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1Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
2Oral Science Laboratory, Department of Dental Hygiene, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea
3Department of Preventive Dentistry & Public Oral Health, Yonsei University College of Dentistry, Seoul, Korea
4Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
5Department of Public Health, Yonsei University Graduate School, Seoul, Korea
© 2024, Korean Society of Epidemiology
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of interest
The authors have no conflicts of interest to declare for this study.
Funding
This research was supported by “Regional Innovation Strategy (RIS)” through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (MOE) in 2023 (2022RIS-005).
Author contributions
Conceptualization: Kang JH, Jung HI, Han SY. Data curation: Kang JH, Jung HI, Park SC. Formal analysis: Jung HI. Funding acquisition: Han SY. Methodology: Kang JH, Jung HI, Park SC. Visualization: Jung HI. Writing original draft: Kang JH. Writing review & editing: Kang JH, Park SC, Jung HI, Jung SJ, Park HJ, Kim SM, Jo MJ, Lee YS, Han SY.
Characteristics | Total sample (n=100) | Robust (n=7) | Pre-oral frail (n=20) | Oral frail (n=73) | p-value1 | Post-hoc |
---|---|---|---|---|---|---|
Age (yr) | 78.0±7.4 | 71.9±4.5 | 74.7±7.5 | 79.5±7.0 | 0.002 | Robust-Oral frail, Pre-oral frail-Oral frail |
Sex (male/female) | 32/68 | 3/4 | 11/9 | 18/55 | 0.029 | |
Body mass index (kg/m2) | 25.1±3.5 | 26.2±3.0 | 25.1±3.2 | 25.0±3.7 | 0.704 | |
Comorbidities (no/yes) | ||||||
Hypertension | 37/63 | 2/5 | 8/12 | 27/46 | 0.865 | |
Diabetes mellitus | 76/24 | 4/3 | 17/3 | 55/18 | 0.321 | |
Heart disease | 88/12 | 6/1 | 17/3 | 65/8 | 0.869 | |
Thyroid disorder | 95/5 | 6/1 | 18/2 | 71/2 | 0.211 | |
Neurological disorder | 94/6 | 7/0 | 19/1 | 68/5 | 0.750 | |
Liver disease | 99/1 | 7/0 | 19/1 | 73/0 | 0.133 | |
Respiratory disease | 99/1 | 7/0 | 20/0 | 72/1 | 0.830 | |
Previous cancer history | 93/7 | 7/0 | 16/7 | 70/3 | 0.036 | |
Osteoporosis | 98/2 | 6/1 | 20/0 | 72/1 | 0.051 | |
Hyperlipidemia | 78/22 | 6/1 | 15/5 | 57/16 | 0.840 | |
Arthritis | 87/13 | 7/0 | 19/1 | 61/12 | 0.230 | |
Depression | 96/4 | 6/1 | 19/1 | 71/2 | 0.319 |
Variables | Total sample (n=100) | Robust (n=7) | Pre-oral frail (n=20) | Oral frail (n=73) | p-value1 | Post-hoc |
---|---|---|---|---|---|---|
No. of teeth | 19.1±10.2 | 27.0±1.3 | 24.4±5.7 | 16.9±10.8 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Denture wearer (no/yes) | 71/29 | 7/0 | 16/4 | 42/32 | 0.017 | |
Chewing ability (level)1 | 4 (3-5) | 4 (4-5) | 5 (4-5) | 4 (3-5) | 0.177 | |
Robust/Chewing disability | 86/14 | 7/0 | 20/0 | 59/14 | 0.049 | |
Occlusal force (n) | 402.9±324.7 | 966.6±511.3 | 636.2±249.3 | 285.0±216.1 | <0.001 | Robust-Pre-oral frail, Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Reduced occlusal force | 31/69 | 7/0 | 15/5 | 9/64 | <0.001 | |
