Authors (including presenting author) :
Lam CY, Lui BKP, Chan TS, Yu SP, Lam SS, Chan LY, Lee KN, Chan LW, Tong PY, Ho SKS, Pang HSI, Wong CW, Wan MC
Affiliation :
Lam CY, Lui BKP, Chan TS, Yu SP, Lam SS, Chan LY, Lee KN, Chan LW, Tong PY, Ho SKS, Pang HSI, Wong CW, Wan MC.
Introduction :
Oral frailty refers to the decline in oral function, which was reported to be associated with lower intake of nutrients, including protein, and undernutrition. Oral frailty is associated with increased care needs and mortality in community-dwelling elderly. Previous studies have shown that oral frailty occurs before physical frailty and sarcopenia. If the declining oral functions are left undetected and untreated, and only nutritional intervention and physical exercises are used for sarcopenia, the effectiveness of intervention may be limited.
Oral frailty was determined by six measures, namely the number of teeth, chewing ability, maximum tongue pressure, articulatory oral motor skill, subjective difficulties in eating tough food and subjective swallowing difficulties. It is thus difficult to assess in outpatient or day hospital setting. Oral Frailty Index-8 (OFI-8) is an easy-to-use, eight-item screening questionnaire that interrogates oral health-related behaviors and oral frailty concepts. The total score ranges from 0 to 11 points, with higher scores indicating poorer oral health. The cutoff value of 3 points or higher identifies patients with baseline oral frailty with a sensitivity of 91% and a specificity of 63%, or with 2.1-fold risk of new onset oral frailty in 6 years.
Objectives :
The aim of this study was to assess whether oral frailty is present among community-dwelling older people with sarcopenia.
Methodology :
In this retrospective, cross-sectional study, we used data from patients aged 65 years or older attending Geriatric Day Hospital (GDH) in the 1-month period from 14th October 2024 to 20th November 2024. Those who attended GDH for rehabilitation after a recent stroke or other CNS pathology, spinal cord diseases, myopathy, myositis or neuromuscular diseases, and those living in residential care home for elderly were excluded. The eligible subjects would be assessed for sarcopenia according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) by geriatric nurses. Those who were diagnosed with possible sarcopenia, sarcopenia and severe sarcopenia would be screened for presence of oral frailty using the OFI-8 tool. Demographic data and medical history were also collected for analysis. The degree of comorbidity was described with Charlson’s Comorbidity Index (CCI).
Result & Outcome :
Result
Within the study period, 61 eligible patients (56% female) were identified. Eighteen patients (29.5%) confirmed to have no sarcopenia according to AWGS diagnostic algorithm. Among the 43 sarcopenic patients, the mean age was 85.27.6 years and 25 (58%) were female. The mean CCI score was 5.11.2 (range 3-9). Possible sarcopenia, sarcopenia and severe sarcopenia were found in 7(16.3%), 24 (55.8%) and 12 (27.9%) of patients respectively. Three patients were unable to complete the OFI-8 questionnaires. Using OFI-8 cutoff at 3 out of 11, 37 patients (92.5%) sarcopenic patients were found to have high risk of baseline and at risk of new onset oral frailty. The presence of oral frailty did not differ significantly with age, gender, level of comorbidity and possible sarcopenia (100%), sarcopenia (85.7%) and severe sarcopenia groups (90.9%).
Conclusions
Large proportion of sarcopenic community-dwelling elderly people are either having baseline or at high risk of developing new onset oral frailty. Treatment directed to oral frailty would be needed to treat sarcopenia for this group of patients. Further studies would be needed to describe which component of oral frailty contributed the most to guide directed therapy and healthcare policy in future.
