Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan

Viviana Albani,Andrew Kingston,Sheena E Ramsay,Louise Robinson,Michiyo Takayama,Toshimitsu Iinuma,Yasumichi Arai,Eftychia Kotronia,Barbara Hanratty,Tomoka Ito,Paula Moynihan,Yukiko Abe,Kensuke Nishio

doi:10.1186/s12877-021-02081-5

Viviana Albani, Andrew Kingston + Show 11 more

Open Access

https://doi.org/10.1186/s12877-021-02081-5

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Abstract

BackgroundVery few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan.MethodsThe Newcastle 85+ Study in England (n = 853) and the Tokyo Oldest Old Survey on Total Health (TOOTH; n = 542) comprise random samples of people aged > 85 years. Oral health markers included tooth loss, dryness of mouth, difficulty swallowing and difficulty eating due to dental problems. Physical functioning was based on grip strength and gait speed; disability was assessed as mobility limitations. Frailty was ascertained using the Fried frailty phenotype. Cross-sectional analyses were undertaken using logistic regression.ResultsIn the Newcastle 85+ Study, dry mouth symptoms, difficulty swallowing, difficulty eating, and tooth loss were associated with increased risks of mobility limitations after adjustment for sex, socioeconomic position, behavioural factors and co-morbidities [odds ratios (95%CIs) were 1.76 (1.26–2.46); 2.52 (1.56–4.08); 2.89 (1.52–5.50); 2.59 (1.44–4.65) respectively]. Similar results were observed for slow gait speed. Difficulty eating was associated with weak grip strength and frailty on full adjustment. In the TOOTH Study, difficulty eating was associated with increased risks of frailty, mobility limitations and slow gait speed; and complete tooth loss was associated with increased risk of frailty.ConclusionDifferent markers of poor oral health are independently associated with worse physical functioning and frailty in the oldest old age groups. Research to understand the underlying pathways is needed.

Highlights

Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years)
Self-reported oral health measures such as level of difficulty eating specific foods because of dental problems were consistently related to physical function and frailty measures; tooth loss was associated with mobility limitations and slow gait speed
Our findings showed that self-reported difficulty eating due to dental problems and difficulty swallowing, were associated with frailty, mobility limitations, gait speed and grip strength

Summary

Introduction

Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan. In the UK, the number of people 85 years and above is projected to increase by 74% between 2019 and 2039 [1]. Countries such as Japan show sharp increases in the proportion of oldest old [2]. Poor physical function (e.g. muscle weakness, limited mobility) are often early manifestations of frailty and in the very old is a risk factor for mortality and morbidity, both independently and through its association with frailty [5]

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