Asociación entre función oral y fragilidad en personas mayores

Resum

Background: Frailty is a syndrome characterized by a reduction in resistance and physiological reserves, which leads to adverse health effects. Globally, the prevalence of frailty in older adults reaches between 26.8% to 51.5% in institutionalized elderly. It has been suggested that there are clear differences by sex, being present more frequently in women, regardless of age range. Among the factors associated with this syndrome are sociodemographics, general and oral factors. Recently, frailty has been associated with oral hypofunction, a new clinical concept that evaluates various aspects of the oral health. However, this relationship has not been previously evaluated among institutionalized older patients, a particularly vulnerable group. Objectives: 1) Estimate the prevalence of frailty and of each of its components in institutionalized older people. 2) Analyze the oral status in institutionalized people and its association with the presence of frailty. 3) Evaluate the presence of oral hypofunction and which components are most affected in institutionalized older people. 4) Analyze the association between the presence of oral hypofunction, each one of its components and frailty, considering possible differences by sex. Methodology: This cross-sectional study was carried out in institutionalized older adults in the city of Guayaquil (Ecuador). The inclusion criteria were: 1) older adults permanently or temporarily institutionalized in private or public residences, 2) older adults without mild or severe cognitive impairment demonstrated by the Lobo Mini Cognitive Examination (score >23/30). The sources of information used were: personal interview, oral exploration, biological saliva samples and general physical exploration. Information on sociodemographic data, general and oral health status was obtained. As main variables, the presence of pre-frailty and frailty was evaluated according to the Fried phenotype. The presence of oral hypofunction was determined through the criteria established by the Japanese Society of Gerontology. To analyze the association between oral status or oral hypofunction and frailty, multivariate logistic regression models were performed and the sex was evaluated as a potential modifier. Results: Of the 589 participants (65.0% women), 66.7% (95% CI: 62.8-70.5%) presented pre-frailty and 28.9% (95% CI: 25.2-32.7%) presented frailty, with weakness as the most frequent item (84.6%, 95% CI: 81.4-87.4%). Although without reaching the statistical significant, women had a higher prevalence of this syndrome with only 3.7% being robust. There was an inverse association between the number of functional pairs and the presence of frailty (anterior: aOR: 0.87; 95% CI: 0.79-0.96 and posterior aOR: 0.91; 95% CI: 0.85 -0.98). 71% (CI 95%: 67.1-74.6%) of institutionalized elderly patients presented oral hypofunction and the prevalence was higher in men. The most affected components were the poor oral hygiene (81.5%, CI 95%: 78.1-84.6%). In the overall sample, the frequency of frailty was 2.06 times higher (95% CI: 1.30-3.29) in patients with oral hypofunction and this association was only maintained in women (aOR: 2.18; 95% CI: 1.21-3.94). Conclusions: The prevalence of frailty and pre-frailty found in institutionalized elderly was high and more frequent in women. Oral status and oral function could be relevant factors to approach the frailty in institutionalized patients, and sex may be a key element.