The concept of oral frailty was first proposed in Japan in 2014 by the “Joint Working Committee on Oral Frailty,” consisting of three academic societies—the Japan Geriatrics Society, the Japanese Society of Gerodontology, and the Japanese Association on Sarcopenia and Frailty—to enhance public understanding of oral frailty. Oral frailty is a state between robust oral function (a “healthy mouth”) and its decline, characterized by slight declines in oral function, including tooth loss and difficulties in eating and communicating, which increase the risk of impaired oral functional capacity but can be reversed with proper intervention and treatment. Oral frailty can be assessed using the Oral Frailty 5‐item Checklist (OF‐5) without the need for a dental health professional. Oral frailty is defined as having at least two of the following components: (i) fewer teeth, (ii) difficulty chewing, (iii) difficulty swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. Approximately 40% of community‐dwelling older adults have oral frailty. Oral frailty is associated with poor dietary variety, social isolation, physical frailty, disability, and mortality. This statement introduces the concept and definition of oral frailty, a new assessment tool (OF‐5), and concept diagrams for healthcare professionals and the general public. These tools aim to promote public awareness and facilitate collaboration between medical and dental healthcare providers. Geriatr Gerontol Int 2024; 24: 1111–1119.

Studies investigating the associations of oral function and dysphagia with frailty and sarcopenia in community-dwelling older adults are increasing; however, they have not been systematically summarized. We conducted a systematic review to investigate these associations. We searched electronic databases and synthesized relevant data using conventional (frequentist-style) and Bayesian meta-analyses. Twenty-four studies were found to be eligible for our review, including 20 cross-sectional and four prospective cohort studies. Older adults with frailty or sarcopenia had lower tongue pressure, according to the results of conventional meta-analysis (mean difference [95% confidence interval or credible interval]: −6.80 kPa [−10.22 to −3.38] for frailty and −5.40 kPa [−6.62 to −4.17] for sarcopenia) and Bayesian meta-analysis (−6.90 kPa [−9.0 to −4.8] for frailty, −5.35 kPa [−6.78 to −3.89] for sarcopenia). People with frailty had a higher odds ratio (OR) for dysphagia according to the results of conventional meta-analysis (3.99 [2.17 to 7.32]) and Bayesian meta-analysis (1.38 [0.77 to 1.98]). However, the results were inconclusive for people with sarcopenia. A prospective association could not be determined because of the lack of information and the limited number of studies. Decreased oral function and dysphagia can be important characteristics of frailty and sarcopenia in community-dwelling older adults.

Oral frailty, overlapping a decline in multi-faceted oral functions and often seen in older adults, increases risks of adverse health outcomes, thereby necessitating earlier measures. Tooth loss, a major element of oral frailty, is mainly caused by periodontal disease and is an irreversible event. Therefore, this study aimed to clarify whether advanced periodontal disease increases the risks of “new-onset” oral frailty through a longitudinal analysis based on the 2012 baseline survey of the Kashiwa cohort and the follow-up assessments conducted in 2013, 2014, 2016, and 2018. The participants were disability-free, non-orally frail older adults living in Kashiwa City. Of the 1234 participants (72.2 ± 5.1 years old; 50.8% men) analyzed in this study, oral frailty occurred in 23.1% within the six-year period. The group with Community Periodontal Index (CPI) ≥ 3 at baseline had no significant difference in the risk of oral frailty compared with CPI ≤ 2; however, CPI4 at baseline was related to the increased risk of oral frailty compared with CPI ≤ 3 (an adjusted hazard ratio (95% confidence interval): 1.42 (1.12–1.81). Conclusively, severe periodontitis (CPI4) might be associated with new-onset oral frailty, suggesting that prevention of periodontal disease could contribute to oral frailty prevention.

Health literacy (HL) promotes healthy lifestyle behaviors among older adults, and its relationship with frailty remains unclear. This study examined whether HL is a predictor of frailty progression among community-dwelling older adults. Data from two surveys conducted in 2012 and 2016 involving older residents (mean age, 71.6 ± 4.6 years) of Kashiwa City, Chiba Prefecture, Japan were used. Only healthy individuals without frailty and cognitive impairments participated in the 2012 assessment, where the Kihon Checklist (KCL), HL, and other variables were assessed. Logistic and multiple logistic analyses were used to assess the effects of HL and other factors on frailty between the ‘high HL’ vs. ‘low HL’ groups in 2012 and between the ‘robust’ vs. ‘frailty-progressing’ groups in 2016. Of the 621 robust participants, 154 (25.4%) had progression of frailty in 2016, which was significantly associated with advanced age, higher KCL score, lower HL, poor mental health, and lack of social support. Furthermore, low HL was a predictor of frailty progression. Low HL may be associated with frailty progression. The obtained results suggest that increased health literacy should be effective in preventing frailty for community-dwelling older residents.

A statistical model to predict oral frailty based on information obtained from questionnaires might help to estimate its prevalence and clarify its determinants. In this study, we aimed to develop and validate a predictive model to assess oral frailty thorough a secondary data analysis of a previous cross-sectional study on oral frailty conducted on 843 patients aged ≥ 65 years. The data were split into training and testing sets (a 70/30 split) using random sampling. The training set was used to develop a multivariate stepwise logistic regression model. The model was evaluated on the testing set and its performance was assessed using a receiver operating characteristic (ROC) curve. The final model in the training set consisted of age, number of teeth present, difficulty eating tough foods compared with six months ago, and recent history of choking on tea or soup. The model showed good accuracy in the testing set, with an area of 0.860 (95% confidence interval: 0.806–0.915) under the ROC curve. These results suggested that the prediction model was useful in estimating the prevalence of oral frailty and identifying the associated factors.

Objectives Preserving sufficient oral function and maintaining adequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults. Design Single-arm pre-post comparison study. Setting and Participants A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation. Intervention Participants gathered once a month at community centers to learn about oral health and nutrition while eating a “munchy” textured lunch containing proper nutrition. Measurements Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program. Results KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080). Conclusion The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.