Exploring Associations between Oral Health and Frailty in Community-Dwelling Older People

BACKGROUND

In frail older people with natural teeth factors like polypharmacy, reduced salivary flow, a decrease of oral self-care, general healthcare issues, and a decrease in dental care utilization contribute to an increased risk for oral complications. On the other hand, oral morbidity may have a negative impact on frailty.

OBJECTIVE

This study explored associations between oral health and two frailty measures in community-dwelling older people.

DESIGN

A cross-sectional study.

SETTING

The study was carried out in a Primary Healthcare Center (PHC) in The Netherlands.

PARTICIPANTS

Of the 5,816 persons registered in the PHC, 1,814 persons were eligible for participation at the start of the study.

MEASUREMENTS

Two frailty measures were used: 1. Being at risk for frailty, using Electronical Medical Record (EMR) data, and: 2. Survey-based frailty using 'The Groningen Frailty Indicator' (GFI). For oral health measures, dental-record data (dental care utilization, dental status, and oral health information) and self-reported oral problems were recorded. Univariate regression analyses were applied to determine the association between oral health and frailty, followed by age- and sex-adjusted multivariate logistic regressions.

RESULTS

In total 1,202 community-dwelling older people were included in the study, 45% were male and the mean age was 73 years (SD=8). Of all participants, 53% was at risk for frailty (638/1,202), and 19% was frail based on the GFI (222/1,202). A dental emergency visit (Odds Ratio (OR)= 2.0, 95% Confidence Interval (CI)=1.33;3.02 and OR=1.58, 95% CI=1.00;2.49), experiencing oral problems (OR=2.07, 95% CI=1.52;2.81 and OR=2.87, 95% CI= 2.07;3.99), and making dietary adaptations (OR=2.66, 95% CI=1.31;5.41 and OR=5.49, 95% CI= 3.01;10.01) were associated with being at risk for frailty and survey-based frailty respectively.

CONCLUSIONS

A dental emergency visit and self-reported oral health problems are associated with frailty irrespective of the approach to its measurement. Healthcare professionals should be aware of the associations of oral health and frailty in daily practice.

[Priorities and recommendations in oral health care for older people]

The oral health of older people in the Netherlands, especially those who are vulnerable and dependent on care, is insufficient. Older people and other stakeholders participated in a so-called Priority Setting Partnership study to identify hindrances that have been experienced in oral health care and to distil from their experience items for the agenda for further research. For this reason, discussions were held in 5 focus groups with respectively 1 group of older people, caregivers, external parties and health care professionals. In a fifth focus group, a so-called 'consensus group', the definitive list of prioritised items on the agenda was formulated. The most important priorities concern policy and organisation of oral health care, awareness, cooperation among various health care professionals, the financing and organisation of oral health care for older people living at home and education concerning oral health care for all health care professionals. Awareness about the importance of good oral health for older people among health care professionals is the first step towards better oral health care for older people in the Netherlands.