Prevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India

Prevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India Sandhya K N, Beena Varma Varma, Chandasekar Janakiram, Priya Vijayakumar, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4690073/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Objective: Data on the prevalence of frailty in Kerala is sparse. The objective of this study was to estimate the prevalence of frailty among community-dwelling elderly people in Kerala and explore the sociodemographic factors associated with physical and oral frailty among this population. We further explored the associations between physical and oral frailty. Design: Community based cross-sectional study. Setting: Cluster sampled area of Thrissur District, Kerala. Participants: Random sample0 of adults aged 60 years and above, from the cluster sampled area of Thrissur district. Methods: We sampled 1079 community-dwelling adults aged ≥60 years from the Thrissur district of Kerala, using stratified random cluster sampling. Physical frailty was defined and recorded based on Fried’s Frailty Phenotype, Reported Edmonton Frail Scale (REFS), and SARC-F sarcopenia scales. Oral frailty was recorded based on Tanaka measures and Oral and Maxillofacial Frailty Index (OMFI). Logistic regressions with robust standard errors were utilized to examine the associations between socio-demographic determinants and frailty, and between physical frailty and oral frailty. Results: Overall, 35.2% were classified as physically frail and 62.2% as prefrail, while 22% of population had oral frailty. In the unadjusted model, individuals with oral frailty showed greater odds of being physically frail than those without oral frailty. (Crude OR= 1.584, 95% CI=1.157-2.169, p-value= 0.004). This association persisted after controlling for socio demographic variables and number of teeth. (Adjusted OR=1.423,95% CI=1.020-1.987, p value;0.038). Conclusion: Integrating the multidisciplinary approaches like oral frailty assessment along with general frailty assessment can promote healthy aging. Physical frailty Oral frailty Geriatric Older adults Healthy Aging Oral health Figures Figure 1 Figure 2 1. Introduction The world's demographic landscape is shifting rapidly, with a marked increase in the elderly population. This trend is evident globally, with the proportion of individuals aged 65 and over rising from 6% in 1990 to 9% in 2019. By 2019, the global elderly population had reached 703 million, and projections indicate a staggering increase to over 1.5 billion by 2050. 1 To navigate this demographic shift effectively, fostering healthy aging practices is paramount. This will ensure a positive balance between the challenges and opportunities presented by an aging population. 2 Frailty is a relatively new term in the lexicon of age-related health ailments. The term frailty is widely regarded as having originated in 2001, when Fried et al . introduced the concept of frailty phenotype. 3 Frailty estimation is critical in healthy aging. Evaluation of frailty with precision can help explore potential interventions for patients according to their different levels of resilience. 4 , 5 India's demographic transition is leading to a significant increase in older adults, with projections indicating a rise from 8% in 2015 to 19% by 2050. 7 Existing studies in India report a wide range of frailty prevalence (11–58%), 8,9 likely due to variations in measurement tools. Notably, Kerala exemplifies this trend, with a sharp rise in the elderly population (16.5% in 2011 compared to 10.5% in 2001). 10 This emphasizes the urgent need for standardized frailty assessment to guide policy interventions for a growing elderly population effectively. Poor oral health, a common condition among older adults, has been linked to poor overall health and an increased risk of frailty. 11 , 12 , 13 Oral frailty is a new concept introduced in Japan. 14 Oral frailty is the age-related functional decline of orofacial structures according to the latest definition. 15 In frail patients, there is a swift reduction in occlusal force, masseter muscle thickness, the rate of oral diadochokinesis, and oral motor skills related to speech. 