Effect of Isometric Tongue Lifting Exercise on Oral Function, Physical Function, and Body Composition in Community-Dwelling Older Individuals: A Pilot Study

<b><i>Introduction:</i></b> It is known that oral frailty is one of the risk factors for physical frailty. Therefore, early detection, appropriate treatment, and prevention of oral frailty are really important. Tongue lifting exercise has been identified as a well-known method for improving decreased tongue pressure, one of the factors for oral frailty. However, few reports have investigated how tongue-strengthening exercises affect physical function and body composition. The aim of this study was to investigate the effects of isometric tongue lifting exercises on oral function, physical function, and body composition. <b><i>Methods:</i></b> Participants were 49 elderly people aged 68–79 years, who had previously participated in the “Itoshima Frail Study.” Participants performed isometric tongue lift exercises for 3 months. Oral function (tongue pressure and oral diadocokinesis), physical function (grip strength, open-eyed one-leg standing, sit-to-stand motion time, 5-m gait speed, and 3-m Timed up and go [TUG]), and body composition were measured at baseline and post-intervention, and the extent of changes in each item was statistically analyzed. Furthermore, participants were divided into physical frailty/pre-frailty and robust groups based on the Japanese version of the frail scale proposed by [BMC Geriatr. 2015 Apr;15:36] and were compared in terms of the extent of changes in each item baseline and the post-intervention. <b><i>Results:</i></b> After the intervention, oral function increased significantly together with a significant improvement in physical function, open-eyed one-leg standing time, sit-to-stand motion, and 3-m TUG. For body composition, visceral fat level and basal metabolic rate decreased significantly. Although no significant change in body composition was observed in the physical frailty/pre-frailty group after the intervention, significant improvements in several items were observed in the robust group. <b><i>Conclusion:</i></b> Isometric tongue lifting exercise can effectively improve oral function. Furthermore, it might affect physical function and body composition.

Effect of an Oral Frailty Measures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial

<b><i>Introduction:</i></b> Oral frailty describes a trivial decline in the oral function and is considered to be related to frailty. Thus, effective management of oral frailty could prevent or ameliorate physical frailty and the need for care. However, there is a lack of consensus regarding specific interventions for oral frailty. In this cluster-randomized controlled trial, we investigated the effects of a newly developed oral frailty measures program mentored by dentists and dental hygienists for elderly people in a clinical setting. <b><i>Methods:</i></b> Of 3,296 participants included in a field survey, 219 who regularly visited dental clinics and met at least 3 of the following 6 criteria for oral frailty were considered eligible: &#x3c;20 natural teeth, decreased chewing ability, decreased articulatory oral-motor skills, decreased tongue pressure, and substantial subjective difficulties in eating and swallowing. After applying the inclusion and exclusion criteria, we studied 51 patients in the intervention group (14 men and 37 women; mean age, 78.6 years) and 32 patients in the control group (7 men and 25 women; mean age, 78.0 years). We implemented a 12-week oral frailty measures program only for the intervention group. The program included preparatory oral exercises, mouth-opening training, tongue pressure training, prosodic training, and masticatory training. Primary outcome measures were the chewing ability score, articulatory oral motor skill for /ta/, tongue pressure, subjective difficulty in eating tough foods, and subjective difficulty in swallowing. We compared baseline characteristics using the Mann-Whitney U and χ² tests for continuous and categorical variables, respectively. A repeated-measures two-way ANOVA was used to determine the efficacy of independent intervention variables, following the Wilcoxon signed-rank test. The groups (intervention/control) and time (baseline/week 12) were the independent variables. Oral frailty measures were the dependent variables. <b><i>Results:</i></b> Baseline characteristics and assessment results were similar between groups. We observed significant improvements in the intervention group in terms of articulatory oral motor skill for /ta/ and tongue pressure (<i>p &#x3c;</i> 0.001). No improvements were observed in the control group. <b><i>Discussion/Conclusion:</i></b> Our results suggest that our oral frailty measures program effectively alleviates oral frailty. Future studies are needed to clarify the impact on preventing physical frailty and improving the nutritional status.