Tongue pressure (kPa) | 24.5±9.4 | 37.4±5.1 | 31.2±6.7 | 21.4±8.4 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Decreased tongue pressure | 30/70 | 7/0 | 13/7 | 10/63 | <0.001 | |
Oral dryness | 26.5±2.6 | 29.0±0.8 | 28.0±1.1 | 25.8±2.7 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Oral dryness1 | 34/66 | 7/0 | 12/8 | 15/58 | <0.001 | |
MWST score | 5 (5-5) | 5 (5-5) | 5 (5-5) | 5 (5-5) | 0.944 | |
Robust/Swallowing difficulty | 98/2 | 7/0 | 20/0 | 71/2 | 0.686 | |
Oral hygiene (score) | 1 (1-1) | 0 (0-1) | 1 (1-1) | 1 (1-1) | 0.051 | |
Robust/Poor oral hygiene | 89/11 | 7/0 | 20/0 | 62/11 | 0.102 | |
Oral diadochokinesis (times/sec) | ||||||
[pʌ] | 4.12±1.30 | 4.88±0.70 | 4.00±1.09 | 4.09±1.38 | 0.270 | |
Robust/At risk1 | 12/88 | 2/5 | 1/19 | 9/64 | 0.252 | |
[kʌ] | 4.08±1.47 | 5.13±1.09 | 4.09±1.3 | 3.98±1.53 | 0.140 | |
Robust/At risk1 | 15/85 | 3/4 | 3/17 | 9/64 | 0.097 | |
[tʌ] | 4.19±1.31 | 5.17±1.01 | 4.05±1.14 | 4.14±1.36 | 0.118 | |
Robust/At risk1 | 15/85 | 3/4 | 3/17 | 9/64 | 0.097 | |
Subjective eating difficulties (no/yes)1 | 69/31 | 5/2 | 16/4 | 48/25 | 0.470 | |
Subjective swallowing difficulties (no/yes)1 | 92/8 | 7/0 | 20/0 | 65/8 | 0.200 |
Variables |
Oral frailty |
p-value1 | ||||
---|---|---|---|---|---|---|
Robust | Pre-oral frail | Oral frail | Total | |||
Screening questionnaire | Robust | 1 | 14 | 21 | 36 | 0.004 |
At risk | 4 | 5 | 25 | 34 | ||
At high risk | 2 | 1 | 27 | 30 | ||
Total | 7 | 20 | 73 | 100 |
Characteristics | Total sample (n=100) | Robust (n=7) | Pre-oral frail (n=20) | Oral frail (n=73) | p-value |
Post-hoc |
---|---|---|---|---|---|---|
Age (yr) | 78.0±7.4 | 71.9±4.5 | 74.7±7.5 | 79.5±7.0 | 0.002 | Robust-Oral frail, Pre-oral frail-Oral frail |
Sex (male/female) | 32/68 | 3/4 | 11/9 | 18/55 | 0.029 | |
Body mass index (kg/m2) | 25.1±3.5 | 26.2±3.0 | 25.1±3.2 | 25.0±3.7 | 0.704 | |
Comorbidities (no/yes) | ||||||
Hypertension | 37/63 | 2/5 | 8/12 | 27/46 | 0.865 | |
Diabetes mellitus | 76/24 | 4/3 | 17/3 | 55/18 | 0.321 | |
Heart disease | 88/12 | 6/1 | 17/3 | 65/8 | 0.869 | |
Thyroid disorder | 95/5 | 6/1 | 18/2 | 71/2 | 0.211 | |
Neurological disorder | 94/6 | 7/0 | 19/1 | 68/5 | 0.750 | |
Liver disease | 99/1 | 7/0 | 19/1 | 73/0 | 0.133 | |
Respiratory disease | 99/1 | 7/0 | 20/0 | 72/1 | 0.830 | |
Previous cancer history | 93/7 | 7/0 | 16/7 | 70/3 | 0.036 | |
Osteoporosis | 98/2 | 6/1 | 20/0 | 72/1 | 0.051 | |
Hyperlipidemia | 78/22 | 6/1 | 15/5 | 57/16 | 0.840 | |
Arthritis | 87/13 | 7/0 | 19/1 | 61/12 | 0.230 | |
Depression | 96/4 | 6/1 | 19/1 | 71/2 | 0.319 |
Variables | Total sample (n=100) | Robust (n=7) | Pre-oral frail (n=20) | Oral frail (n=73) | p-value |
Post-hoc |
---|---|---|---|---|---|---|
No. of teeth | 19.1±10.2 | 27.0±1.3 | 24.4±5.7 | 16.9±10.8 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Denture wearer (no/yes) | 71/29 | 7/0 | 16/4 | 42/32 | 0.017 | |
Chewing ability (level) |
4 (3-5) | 4 (4-5) | 5 (4-5) | 4 (3-5) | 0.177 | |
