Does Oral Health Status Predict Incident Frailty Over the 13-Year Follow-Up in Older Adults in England?

This study aimed to assess longitudinal associations between oral health and incident frailty, assessed by a multidimensional frailty index, in a national sample of older adults in England with participant mortality and drop out considered as competing risks.

A nationally representative sample of adults aged ≥ 50 from the English Longitudinal Study of Ageing (ELSA) was analysed. Oral health was assessed using edentulousness, self-rated oral health and the Oral Impacts on Daily Performances (OIDP) measures. Frailty was evaluated with the Rockwood frailty index. Competing risks regression models assessed the association between oral health at Wave 3 (2006/7) and incident frailty up to Wave 9 (2018/19), sequentially adjusting for demographic characteristics, socioeconomic factors and smoking, and accounting for participants' mortality and dropout.

Of 5760 non-frail respondents at baseline, 1395 (24.2%) became frail during the 13-years follow-up. Edentate males had 1.40 (1.12-1.76) times higher risk of incident frailty than dentate males, whereas the association was not significant among females. Respondents with fair or poor self-rated oral health had 1.48 (1.29-1.70) times and those that reported oral impacts had 1.85 (1.54-2.21) times higher risk of incident frailty than those reporting better oral health and no oral impacts respectively. Oral impacts on functional aspects (i.e., difficulties eating and speaking) were associated with increased incident frailty risk.

Poor oral health can serve as a 'canary in the coal mine' and act as an early marker of frailty development among older adults in England. Future research should investigate whether public health strategies, such as oral health promotion and disease prevention, can help reduce the risk of frailty in later life.