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Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study

  • Original Research
  • Physical Frailty
  • Published:
The Journal of Frailty & Aging Aims and scope Submit manuscript

Abstract

Background

Poor oral health is known to be associated with adverse outcomes, but the frequency and impact of poor oral health on older adults in the acute inpatient setting has been less well studied.

Objectives

We examined the association between oral health, frailty, nutrition and functional decline in hospitalized older adults.

Design

Retrospective cross-sectional study.

Setting and Participants

We included data from 465 inpatients (mean age 79.2±8.3 years) admitted acutely to a tertiary hospital.

Methods

We evaluated oral health using the Revised Oral Assessment Guide (ROAG), frailty using the Clinical Frailty Scale (CFS), malnutrition risk using the Nutritional Screening Tool (NST) and functional status using a modified Katz Activities of Daily Living (ADL) scale. We examined cross-sectional associations of oral health with frailty, malnutrition risk and functional decline on admission, followed by multivariate logistic regression models evaluating the association between poor oral health and the aforementioned outcomes.

Results

343 (73.8%), 100 (21.5%) and 22 (4.7%) were classified as low, moderate and high risk on the ROAG, respectively. Poorer oral health was associated with greater severity of frailty, functional decline on admission and malnutrition risk. Abnormalities in ROAG domains of voice changes, swallowing difficulty, xerostomia, lips and tongue appearance were more frequently present at greater severity of frailty. Poor oral health was associated with frailty [odds ratio (OR): 1.76, 95% confidence interval (CI) 1.05–2.97; P=0.034]; malnutrition risk [OR: 2.76, 95% CI 1.46–5.19, P=0.002] and functional decline [OR: 1.62, 95% CI 1.01–2.59, P=0.046].

Conclusions

Poor oral health is significantly associated with frailty, malnutrition risk and functional decline in older inpatients. Oral health evaluation, as part of a comprehensive geriatric assessment may be a target for interventions to improve outcomes. Further research including longitudinal outcomes and effectiveness of specific interventions targeted at oral health are warranted in older adults in the inpatient setting.

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Acknowledgements

The authors wish to thank all participants in the study and Dr Glenn Tan and the Department of General Surgery, TTSH for their support.

Funding

This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, Singapore, 308433

    Justin Chew, J. Q. Chia, K. K. Kyaw, J. K. Fu, J. Ang, H. N. Tan & W. S. Lim

  2. Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore

    Justin Chew, H. N. Tan & W. S. Lim

  3. Nutrition and Dietetics, Tan Tock Seng Hospital, Singapore, Singapore

    Y. P. Lim

  4. Department of Dental Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    K. Y. Ang

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  1. Justin Chew
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Corresponding author

Correspondence to Justin Chew.

Ethics declarations

Conflict of interest: All the authors have no conflict of interest or financial disclosure of note.

Ethical standards: The National Healthcare Group Domain Specific Review Board (DSRB) granted ethics approval for this study (DSRB reference number: 2022/00578).

Additional information

How to cite this article: J. Chew, J.Q. Chia, K.K. Kyaw, et al. Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study. J Frailty Aging 2023;12(4)277-283; https://doi.org/10.14283/jfa.2023.33

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Chew, J., Chia, J.Q., Kyaw, K.K. et al. Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study. J Frailty Aging 12, 277–283 (2023). https://doi.org/10.14283/jfa.2023.33

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