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Year : 2021  |  Volume : 19  |  Issue : 3  |  Page : 233-234

Let's focus on frailty

Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Date of Submission01-Jun-2021
Date of Acceptance17-Aug-2021
Date of Web Publication15-Oct-2021

Correspondence Address:
Chandrashekar Janakiram
Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi - 682 041, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_93_21

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How to cite this article:
Ayoob AK, Janakiram C. Let's focus on frailty. J Indian Assoc Public Health Dent 2021;19:233-4

How to cite this URL:
Ayoob AK, Janakiram C. Let's focus on frailty. J Indian Assoc Public Health Dent [serial online] 2021 [cited 2022 May 20];19:233-4. Available from: https://www.jiaphd.org/text.asp?2021/19/3/233/328282

  Introduction Top

Frailty may be a clinical condition during which a person's vulnerability to acquiring dependency and/or mortality increases after they are subjected to a stressor.[1] Frailty is most regularly characterized as an aging-related disorder of physiological decline, characterized by marked vulnerability to unfavorable health outcomes, such as comorbidities, polypharmacy, the loss of independence, increasing hospitalizations, and mortality, improving the care for the most vulnerable subset of patients by frailty awareness and associated risks for adverse health outcomes.

The physical frailty is “A medical syndrome with multiple causes and contributors that are characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing increased dependency and/or death.”[2] Frail people usually have three or more than five symptoms such as unintentional weight loss (10 or more pounds within the past year), muscle loss and weakness, fatigue, reduced walking speed, and reduced levels of physical activity.

  What are Consequences of Frailty? Top

Frailty is viewed as a geriatric disorder with various causes and contributors portrayed by reduced strength, perseverance and diminished physiologic capacity, and increasing a person's weakness for developing disability.[1] As one of the fundamental causes of functional decrease in the elderly, sarcopenia has a high clinical effect, influencing the status and recuperation of an individual's mobility, independence, and quality of life conveys an increased danger for chronic frailty which results in falls, disability, hospitalization, and mortality.[3]

  What are the Risk Factors for Frailty? Top

The elements related with frailty, especially sociodemographic factors such as age, gender, and educational level, just as actual factors, for example, body weight and activities of daily living.[4] Malnutrition, inactivity, and comorbidities have a high antagonistic effect in older people and are risk factors for sarcopenia and physical frailty. The loss of muscle mass, strength, and function, called sarcopenia, is a key factor in the development of physical frailty.

  What is Oral Frailty? Top

Oral frailty is characterized as a progression of phenomena and cycles that lead to changes in different oral conditions (number of teeth, oral cleanliness, oral capacities, and so forth) related with aging, and accompanied by diminished interest in oral health, decreased physical and mental reserve capacity, and an expansion in oral frailty prompting to eating dysfunction; the general impact is of deteriorating physical and mental capacity.[5]

  How to Assess the Oral Frailty? Top

Oral assessments comprised of 16 measures including five dental status, eight oral functions, and three subjective difficulties. The 16 measures were as follows: dental status – number of natural teeth and functioning teeth, community periodontal index, tongue thickness as a marker of oral nutrient status, and turbidity of mouth-rinsed water as a marker of oral hygiene. Oral functions – maximum occlusal force, chewing ability as a marker of general masticatory performance, maximum tongue pressure, repetitive saliva-swallowing test (RSST), articulatory oral motor skill for “pa, ta, ka” and experience of dry mouth measured-oral wettability. Subjective assessments – difficulties in eating and swallowing, and using the questionnaire chewing ability, RSST, xerostomia. Oral frailty – the accumulation of a slightly poor status of oral conditions and function, strongly predicts physical frailty, dysphagia, malnutrition, need for long-term care, and mortality.

  Is Oral Frailty Linked to Physical Frailty? Top

A hypothesis for the connection between poor oral health and frailty is that poor diet intervenes the impact of poor oral health (like loss of teeth, dental agony, or potentially biting issues), prompting to frailty.[6] Poor eating routine and nutritional risk have for some time been involved in the etiology and progression of frailty by affecting useful functional reserves and strength and leading to loss of energy, functional decline, morbidity, and subsequent frailty. Oral frailty was essentially connected with physical frailty by 66.6% and sarcopenia by 72.7%. Poor oral condition in hospitalized patients can be attributed to factors such as age, physical dependency, psychological decline, malnutrition, low skeletal muscle mass and strength, and multimorbidity.[7]

  What are the Policy Implications? Top

The proof from frailty studies has not yet been completely converted into clinical practice and medical care strategy making. As of now, in any case, there is no viable treatment for frailty and the best intervention is not yet known. In view of presently available proof, the multicomponent exercise, which incorporates resistance training, appears to be promising.[8] The current challenges in frailty research incorporate the absence of a worldwide standard meaning of frailty, further comprehension of interventions to reverse frailty, the best planning for intervention, and education/training of health-care professionals. Population-based evaluation for frailty could be costly and resource intensive, and as of now, there is no obvious proof for expected advantage, cost-adequacy, or improved results. Research and development efforts aimed toward building up and spreading best practice in frailty should not lack strategic consideration regarding older people with early (pre-) frailty that passes up on a chance to address a few requests on health and social care services.

Another significant space of delicacy research is schooling and preparing

The medical services experts including doctors, attendants, and other medical workers need to comprehend essential standards of care for frail older adults and to have the option to distinguish frailty and give therapy/interventions.

There is an increasing interest in frailty in other medical fields than the geriatrics

One model is that frailty has recently been pursued as a potential risk assessment measure for older surgical patients and has demonstrated to be promising in anticipating postoperative intricacies, for example, mortality or length of emergency clinic stay.

Finally, frailty research may have evolved without considering the patient perspective

Frailty can be considered as a profoundly adverse term and being marked as frail may influence contrarily the weakest people differently. The individuals who were marked as “old and fragile” by others were bound to be related with a loss of interest in friendly and proactive tasks, poor physical health, and increased disparagement. The future innovative work endeavors need to recognize the risks of naming older individuals in defaming ways and stay away from turning into the new cloak of ageism and an instrument for segregation.[8]

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Conflicts of interest

There are no conflicts of interest.

  References Top

Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: A call to action. J Am Med Dir Assoc 2013;14:392-7.  Back to cited text no. 1
Gordon AL, Masud T, Gladman JR. Now that we have a definition for physical frailty, what shape should frailty medicine take? Age Ageing 2014;43:8-9.  Back to cited text no. 2
Xue QL. The frailty syndrome: Definition and natural history. Clin Geriatr Med 2011;27:1-15.  Back to cited text no. 3
Feng Z, Lugtenberg M, Franse C, Fang X, Hu S, Jin C, et al. Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies. PLoS One 2017;12:e0178383.  Back to cited text no. 4
Watanabe Y, Okada K, Kondo M, Matsushita T, Nakazawa S, Yamazaki Y. Oral health for achieving longevity. Geriatr Gerontol Int 2020;20:526-38.  Back to cited text no. 5
Kamdem B, Seematter-Bagnoud L, Botrugno F, Santos-Eggimann B. Relationship between oral health and Fried's frailty criteria in community-dwelling older persons. BMC Geriatr 2017;17:174.  Back to cited text no. 6
Shiraishi A, Wakabayashi H, Yoshimura Y. Oral management in rehabilitation medicine: oral frailty, oral sarcopenia, and hospital-associated oral problems. J Nutr Health Aging 2020;24:1094-9.  Back to cited text no. 7
Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: Implications and challenges for health care policy. Risk Manag Healthc Policy 2019;12:23-30.  Back to cited text no. 8


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