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Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

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Abstract

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.

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Acknowledgements

We thank the “Salus in Apulia” Research Team. This manuscript is the result of the research work on frailty undertaken by the “Italia Longeva: Research Network on Aging” team, supported by the resources of the Italian Ministry of Health—Research Networks of National Health Institutes. We thank M.V. Pragnell for her precious help as native English language supervisor. All authors have access to all the data reported in this systematic review.

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Authors and Affiliations

  1. Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Vittorio Dibello & Frank Lobbezoo

  2. Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology Saverio de Bellis, Research Hospital, Castellana Grotte, Bari, Italy

    Madia Lozupone, Rodolfo Sardone & Francesco Panza

  3. Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy

    Madia Lozupone

  4. Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy

    Madia Lozupone, Giuseppe Berardino & Anita Mollica

  5. Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario Ernesto Quagliariello, University of Bari Aldo Moro, Bari, Italy

    Andrea Ballini

  6. School of Physical Education, University of Campinas, Cidade Universitaria Zeferino Vaz, Barao Geraldo, Campinas, Brazil

    Hélio José Coelho-Júnior

  7. Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Policlinico, Bari, Italy

    Giovanni De Pergola

  8. Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy

    Roberta Stallone

  9. Accident and Emergency Department (AED), F. Perinei Hospital, Altamura, Bari, Italy

    Antonio Dibello

  10. Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy

    Antonio Daniele

  11. Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

    Antonio Daniele

  12. Interdisciplinary Department of Medicine, Section of Dentistry, University of Bari Medical School, Bari, Italy

    Massimo Petruzzi

  13. Dentistry Department, Rey Juan Carlos University, Madrid, Spain

    Filippo Santarcangelo

  14. Cesare Frugoni Internal and Geriatric Medicine and Memory Unit, University of Bari Aldo Moro, Bari, Italy

    Vincenzo Solfrizzi

  15. Department of Biomedical Technologies, School of Dentistry, University of Siena, Siena, Italy

    Daniele Manfredini

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  1. Vittorio Dibello
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Contributions

VD and FP conceptualized this systematic review. ML, RS, AB, GB, AM, HJC-J, GDP, RS, AD, and ADa contributed to data collection. VD, FL, RS, ML, MP, FS, VS, DM, and FP contributed to data interpretation. All authors contributed to drafting, revising, and approving the submitted paper.

Corresponding author

Correspondence to Francesco Panza.

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Dibello, V., Lobbezoo, F., Lozupone, M. et al. Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review. GeroScience 45, 663–706 (2023). https://doi.org/10.1007/s11357-022-00663-8

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