary patterns and frailty among older men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2024; 28:100021. [PMID: 38267155 DOI: 10.1016/j.jnha.2023.100021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Diet may be associated with frailty. OBJECTIVE We aimed to evaluate the associations between empirically derived dietary patterns and frailty in older men. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 785 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Factor analysis identified three dietary patterns. Multinomial logistic regression was conducted between frailty and dietary patterns for cross-sectional analyses and longitudinal analyses over a 3-year follow-up. Frailty was defined by the Fried frailty phenotype. RESULTS Of the 785 men, pre-frailty was prevalent in 47.1% (n = 370), and frailty in 8.3% (n = 65). In fully adjusted cross-sectional analyses, the top tertile and a higher 'vegetables-legumes-seafood' dietary pattern score were associated with reduced prevalence of frailty (OR 0.34 [95% CI: 0.12, 0.93, P = .036]) and OR 0.50 [95% CI: 0.30, 0.83, P = .007] respectively). The top tertile of the 'discretionary-starchy vegetables-processed meats' dietary pattern was also associated cross-sectionally with increased prevalence of pre-frailty (OR 1.75 [95% CI: 1.08, 2.83, P = .022]). Of the 296 robust men in fully adjusted longitudinal analyses, the incidence of pre-frailty was 52.4% (n = 155), and frailty was 5.4% (n = 16) over a 3-year follow-up. The middle tertile of the 'vegetables-legumes-seafood' dietary pattern had a non-significant trend towards reduced incident pre-frailty (OR 0.52 [95% CI: 0.27, 1.00, P = .050]). CONCLUSION Consumption of a 'vegetables-legumes-seafood' dietary pattern appears to be less favoured by frail older men.
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Affiliation(s)
- Rebecca Luong
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia; School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia; Andrology Department, Concord Hospital, Concord, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vasant Hirani
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
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Castrejón-Pérez RC, Wanyonyi KL, García-Vázquez PE, Cruz-Hervert LP, Ramírez-Aldana R, Borges-Yáñez SA. Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis. Gerodontology 2023; 40:372-381. [PMID: 36358062 DOI: 10.1111/ger.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people. BACKGROUND Studies suggest that the association between frailty and oral conditions are mediated by nutrition. MATERIALS AND METHODS This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome. RESULTS Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index. CONCLUSION Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.
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Affiliation(s)
| | | | - Paola E García-Vázquez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Luis Pablo Cruz-Hervert
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
| | - Ricardo Ramírez-Aldana
- Instituto Nacional de Geriatría, National Institutes of Health, Ministry of Health, Mexico City, Mexico
| | - S Aída Borges-Yáñez
- Postgraduate and Research Studies Division, Dentistry School, National Autonomous University of Mexico, Mexico City, Mexico
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Dibello V, Lobbezoo F, Lozupone M, Sardone R, Ballini A, Berardino G, Mollica A, Coelho-Júnior HJ, De Pergola G, Stallone R, Dibello A, Daniele A, Petruzzi M, Santarcangelo F, Solfrizzi V, Manfredini D, Panza F. Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review. GeroScience 2022; 45:663-706. [PMID: 36242694 PMCID: PMC9886742 DOI: 10.1007/s11357-022-00663-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/14/2022] [Indexed: 02/03/2023] Open
Abstract
A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.
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Affiliation(s)
- Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Madia Lozupone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario Ernesto Quagliariello, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Berardino
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anita Mollica
- Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Hélio José Coelho-Júnior
- School of Physical Education, University of Campinas, Cidade Universitaria Zeferino Vaz, Barao Geraldo, Campinas, Brazil
| | - Giovanni De Pergola
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy
| | - Roberta Stallone
- Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy
| | - Antonio Dibello
- Accident and Emergency Department (AED), F. Perinei Hospital, Altamura, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy
- Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, Section of Dentistry, University of Bari Medical School, Bari, Italy
| | | | - Vincenzo Solfrizzi
- Cesare Frugoni Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy.