16 The prevalence of oral frailty varies significantly across the globe, with estimates ranging from 4.1–63.7%. 17 In Japan, oral and physical frailty has been extensively studied. 18 Impaired perception of oral health can be indicative of a broader decline in overall health status. 19 Similarly, Physical frailty can affect oral hygiene and the condition of the remaining teeth in elderly patients. In effect, the relationship between the two is bidirectional. Poor oral health significantly predicted the onset of negative health outcomes, including mortality, among elderly individuals living in the community. Functional, physiological, psychosocial, and therapeutic factors comprise the connections between oral and physical frailty. 19 , 20 Physical and oral frailty assessment in Kerala can help in tailoring individualized care plans that improve the overall quality of life for the elderly by addressing their specific health needs and promoting independence. Data from frailty assessments can inform policymakers about the healthcare needs of the elderly population, leading to more effective health policies and programs. Therefore, the current study was planned to give baseline information on the prevalence of physical and oral frailty in the community-dwelling geriatric population of Thrissur, Kerala. 2. Methodology 2.1 Study Design and Participants A community-based cross-sectional study to assess the prevalence of physical, oral, and social frailty among the geriatric population of Thrissur, Kerala. The proposed study was conducted in an area within a radius of 12km from the study center, Government Medical College, Thrissur. The demarcated area included six panchayats, one municipality, and one corporation. We employed a two-stage stratified random cluster sampling method to select participants. Stratification occurred at the rural-urban level (level 1) and the level of individual local self-governing units (LSGs, level 2). Thirty-six clusters were randomly chosen from all available clusters within the designated geographical area. Each cluster encompassed an electoral ward within an LSG. We aimed to interview 30 individuals from each cluster, resulting in a target sample size of 1080 older adults. The identified individuals were approached with the help of ASHA worker (Accredited Social Health Activist) after getting permission from concerned Panchayat/Municipality/corporation authority. Figure 1 demonstrates the sampling frame. Any ambulant adult above the age group of 60 years attending the OPD of selected health centers, irrespective of any medical conditions and responsive to questionnaire was included. Participants who were unresponsive to the questionnaire and not willing to participate in the study were excluded. Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences, Kerala, India before the conduct of the study. (ECASM-AIMS-2021-176, date:28-09- 2021). Informed consent forms explaining the study details, as well as the oral and physical examination were given to all volunteering participants. Questionnaire for Interview A structured questionnaire, along with oral and physical examinations, was developed to assess frailty and its associated factors during the interview. a) Socio-demographic characteristics The socio-demographic characteristics included age, gender, marital status, socio-economic status(Kuppuswamy assessment) 21 b) Nutritional status: Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) by Nestle Nutritional Institute on which a score of ≤ 17 is considered to indicate a risk of malnutrition. c) Anthropometric Measurements: The body weight and height were recorded using the SKnol 7227 weighing scale and fiber-reinforced tape, respectively, and the body mass index (BMI) was calculated. Asian cut-off values were used for BMI classification. 22,23 d) Physical Frailty Assessment: Frailty was measured using three scales including Fried’s Frailty Phenotype, Reported Edmonton Frail Scale (EFS), and SARC-F sarcopenia scale. 