Association Between Oral Health and Frailty Among American Older Adults

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Objective: We examined the association between tooth loss, periodontal diseases, and frailty among older American adults. Designs, Settings, and Participants: Data from the National Health and Nutrition Examination Surveys (NHANES) 2011–2014 was used. We included 2368 community-dwelling adults aged 60 years and older. Frailty was measured with the 49-item frailty index. Oral health indicators included number of teeth and periodontal disease. A composite nutritional intake variable based on 13 micronutrients from the dietary assessment was created. Negative binomial regression was used to test the association between oral health and frailty. The first model was adjusted for age and gender, the second model was additionally adjusted for nutritional intake, and the third model was additionally adjusted for other covariates. Results: For each additional tooth, the rate ratio (RR) for frailty was 0.99 [95% confidence interval (CI) 0.98–0.99] in the fully adjusted model. Similarly, participants with moderate-severe periodontitis had 1.08 RR (95% CI 1.02–1.14) for frailty index compared with participants with no periodontitis after adjusting for age, gender, and poor nutritional intake. The association lost significance in the fully adjusted model. Conclusions and Implications: Oral health is associated with the frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared with number of teeth. The findings highlight the importance of maintaining good oral health at older age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.

Original languageEnglish
Pages (from-to)P559-563
JournalJournal Of The American Medical Directors Association
Issue number3
Early online date25 Aug 2020
Publication statusPublished - 1 Mar 2021


  • Aging
  • frailty
  • nutrition
  • oral health
  • tooth loss


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