Robust/Chewing disability | 86/14 | 7/0 | 20/0 | 59/14 | 0.049 | |
Occlusal force (n) | 402.9±324.7 | 966.6±511.3 | 636.2±249.3 | 285.0±216.1 | <0.001 | Robust-Pre-oral frail, Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Reduced occlusal force | 31/69 | 7/0 | 15/5 | 9/64 | <0.001 | |
Tongue pressure (kPa) | 24.5±9.4 | 37.4±5.1 | 31.2±6.7 | 21.4±8.4 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Decreased tongue pressure | 30/70 | 7/0 | 13/7 | 10/63 | <0.001 | |
Oral dryness | 26.5±2.6 | 29.0±0.8 | 28.0±1.1 | 25.8±2.7 | <0.001 | Robust-Oral frail, Pre-oral frail-Oral frail |
Robust/Oral dryness |
34/66 | 7/0 | 12/8 | 15/58 | <0.001 | |
MWST score | 5 (5-5) | 5 (5-5) | 5 (5-5) | 5 (5-5) | 0.944 | |
Robust/Swallowing difficulty | 98/2 | 7/0 | 20/0 | 71/2 | 0.686 | |
Oral hygiene (score) | 1 (1-1) | 0 (0-1) | 1 (1-1) | 1 (1-1) | 0.051 | |
Robust/Poor oral hygiene | 89/11 | 7/0 | 20/0 | 62/11 | 0.102 | |
Oral diadochokinesis (times/sec) | ||||||
[pʌ] | 4.12±1.30 | 4.88±0.70 | 4.00±1.09 | 4.09±1.38 | 0.270 | |
Robust/At risk |
12/88 | 2/5 | 1/19 | 9/64 | 0.252 | |
[kʌ] | 4.08±1.47 | 5.13±1.09 | 4.09±1.3 | 3.98±1.53 | 0.140 | |
Robust/At risk |
15/85 | 3/4 | 3/17 | 9/64 | 0.097 | |
[tʌ] | 4.19±1.31 | 5.17±1.01 | 4.05±1.14 | 4.14±1.36 | 0.118 | |
Robust/At risk |
15/85 | 3/4 | 3/17 | 9/64 | 0.097 | |
Subjective eating difficulties (no/yes) |
69/31 | 5/2 | 16/4 | 48/25 | 0.470 | |
Subjective swallowing difficulties (no/yes) |
92/8 | 7/0 | 20/0 | 65/8 | 0.200 |
Variables | Oral frailty based on tanaka’s criteria |
Clinimetric values |
||||||||
---|---|---|---|---|---|---|---|---|---|---|
Robust (n) | Oral frailty (n) | Total (n) | Sensitivity, % (95% CI) | Specificity, % (95% CI) | LR+ (95% CI) | LR- (95% CI) | PPV, % (95% CI) | NPV,% (95% CI) | ||
Oral frailty screening questionnaires | Robust | 31 | 5 | 36 | 87.8 (73.8, 95.9) | 52.5 (39.1, 65.7) | 1.85 (1.38, 2.48) | 0.23 (0.10, 0.55) | 56.3 (43.3, 68.6) | 86.1 (70.5, 95.3) |
At risk | 28 | 36 | 64 | |||||||
Total | 59 | 41 | 100 | |||||||
Oral frailty diagnosis | Robust | 25 | 2 | 27 | 95.1 (83.5, 99.4) | 42.4 (29.6, 55.9) | 1.65 (1.31, 2.08) | 0.12 (0.03, 0.46) | 53.4 (41.4, 65.2) | 92.6 (75.7, 99.1) |
Oral frail | 34 | 39 | 73 | |||||||
Total | 59 | 41 | 100 |
Variables | Oral frailty |
p-value |
||||
---|---|---|---|---|---|---|
Robust | Pre-oral frail | Oral frail | Total | |||
Screening questionnaire | Robust | 1 | 14 | 21 | 36 | 0.004 |
At risk | 4 | 5 | 25 | 34 | ||
At high risk | 2 | 1 | 27 | 30 | ||
Total | 7 | 20 | 73 | 100 |
Values are presented as mean±standard error or number. From the chi-square test or independent t-test.
Values are presented as mean±standard error, number or median (25th-75th percentile). MWST, modified water swallowing test. From the chi-square test or independent t-test.
CI, confidence interval; LR+, positive likelihood; LR-, negative likelihood; PPV, positive predictive value; NPV, negative predictive value.
From chi-square test.