1. Fried’s Frailty Phenotype : This scale is used for recording five domains – weight loss, weakness, endurance /exhaustion, slowness, and low level of physical activity. Weakness and slowness are measured using the dominant handgrip strength (handheld dynamometer) and the usual gait speed (time to walk 5 m) Exhaustion is measured as a positive answer to either of the following two self-reported questions: “(i) In the last 2 weeks, have you felt tired without a reason? (ii) In the last 2 weeks, have you felt difficulty in doing what you could do easily before?” Low physical activity was defined as less than 30 min of moderate exercise like walking or less than 20 min of vigorous exercise three days a week. The scoring is as follows: Frail -impairments in at least three of the five domains, Prefrail-impairments in one or two of the five domains, Robust -without impairments in any of the five domains) 2. Reported Edmonton Frail Scale (REFS): Cognition, general health status, functional independence, social support, medication use, nutrition, mood and self-reported performance are the domains evaluated in this scale. Total Score =18. No frail= 0-5, Apparently Vulnerable =6-7, Mildly frail =8-9, Moderately frail= 10-11, and severe frailty= 12-18. 3. SARC-F –Sarcopenia scale: This scale is based on the following criteria: strength, assistance in walking, rising from a chair, climbing stairs, and falls. The scores range from 0 to 10, with 0 to 2 points for each component. A score equal to or greater than 4 is predictive of sarcopenia and poor outcomes. e) Assessment of oral frailty: Oral frailty was assessed by the Tanka 6-measure method and oral frailty was assessed by the Oral and Maxillofacial Frailty Index. 24 a) Tanaka’s 6 measures 24 : The parameters measured– Chewing ability status (Assessed subjectively using the question-Are you able to chew at least five peanuts?) Repetitive saliva swallowing test (RSST): The RSST, is a screening test introduced in Japan by Oguchi et al., 25 here the patient is asked to swallow their saliva as many times as possible in 30 seconds while the assessor counts the number of swallows by palpating the larynx, or by just looking at the larynx. The outcomes are categorised as 3 swallows per 30 seconds. Dry mouth: frequency of dry mouth categorized as never, occasionally, or frequently Tongue pressure: Tongue pressure was assessed using a tonguometer. Figure 2 The tongue pressure probe was placed between the tongue and palate, and the participant was asked to apply tongue pressure with maximal voluntary muscular effort for approximately 7 seconds. The readings were collected from the mobile phone application connected to the device using Bluetooth. Three measurements were taken, and the maximum value was used. The normal tongue pressure values: Male26.5 Kg. Figure 2 demonstrates the Tonguometer. v) Oral diadochokinesis (ODK) represents the dexterity of the tongue. The Count-by-Time test was used for data collection. The syllables “pa”, “ta” and “ka” is asked to be repeated for 15 seconds and recorded. Normal values: Pa-Male:12.3±1.6, Female-12.3±1.8; Ta- Male: 13.1±1.6, Female 13.2±1.8; Ka-Male:13.5±2.1, Female 13.4±2.3. vi) The Kihon checklist is a 25-item questionnaire comprising seven categories 26 :Three items in the Kihon checklist were assessed for recording the oral frailty score. As a subjective evaluation, participants who responded "yes" to "Do you have any difficulties eating tough foods compared to 6 months ago?" were considered to have decreased masticatory performance and those who responded "yes" to "Have you choked on your tea or soup recently?" was considered to have decreased swallowing function. Individuals who did not respond positively to any relevant items were regarded as robust. Those who responded positively to 1–2 items and ≥ 3 items were categorized as having oral prefrailty and oral frailty, respectively. An oral frailty score of 0/6 at baseline, an oral frailty score of 1 or 2 was associated with an increased risk of physical frailty, and a score of 3 or more was significantly associated with an increased risk of new onset of all two outcomes (physical frailty and sarcopenia). Dental status : Number of teeth present and absent, presence or absence of denture,etc. were examined. b) Oral and Maxillofacial Index: The OMFI includes 10 items - pain and/or bleeding in the tooth or gum, difficulties in chewing, the necessity of water when eating dry food, jaw pain or difficulties in opening the mouth, intra‐oral pain or ulcer, taste alteration or difficulties in taste perception, difficulties in jaw or tongue movements, difficulties in speaking or pronunciation, difficulties in swallowing and difficulties in facial expression. The scoring was: 1-Never,2-Occasionally,3-Fairly often,4-Very often. Based on the total score, participants were categorized as Normal- 0 to 20, Mild-20-40, Moderate-40-60, and Severe-60-80. Before the study commenced, the above tools were validated for use in Kerala Population. 