Association Between Oral Health and Frailty Among Older Adults in Madinah, Saudi Arabia: A Cross-Sectional Study

Abstract

Objectives

This study aimed to examine the association between normative and subjective oral health indicators and frailty assessed by Frailty Phenotype (FP) and frailty index (FI) among older Saudi adults.

Design

cross-sectional study.

Setting

community and hospital-based.

Participants

participants were 356 community-dwelling older adults attending dental clinics and social centres at Madinah, Saudi Arabia.

Methods

Frailty was measured with the frailty phenotype and a 34-item FI. Oral health included the following measures: self-rated oral health, number of teeth, and functional dentition. Covariates included sociodemographic factors and nutritional status. Logistic regression and negative binomial regression models were constructed to test the association between oral health indicators, FP, and FI, respectively. The first model was adjusted for demographic and socioeconomic factors, the second model was additionally adjusted for nutritional status.

Results

The number of teeth, functional dentition and self-rated oral health showed significant associations with frailty after adjusting for demographic and socioeconomic variables for both FP and FI. Adjusting for nutritional status attenuated the associations.

Conclusion

This study has shown significant associations between oral health indicators namely number of teeth, functional dentition and self-rated oral health, and both FP and FI among Saudi older adults. Nutritional status appeared to mediate the association between oral health and frailty implicating inability to eat in this relationship.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clinical interventions in aging 2014; 9: 433.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet 2013; 381: 752–62.

    Article  Google Scholar 

  3. 3.

    Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001; 56: M146–M57.

    CAS  Article  Google Scholar 

  4. 4.

    Castrejón-Pérez RC, Jiménez-Corona A, Bernabé E, et al. Oral disease and 3-year incidence of frailty in Mexican older adults. The Journals of Gerontology: Series A 2017; 72: 951–57.

    Google Scholar 

  5. 5.

    Hakeem FF, Bernabé E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontology 2019.

  6. 6.

    Gaewkhiew P, Sabbah W, Bernabé E. Does tooth loss affect dietary intake and nutritional status? A systematic review of longitudinal studies. Journal of dentistry 2017; 67: 1–8.

    Article  Google Scholar 

  7. 7.

    Tôrres LHdN, Tellez M, Hilgert JB, Hugo FN, de Sousa MdLR, Ismail AI. Frailty, frailty components, and oral health: a systematic review. Journal of the American Geriatrics Society 2015; 63: 2555–62.

    Article  Google Scholar 

  8. 8.

    Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal 2005; 173: 489–95.

    Article  Google Scholar 

  9. 9.

    Gu Y, Wu W, Bai J, et al. Association between the number of teeth and frailty among Chinese older adults: a nationwide cross-sectional study. BMJ open 2019; 9: e029929.

    Article  Google Scholar 

  10. 10.

    Cesari M, Gambassi G, Abellan van Kan G, Vellas B. The frailty phenotype and the frailty index: different instruments for different purposes. Age and ageing 2013; 43: 10–12.

    Article  Google Scholar 

  11. 11.

    Zheng Z, Guan S, Ding H, et al. Prevalence and incidence of frailty in community-dwelling older people: Beijing longitudinal study of aging II. Journal of the American Geriatrics Society 2016; 64: 1281–86.

    Article  Google Scholar 

  12. 12.

    Theou O, Cann L, Blodgett J, Wallace LM, Brothers TD, Rockwood K. Modifications to the frailty phenotype criteria: Systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe. Ageing research reviews 2015; 21: 78–94.

    Article  Google Scholar 

  13. 13.

    Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC geriatrics 2008; 8: 24.

    Article  Google Scholar 

  14. 14.

    World Health Organization. Oral health surveys: basic methods: World Health Organization, 2013.

  15. 15.

    Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001; 56: M366–M72.

    CAS  Article  Google Scholar 

  16. 16.

    Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K. Frailty in NHANES: comparing the frailty index and phenotype. Archives of gerontology and geriatrics 2015; 60: 464–70.

    Article  Google Scholar 

  17. 17.

    Alqahtani BA, Nasser TA. Assessment of frailty in Saudi community-dwelling older adults: validation of measurements. Annals of Saudi Medicine 2019; 39: 197–204.

    Article  Google Scholar 

  18. 18.

    de Andrade FB, Lebrão ML, Santos JLF, de Oliveira Duarte YA. Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. Journal of the American Geriatrics Society 2013; 61: 809–14.

    Article  Google Scholar 

  19. 19.

    Ramsay SE, Papachristou E, Watt RG, et al. Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men. Journal of the American Geriatrics Society 2018; 66: 473–79.

    Article  Google Scholar 

  20. 20.

    Lee S, Sabbah W. Association between number of teeth, use of dentures and musculoskeletal frailty among older adults. Geriatrics & gerontology international 2018; 18: 592–98.

    Article  Google Scholar 

  21. 21.

    Iwasaki M, Yoshihara A, Sato M, et al. Dentition status and frailty in community-dwelling older adults: A 5-year prospective cohort study. Geriatrics & gerontology international 2018; 18: 256–62.

    Article  Google Scholar 

  22. 22.

    Castrejón-Pérez RC, Borges-Yàñez SA, Gutiérrez-Robledo LM, Ávila-Funes JA. Oral health conditions and frailty in Mexican community-dwelling elderly: a cross sectional analysis. BMC public health 2012; 12: 773.

    Article  Google Scholar 

  23. 23.

    Shwe PS, Ward SA, Thein PM, Junckerstorff R. Frailty, oral health and nutrition in geriatrics inpatients: A cross-sectional study. Gerodontology 2019; 36: 223–28.

    Article  Google Scholar 

  24. 24.

    Dorner T, Luger E, Tschinderle J, et al. Association between nutritional status (MNA®-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients. The journal of nutrition, health & aging 2014; 18: 264–69.

    CAS  Article  Google Scholar 

  25. 25.

    Wei K, Gao Q, Wee S-L, Yap K-B, Ng T-P. Association of frailty and malnutrition with long-term functional and mortality outcomes among community-dwelling older adults: results from the Singapore longitudinal aging study 1. JAMA network open 2018; 1: e180650–e50.

    Article  Google Scholar 

  26. 26.

    Khoja AT, Aljawadi MH, Al-Shammari SA, et al. The health of Saudi older adults; results from the Saudi National Survey for Elderly Health (SNSEH) 2006–2015. Saudi Pharmaceutical Journal 2017.

  27. 27.

    Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Applied Physiology, Nutrition, and Metabolism 2017; 42: 449–58.

    Article  Google Scholar 

Download references

Aknowledgment

The study did not recive any financial support

Author information

Affiliations

Authors

Corresponding author

Correspondence to Faisal Hakeem.

Ethics declarations

Conflict of interest: The aouthrs declare no conflict of interest.

Ethical Standards: The study was approved by King’s College London Research Ethics Committee (HR-18/19-8791) and Taibah University, College of Dentistry Research Ethics Committee (TUCDREC/20190129/FHakeem).

Electronic supplementary material

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hakeem, F., Bernabé, E., Fadel, H.T. et al. Association Between Oral Health and Frailty Among Older Adults in Madinah, Saudi Arabia: A Cross-Sectional Study. J Nutr Health Aging (2020). https://doi.org/10.1007/s12603-020-1419-z

Download citation

Key words

  • Aging
  • frailty
  • nutrition
  • oral health
  • teeth loss