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      Relationship between Fried’s frailty phenotype and oral frailty in long-term care residents

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          Abstract

          Background

          oral frailty (OFr) may be called a syndrome lacking a consensus on its definition.

          Objective

          the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care.

          Design

          the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition.

          Setting

          participants were divided into groups according to the number of OFr signs: Group 1 (0–1 sign), Group 2 (2–4 signs) and Group 3 (5–6 signs).

          Subjects

          the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland.

          Methods

          frailty status was defined according to Fried’s frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination.

          Results

          a significant linear relationship across the OFr groups with Fried’s frailty phenotype was found ( P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties.

          Conclusions

          OFr is related to Fried’s frailty phenotype, general health, nutrition and need for help with daily activities.

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          Most cited references47

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.

            The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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              Frailty in older adults: evidence for a phenotype.

              Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.
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                Author and article information

                Contributors
                Journal
                Age Ageing
                Age Ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                November 2021
                28 August 2021
                28 August 2021
                : 50
                : 6
                : 2133-2139
                Affiliations
                Department of Oral and Maxillofacial Diseases , University of Helsinki , Helsinki, Finland
                City of Helsinki , Department of Social Services and Health Care, Oral Health Care , Helsinki, Finland
                Primary Health Care Unit , Kuopio University Hospital , Kuopio, Finland
                Folkhälsan Research Center , Folkhälsan, Helsinki, Finland
                City of Helsinki , Department of Social Services and Health Care, Oral Health Care , Helsinki, Finland
                Health Care, Geriatric Clinic, Helsinki Hospital , Helsinki, Finland
                Department of General Practice , University of Helsinki , Helsinki, Finland
                Institute of Dentistry , University of Eastern Finland , Kuopio, Finland
                Oral and Maxillofacial Diseases, Kuopio University Hospital , Kuopio, Finland
                Author notes
                Address correspondence to: Kaija Hiltunen. Department of Oral and Maxillofacial Diseases, P.O. Box 41, University of Helsinki 00014, Finland. Tel: 358407280202. Email: kaija.hiltunen@ 123456helsinki.fi
                Article
                afab177
                10.1093/ageing/afab177
                8581380
                34473831
                da011af7-de07-490d-9ed6-55a27c591ddc
                © The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 22 April 2021
                : 3 July 2021
                Page count
                Pages: 7
                Funding
                Funded by: Sohlberg Foundation, Helsinki City and Helsinki University Hospital;
                Funded by: Finnish Dental Society Apollonia, DOI 10.13039/501100005634;
                Funded by: Finnish Society of Female Dentists;
                Categories
                Research Paper
                AcademicSubjects/MED00280
                ageing/4
                ageing/15
                ageing/19

                Geriatric medicine
                long-term facilities,older adults,oral frailty,frailty,older people
                Geriatric medicine
                long-term facilities, older adults, oral frailty, frailty, older people

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