2.3 Sample size estimation Because there are no Indian studies to assess oral/social frailty, a pilot study with 30 patients was conducted first. Based on the results, the final sample estimation was done. Based on the proportion of oral frailty (70%) among geriatric patients observed in the pilot study conducted with 30 samples and with 20% allowable error and 95% confidence, the minimum sample size for the study was 384. We enrolled a total of 1079 participants anticipating significant subgroup differences within the study sample. (As one participant was omitted due to missing data) 2.4 Statistical Analysis The collected data were entered in a Microsoft Excel spreadsheet and later transferred for analysis to Statistical Package of Social Sciences IBM (SPSS) version 23 (IBM SPSS for Windows, SPSS INC., Chicago, IL, USA). The characteristics of the subject’s variables were described using frequency distribution for categorical variables and mean and standard deviation for continuous variables. Chi- Square test was used to test the statistical significance between the physical and oral frailty measures. The percentage prevalence rate of prevalence and association of physical, oral, and social frailty among the geriatric population was computed with a 95% confidence level. Univariate analysis was used to assess the Crude Odd’s ratio. Multivariate analysis using binary logistic regression was performed to explore the effect of age, sex, weight, number of teeth, and oral frailty on physical frailty and sarcopenia. A p-value of < 0.05 was considered statistically significant. 3. Results Data collection involved face-to-face interviews conducted in participants' homes between October 2021 and April 2022. A pretested questionnaire, translated into Malayalam (the local language), guided the interviews. A single trained field investigator (SKN) ensured standardized measurement of all parameters throughout the data collection process. 3.1 Descriptive statistics This study included 1079 people, with 55.2% females. Table 1 shows the demographic characteristics of the study population. The average age of the study population was 68.06 years. According to the Kuppuswamy socioeconomic status scale, 29.7% belonged to the upper middle class. Around 64.9 % of the population were in normal weight category. H/o Diabetes was reported by 51.9% while a history of hypertension was there in 43.4% of the population. Table 1: Characteristics of the study population: Variables n % Age (in years) 60-70 years 735 68 Above 70 344 32 Gender Male 483 44.8 Female 596 55.2 Marital status Married 1056 97.9 Unmarried 23 2.1 Living alone Yes 95 8.8 No 977 91.2 Socioeconomic status (Kuppuswamy Scale) Upper 59 5.5 Upper middle 321 29.7 Lower middle 128 11.9 Upper lower 286 26.5 Lower 285 26.4 H/o Diabetes Present 259 24.0 Absent 820 76.0 H/O Hypertension Present 367 34 Absent 712 66 BMI (Weight in Kg/Height in m 2 ) Underweight (<18.5) 85 7.8 Normal weight (18.5-24.9) 696 64.6 Overweight (25-29.9) 222 20.57 Obese (more than 30) 76 7.04 Table 2 lists the outcomes related to physical frailty assessed using three scales: Fried Frailty phenotype, Edmonton Frail scale, and Sarc-F screen for Sarcopenia. According to Fried's Frailty Phenotype classification, 35.2% and 62.2% of the population were categorized as frail and prefrail, respectively. According to the Reported Edmonton Frail Scale, 68.2% of participants were classified as ‘no frail’. According to the SARC-F screening, 31.8% of participants were at risk of sarcopenia. Table 2: Physical frailty status of the