Edentulousness and Frailty: A Study of Directionality and Pathways

Associations between tooth loss and frailty have been reported, but longitudinal evidence on directionality and pathways of this association is lacking. We examined the direction and pathways of the association between edentulousness and frailty among older adults in England using a nationally representative sample of 6,800 adults aged ≥50 y who participated in the English Longitudinal Study of Ageing (ELSA) at wave 3. Edentulousness and frailty (determined using the Frailty Index) were assessed at waves 3 (2006/7), 5 (2010/11), and 7 (2014/15). The following mediators were assessed at waves 4 (2008/9) and 6 (2012/13): loneliness (UCLA Loneliness Scale), C-reactive protein (CRP), and consumption of fruit and vegetables. A cross-lagged longitudinal structural equation model with a Bayesian estimator using probit regression assessed the direction and pathways of the association between edentulousness and frailty at 2 time points (i.e., wave 3 to wave 5 and wave 5 to wave 7), after adjusting for sociodemographic factors and smoking. Being edentate at wave 3 was associated with an increased probability of frailty at wave 5, but the path was not significant between waves 5 and 7 (probit regression coefficient 0.05; 95% CI, -0.02 to 0.13). The paths from frailty to edentulousness were not significant at either time point (probit regression coefficients 0.09 [95% CI, -0.10 to 0.279] and 0.14 [95% CI, -0.03 to 0.31] for waves 3-5 and waves 5-7, respectively). The estimates of indirect paths via loneliness and CRP were of small magnitude but significant at both time points. No significant mediation was observed via the consumption of fruit and vegetables. Health promotion strategies aimed at preserving natural teeth and tackling loneliness in older people may have the potential to prevent frailty.