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Association Between Oral Health and Frailty Among American Older Adults

Research output: Contribution to journalArticle

Original languageEnglish
JournalJournal Of The American Medical Directors Association
Publication statusAccepted/In press - 17 Jul 2020

King's Authors


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 2,368 community-dwelling older adults aged 60 years and older. Frailty was measured with 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% 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 to 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 frailty index, and nutritional intake appears to have a modest effect on the association. Periodontal disease has a weaker association with frailty compared to number of teeth. The findings highlight the importance of maintaining good oral health at old age and incorporating oral health indicators in routine geriatric assessments. Future research should investigate the role of potential mediating factors in this association.

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