population Variables n % Fried’s frailty Phenotype Weight loss (Self reported unintentional weight loss of ≥2Kg or ≥5%over the previous 6 months) Yes 176 16.3 No 903 83.7 Weakness (low handgrip strength was determined based on a sex-specific cut off value-men<26kg, women173 ≥6 (0.76 m/s) Height Female: ≤159 ≥7 (0.65 m/s)>159 ≥6 (0.76 m/s) Not slow 504 46.7 Slow 575 53.3 Low level of physical activity (less than 30 mins of moderate exercise like walking or less than 20 mins of vigorous exercise three days a week) Yes 407 37.9 No 672 62.1 Fried frailty score Frail 380 35.2 Pre-frail 671 62.2 Robust 28 2.6 Edmonton Frail Scale (EFS) No frail= (0-5 score) 759 70.3 Apparently Vulnerable = (6-7 score) 231 21.4 Mildly frail = (8-9 score) 44 4.1 Moderately frail= (10-11 score) 35 3.2 Severe frailty= (12-18 score) 10 0.9 SARC-F Screen for Sarcopenia No risk of sarcopenia 736 68.2 Risk of sarcopenia (More than 4) 343 31.8 Table 3 highlights the findings related to oral frailty. About 43.7% of the population had difficulty chewing, 86.7% had more than three swallows in 30 seconds in the repetitive saliva swallowing test, and 33.2% had dry mouth. The pa/ta/ka values were 59.8% less than the normal ODK rates, while 59.8% had less tongue pressure, and 73.6% population had difficulties in subjective measures based on the Kihon checklist. Based on the overall score of the oral frailty status, 22.6% had an increased risk of new onset of physical frailty and sarcopenia. About 65.2% of the population had fewer than 20 teeth in their oral cavity (35.1% had 0-9 teeth and 30.1% had 10-19 teeth), while 34.8 percent had more than 20 teeth in their oral cavity. Table 3: Oral Frailty Status of the study population: Variables N % Oral frailty Status Difficulty in Chewing Yes 471 43.7 No 608 56.3 Repetitive saliva-swallowing test (RSST) 3 swallows/30sec 936 86.7 Dry Mouth Never 156 62.4 Occasionally 83 33.2 Frequently 11 4.4 Oral diadochokinetic rate (ODK) pa Less than normal ODK * 443 41.06 More than normal ODK * 636 58.94 ta Less than normal ODK * 401 37.2 More than normal ODK * 678 62.8 ka Less than normal ODK * 371 34.4 More than normal ODK * 708 65.6 Tongue pressure (<21.4 kpa for males, <26.5 kpa for females) Less than normal** 645 59.8 Normal** 434 40.2 Subjective measures Difficulties eating tough foods Yes 794 73.6 No 285 26.4 Difficulties in swallowing on tea or soup Yes 92 8.5 No 987 91.5 Experience having a dry mouth Yes 367 34 No 712 66 Oral Frailty Score No oral frailty 835 77.4 Presence of oral frailty 244 22.6 Prosthesis Use of prosthesis Not using denture 862 79.9 Using Partial denture 67 6.2 Using Complete denture 150 13.9 Number of teeth present 0-9 379 35.1 10-19 325 30.1 Above 20 375 34.8 Oral and Maxillofacial Frailty Index (OMFI) Normal 300 27.80 Mild 779 72.19 Moderate 0 0 Severe 0 0 *Normal ODK rates- pa: M-12.88 ± 1.96, F:13.33 ± 2.1; ta- M:12.89 ± 2.67, F:12.2 ± 3.875, ka- M:13.82± 2.36, F:12.51 ± 2.45 **Normal tongue pressure values- M: < 21.4 kg, F: 26.5 kg M = Males, W=Women Frailty was higher in females (21.6%) compared to males (13.6%). Frailty was also noted in 37.9% of diabetics, 2.3% of underweight people, and 2.9% of obese people. 3.2 Association between oral frailty and physical frailty The result showed that the people with physical frailty were 1.58 times more likely to experience oral frailty compared to those without oral frailty and it was statistically significant. (OR=1.58,95% CI=1.16-2.17, p-value-0.004) Association between the oral and maxillofacial index and physical frailty showed that according to the Fried Frailty Phenotype, individuals with physical frailty had 5 times more chance of getting mild oral frailty. (OR=5.17, CI=2.5-10.47, p-value-0.01) than individuals without physical frailty. Also, people with sarcopenia were likely to experience oral frailty 2.75 times (OR=2.73,95%CI=1.45-5.17, p value-0.002) as compared to those without sarcopenia, as shown in Table 4. Multivariate logistic regression revealed that in the adjusted model, (Model 1) individuals with oral frailty had 1.4 times more likely to have physical frailty than individuals without oral frailty (OR=1.42,95%CI=1.02-1.99, p value-1.03) which was statistically