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Xerostomia as a key predictor of physical frailty among community-dwelling older adults in Japan: a five-year prospective cohort study from The Otassha Study. Arch Gerontol Geriatr 2022; 99:104608. [DOI: 10.1016/j.archger.2021.104608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/21/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
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van der Heijden EM, Klüter WJ, van der Maarel-Wierink CD, Gobbens RJJ. Exploring associations between multidimensional frailty and oral health in community-dwelling older people. A pilot study. SPECIAL CARE IN DENTISTRY 2022; 42:361-368. [PMID: 35014046 PMCID: PMC9545350 DOI: 10.1111/scd.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022]
Abstract
Objective To determine the associations between four validated multidimensional self‐report frailty scales and nine indices of oral health in community‐dwelling older persons. Materials and Methods This pilot study was conducted in a sample of 208 older persons aged 70 years and older who visited two dental practices in the Netherlands. Frailty status was measured by four different self‐report frailty questionnaires: Tilburg Frailty Indicator (TFI), Groningen Frailty Indicator (GFI), Sunfrail Checklist (SC), and the Sherbrooke Postal Questionnaire (SPQ). Oral health was assessed by two calibrated examiners. Results The prevalence of frailty according to the four frailty measures TFI, GFI, SC, and SPQ was 32.8%, 31.5%, 24.5%, and 49.7%, respectively. The SC correlated with four oral health variables (DMFT, number of teeth, percentage of occlusal contacts, Plaque Index), the TFI with three (number of teeth, percentage of occlusal contacts, Plaque Index), the GFI only with DPSI, and the SPQ with the number of teeth and the number of occlusal contacts. Conclusion Of the studied multidimensional frailty scales, the SC and TFI were correlated with most oral health variables (four and three, respectively). However, it should be noticed that these correlations were small. Clinical relevance The SC and TFI might help to identify older people with risk of poor oral health so that preventive care can be used to ensure deterioration of oral health and maintenance of quality of life. Vice versa early detection of frailty by oral care professionals could contribute to interprofessional management of frailty.
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Affiliation(s)
| | - Wim J Klüter
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,College of Dental Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Claar D van der Maarel-Wierink
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Department of Oral Medicine, Academic Center for Dentistry Amsterdam, University of Amsterdam and VU University, Amsterdam, Netherlands
| | - Robbert J J Gobbens
- BENECOMO, Flemish-Netherlands Geriatric Oral Research Group, Nijmegen, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Zonnehuisgroep Amstelland, Amstelveen, Netherlands.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Salivary IL-6 Concentration Is Associated with Frailty Syndrome in Older Individuals. Diagnostics (Basel) 2022; 12:diagnostics12010117. [PMID: 35054284 PMCID: PMC8775035 DOI: 10.3390/diagnostics12010117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 01/15/2023] Open
Abstract
Background: One of the physiological changes that is most closely associated with frailty is the increase in pro-inflammatory cytokines, and IL-6 in particular. Most studies have demonstrated this association using blood samples. We analyzed the relationship between frailty syndrome, individual frailty criteria, and IL-6 levels obtained by saliva tests. Methods: A cross-sectional pilot study was performed among women institutionalized in nursing homes. Frailty was defined as having three or more of the following components: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those components. Results: There was a significant and positive correlation between the frailty score and salivary IL-6 concentration. Regarding the associations between IL-6 and individual dichotomized frailty criteria, there were significant differences in salivary IL-6 concentration in two frailty criteria: weight loss (p = 0.002) and low physical activity (p = 0.007). Receiver operating characteristic curve analysis showed that IL-6 concentration significantly (p < 0.05) (although moderately) discriminated patients that progressed in the frailty syndrome (the area under the curve value was 0.697 with 95% CI 0.566–0.827). Conclusions: Salivary IL-6 concentration can be used as potential biomarker of frailty syndrome and as a tool to monitor the effects of interventions in frail individuals.