Influence of Oral Health on Frailty in Patients with Type 2 Diabetes Aged 75 Years or Older

Background Poor oral health conditions are known to affect frailty in the elderly. Diabetes is a risk factor for both poor oral health and frailty, and, therefore, oral health status may affect frailty in diabetic patients more than in the general population. The purpose of this study was to evaluate the influence of oral health on frailty in elderly patients with type 2 diabetes. Methods Patients with type 2 diabetes aged 75 years or older were included in this retrospective study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty score categories were evaluated. Results Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 12 cases (4.5 %) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were found to be factors influencing pre-frailty or frailty. In the evaluation of individual frailty score categories, BMI only had an influence on those with a frailty score ≤ 2. The cognitive and living functions score was a factor influencing those with frailty scores ≤ 3. The oral frailty index was found to have a significant influence on all frailty score categories. Conclusion Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥ 75. In this patient population, as frailty progresses, the impact of oral health on frailty may increase. Trial registration: This study was retrospectively registered in UMIN-CTR (UMIN000044227).

Relationship between Decreased Mineral Intake Due to Oral Frailty and Bone Mineral Density: Findings from Shika Study

The relationship between oral frailty (OF) and bone mineral density is unclear. This cross-sectional study analyzed the relationship between mineral intake and bone mineral density in middle-aged and older people with pre-oral and OF. The participants, which included 240 people aged 40 years and older, completed the three oral questions on the Kihon Checklist (KCL), which is a self-reported comprehensive health checklist, the brief-type self-administered diet history questionnaire (BDHQ), and the osteo-sono assessment index (OSI). A two-way analysis of covariance on oral function and OSI indicated that the intake of potassium, magnesium, phosphorus, squid/octopus/shrimp/shellfish, carrots/pumpkins, and mushroom was significantly lower in the OF and low-OSI groups than in the non-OF and high-OSI groups. A multiple logistic regression analysis for OF showed that potassium, magnesium, phosphorous and carrots/pumpkins were significantly associated with OF in the low-OSI group but not in the high-OSI group. These results demonstrated that the decrease in mineral intake due to OF was associated with decreased bone mineral density, suggesting that the maintenance of oral function prevents a decrease in bone mineral density.

Influence of Oral Health on Frailty in Patients With Type 2 Diabetes Aged 75 Years or Older

Background: The purpose of this study was to evaluate the influence of oral health on frailty in elderly patients with type 2 diabetes.Methods: Patients with type 2 diabetes aged 75 years or older were included in this retrospective study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty score categories were evaluated. Results: Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 5 cases (4.5 %) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were factors influencing pre-frailty or frailty. In the evaluation by individual frailty score categories, BMI was found to only influence those with a frailty score ≤2. The cognitive and living functions score was a factor influencing those with frailty scores ≤3. The oral frailty index was found to have a significant influence on all frailty score categories.Conclusion: Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥75. The management of oral health is an important consideration in the prevention of the frailty of elderly patients with diabetes.

Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty.

Structure and Validity of Questionnaire for Oral Frail Screening

Oral frailty is defined as the mild decline in oral function and located at the early and reversible stage of frailty. Therefore, early detection and early treatment of oral frailty is very useful. Simple and easy questionnaires, such as an oral frailty checklist, have been widely used for the screening and enlightenment of oral frailty of the Japanese people. We evaluate the structure and validity of the oral frailty checklist. The questionnaire of oral frailty was distributed for the citizens more than 50 years old from December 2018 to January 2019. The structural validity of the questionnaire is analyzed by structural equation modeling (SEM). The characteristics of the items are analyzed by Item Response Theory (IRT). The data of 725 subjects (360 men, 359 women, 6 no answer, mean age 71.3 ± 9.05) are analyzed. The questionnaire consisted of three latent variables. Items of “Brushing teeth at least twice a day”, “Regular attendance of dental clinic”, and “Using denture”, had low discrimination ability. The questionnaire used in this study is a useful tool for the screening of oral frailty. However, its scoring system needs to be improved.