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Janakiram C, Ayoob A, Neelamana S. Impact of oral frailty on general frailty in geriatric population: A scoping review. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2022. [DOI: 10.4103/jiaphd.jiaphd_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Diaz-Toro F, Petermann-Rocha F, Parra-Soto S, Troncoso-Pantoja C, Concha-Cisternas Y, Lanuza F, Dreyer Arroyo E, Celis A, Celis-Morales C. Association between Poor Oral Health and Frailty in Middle-Aged and Older Individuals: A Cross-Sectional National Study. J Nutr Health Aging 2022; 26:987-993. [PMID: 36437766 DOI: 10.1007/s12603-022-1858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Older adults with poor oral health may be at higher risk of being pre-frail or frail. However, very few studies have examined this association in Latin American countries and middle-aged individuals. Therefore, we aimed to investigate the association between oral health and frailty status among Chilean adults ≥40 years. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS We included 3,036 participants ≥40 years from the Chilean National Health Survey 2016-2017. METHODS Frailty status was assessed with a 49-item frailty index, while the number of teeth, self-reported oral health, tooth decay, use of prostheses, and oral pain were the oral health conditions included. To assess the association between oral health conditions and frailty, we used multinomial logistic regression models status adjusted for sociodemographic and lifestyle variables. RESULTS Overall, 40.6% and 11.8% of individuals were classified as pre-frail and frail, respectively. After adjusting for confounders, individuals with ≤20 teeth had a higher likelihood of being frail (odds ratio (OR): 1.94 [95% CI: 1.18-3.20]) than people with >20 teeth. Moreover, people with bad or very bad oral health, as well as oral pain, had a higher likelihood of being pre-frail (OR: 2.04 [95% CI: 1.40-2.97] and OR: 2.92 [95% CI: 1.58-5.39], respectively). Middle-aged individuals with fewer teeth and poor self-reported oral health had a higher likelihood of being pre-frail and frail than people ≥60. CONCLUSIONS AND IMPLICATIONS Individuals with poor global oral health were more likely to be pre-frail or frail. This association seems to be stronger in people <60 years old. Our results are consistent with previously published reports.
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Affiliation(s)
- F Diaz-Toro
- Fanny Petermann-Rocha, PhD, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile, , Phone: +56 2 26768968
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Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312360. [PMID: 34886085 PMCID: PMC8656978 DOI: 10.3390/ijerph182312360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.
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Khalatbari-Soltani S, Blyth FM, Naganathan V, Le Couteur DG, Handelsman DJ, Seibel MJ, Hirani V, Wright FAC, Waite LM, Cumming RG. Cohort Profile update: The Concord Health and Ageing in Men Project (CHAMP). Int J Epidemiol 2021; 51:31-32h. [PMID: 34601611 DOI: 10.1093/ije/dyab171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, NSW, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - F A Clive Wright
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Louise M Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, NSW, Australia
| | - Robert G Cumming
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia.,ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, Daniele A, De Pergola G, Bortone I, Lampignano L, Giannelli G, Panza F. Oral frailty and its determinants in older age: a systematic review. THE LANCET HEALTHY LONGEVITY 2021; 2:e507-e520. [DOI: 10.1016/s2666-7568(21)00143-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/01/2023]
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Slashcheva LD, Karjalahti E, Hassett LC, Smith B, Chamberlain AM. A systematic review and gap analysis of frailty and oral health characteristics in older adults: A call for clinical translation. Gerodontology 2021; 38:338-350. [PMID: 34331353 DOI: 10.1111/ger.12577] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/02/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This systematic review updates the evidence for association between oral health characteristics and frailty status, identifying gaps in translational dental research and application of frailty assessment into clinical practice. BACKGROUND Clinicians have little guidance on stage-appropriate dental treatment for medically complex older adults. Oral health characteristics have been associated with frailty status, determined through validated assessment tools representing a concise measure of health. Translation of frailty assessment into dental practice has not been the focus of previous reviews. METHODS Utilising the PRISMA framework for systematic reviews, a comprehensive database search identified articles describing the association of interest. Those included were cross-sectional or longitudinal, in English, included participants aged 50 years or older, used validated frailty assessments and measured clinically relevant oral health outcomes. From 835 screened articles, 26 full-text articles were eligible for quality appraisal and synthesis. RESULTS Frailty prevalence ranged from 8.5% to 66.0%. Most studies utilised the Fried frailty criteria. Qualitative synthesis of 17 cross-sectional and nine longitudinal studies demonstrated significant covariate-adjusted association between frailty status and number of teeth, chewing ability, prosthetic characteristics, dental caries, periodontitis, dental utilisation and oral health-related quality of life factors. Variability in findings reflected study sample diversity based on country of study origin, age at recruitment, sample size, frailty assessment type, use of clinical versus self-reported outcome measures and differences in statistical analysis. CONCLUSION Despite robust evidence of association with oral health characteristics, frailty assessment has yet to be sufficiently applied to translational dental research and clinical practice.
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Affiliation(s)
- Lyubov D Slashcheva
- Department of Dental Specialties, Mayo Clinic, Rochester, MN, USA.,Apple Tree Dental, Rochester, MN, USA
| | - Erika Karjalahti
- Roseman University College of Dental Medicine, Henderson, NV, USA
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15
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Takehara S, Hirani V, Wright FAC, Naganathan V, Blyth FM, Le Couteur DG, Waite LM, Seibel MJ, Handelsman DJ, Cumming RG. Appetite, oral health and weight loss in community-dwelling older men: an observational study from the Concord Health and Ageing in Men Project (CHAMP). BMC Geriatr 2021; 21:255. [PMID: 33863274 PMCID: PMC8052725 DOI: 10.1186/s12877-021-02169-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background Unintended weight loss and the reduction in appetite are common phenomenon among older people. Reduced appetite has been linked to medication related reductions in saliva production, reduced taste ability and poor oral health. Poor appetite can result in reduced nutrient intake ensuing weight loss. It is possible that poor appetite is a mediating step on the causal pathway between oral health and weight loss. This study investigates whether poor oral health and loss of appetite are related to weight loss. Methods This is an observational study where data were obtained from the Concord Health and Ageing in Men Project (CHAMP). Information on socio-demographics, appetite and health related behavior was collected by self-completed questionnaire. Intraoral assessment was conducted by calibrated oral health therapists. Height and weight were measured by trained staff. Regression analysis investigated associations between oral health and appetite as risk factors for weight loss. Results Participants included 542 community dwelling older males. 99 older men (18.3%) experienced 5% or more weight loss over 3 years. Men who lost weight from baseline had lower BMI and lower body weight, had higher prevalence of frailty and depression, reported poorer appetite, and had fewer teeth (13.8 ± 9.5) than those who did not lose weight (16.3 ± 9.3). Before adjustment, the prevalence ratio (PR) for weight loss was 1.76 (95% Confidence Interval (CI), 1.19–2.59) for participants with 0–19 natural teeth present compared to those with 20 or more teeth. When adding appetite and other variables to the model, the PR for number of teeth and weight loss was unchanged: 1.78 (95% CI, 1.06–3.00). The mediation analysis showed that the indirect effect of appetite on the association between number of natural teeth on weight loss was not found to be significant. Conclusion This study found that number of natural teeth present and appetite are independently related to weight change among elderly men in Australia. Tooth loss can increase the risk of swallowing difficulty leading to change in food preference, avoidance of foods and a decrease in energy intake. Our study showed the importance of oral health interventions to encourage maintenance of 20 or more natural teeth in older people.
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Affiliation(s)
- Sachiko Takehara
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia. .,Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
| | - Vasant Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - F A Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Fiona M Blyth
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,ANZAC Research Institute, The University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord Hospital, Sydney, NSW, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Takehara S, Wright FAC, Waite LM, Naganathan V, Hirani V, Blyth FM, Le Couteur DG, Seibel MJ, Handelsman DJ, Cumming RG. Oral health and cognitive status in the Concord Health and Ageing in Men Project: A cross-sectional study in community-dwelling older Australian men. Gerodontology 2020; 37:353-360. [PMID: 32227607 DOI: 10.1111/ger.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have examined the relationship between cognition and oral health in older populations. To further understand this relationship, we examined the associations between cognitive function, chewing capacity and the number of teeth present in community-dwelling older males in Australia. METHODS Data were obtained from cross-sectional analysis of fourth wave of the Concord Health and Ageing in Men Project (CHAMP). Participants were 369 community-dwelling males aged 78 years or over. Cognitive function was measured utilising the Mini-Mental State Examination (MMSE). Chewing capacity was determined on ability to chew food items of different textures, and oral health data were collected. Ordinal regression was used to analyse associations between MMSE (four categories) and chewing capacity and number of natural teeth present. RESULTS Overall, 67.5% of participants reported that they could chew all 11 listed food items. Participants with fewer than 20 teeth were statistically significantly more likely to have cognitive impairment (unadjusted odds ratio (OR) 1.87; 95% confidence interval (CI) 1.25-2.79, adjusted OR 1.62; 95% CI 1.07-2.43). Participants with limited chewing capacity were also more likely to have cognitive impairment (unadjusted OR 1.91; 95% CI 1.25-2.94, adjusted OR 1.61; 95% CI 1.03-2.49). CONCLUSIONS This study suggests either that older men with fewer than 20 natural teeth and those with limited chewing capacity are more likely to have an associated cognitive impairment or that those with cognitive impairment are more likely to have fewer teeth and limited chewing capacity. Further longitudinal studies should clarify these relationships.
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Affiliation(s)
- Sachiko Takehara
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Fredrick A Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Vasant Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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