significant. Individuals with number of teeth below 20 had 1.12 times more likely to have physical frailty than individuals with more than 20 teeth (OR=1.12, CI=0.841-1.480, p value-0.03) In Model 2, individuals with oral frailty had 2.14 times more likely to have sarcopenia than individuals without oral frailty. Table 5: Multivariate analysis with Oral frailty status Model 1(Fried Frailty Phenotype and Oral Frailty Status) Model 2(Sarcopenia and Oral Frailty Status) Variable Reference category Crude OR (95%C.I) p value Adjusted OR (95%CI) p value Crude OR p value Adjusted OR p value Age (years) (60-70) Age (years) (Above 70) 0.50 (0.384-0.682) <0.001 .44 (0.331-0.584) <0.001 0.50 (0.379-0.650) <0.001 0.35 (0.26-0.47) <0.001 Gender (Female) Male 0.68 (0.53-0.89) 0.003 .60 (0.46-0.79) <0.001 0.33 (0.250-0.44) <0.001 0.23 (0.17-0.31) <0.001 BMI (kg/m2) (underweight) Normal 2.26 (1.19-4.29) <0.001 1.10 (0.66-1.84) <0.001 0.38 (0.24-0.63) .006 - - Number of teeth present (Below 20) Above 20 0.92 (.710-1.2) 0.003 1.12 (0.84-1.48) 0.03 0.63 (0.82-1.4) .002 1.65 (1.20-2.27) 0.048 Oral Frailty Score (Less than 2) Less than 2 1.58 (1.16-2.17) 0.004 1.42 (1.02-1.98) 0.038 2.23 (1.58-3.15) <0.001 2.14 (1.44-3.17) - Model 1-Dependent variable is physical frailty categorised to frail and pre frail. Model 2-Dependent variable is sarcopenia Adjusted model prepared after adjusting the confounding factors age,gender,BMI,Number of teeth and oral frailty Table 6: Multivariate analysis with OMFI Individuals with number of teeth below 20 had higher risk of physical frailty than individual with more than 20 teeth as shown in Model 3. ( Adjusted OR=1.12(0.84-1.48), p value<0.001 ) Individuals with underweight had higher risk of Physical frailty than individual with normal BMI as shown in Model 4. (adjusted OR=5.35(3.71-7.72),p value-<0.001) Model 3(Fried’s Frailty Phenotype (FFP) and Oral and Maxillofacial Index (OMFI) Model 4 (Reported Edmonton Frail Scale (REFS) and Oral and Maxillofacial Index (OMFI) Variable Reference category Crude OR (95%C.I) p value Adjusted OR (95%CI) p value Crude OR p value Adjusted OR p value Age (years) (60-70) Age (years) (Above 70) 0.500 (0.384-0.682) <0.001 .440 (0.325-0.574) <0.001 3.064 (2.33-4.03) <0.001 0.347 (0.255-0.472) <0.001 Gender (Female) Male 0.682 (0.529-0.879) 0.003 .599 (0.443-0.771) <0.001 3.550 (2.65-4.75) <0.001 0.228 (0.167-0.311) <0.001 BMI (kg/m2) (underweight) Normal 2.26 (1.191-4.286) <0.001 1.100 (0.654-1.830) 0.003 0.044 (0.023-0.084) <0.001 5.350 (3.7-7.72) <0.001 Number of teeth present (Below 20) Above 20 0.923 (0.710-1.2) 0.550 1.12 (0.841-1.480) 0.04 - - - - Oral Frailty Score (Less than 2) Less than 2 0.494 (0.366-0.668) <0.001 0.549 0.04 4.132 (2.958-5.771) <0.001 1.352 (1.003-1.823) 0.048 Model 1-dependent variable is physical frailty categorised to frail and pre frail. Model 2-Dependent variable is sarcopenia Adjusted model prepared after adjusting the confounding factors age,gender,BMI,Number of teeth and oral frailty 4. Discussion The current study assessed the prevalence of oral and physical frailty among the community-dwelling geriatric population and the association between oral and physical frailty. 4.1 Physical Frailty and associated factors As per available literature, the Fried physical phenotype model remains a reference standard for the assessment of frailty in many studies. 27 Accordingly, the Fried frailty phenotype was followed in the current study. We have also assessed physical frailty using different scales like the reported Edmonton frail scale and the SARC-F scale(sarcopenia). Using the Fried frailty phenotype, the prevalence of physical frailty in our study was 35.5%. The physical frailty prevalence is comparable to previous studies conducted in India. 28 , 29 In the Thanjavur community study, the rate of frailty prevalence was 28%. 30 The prevalence is comparable to the Hyderabad study where the prevalence was 37%. 21 A study by Kamdem et al. found that the prevalence of frailty was 35.4%, which closely aligns with our findings. 31 The data from the Longitudinal Ageing Study in India, covering 35 states and union territories, revealed that the prevalence of physical frailty was 35.5% (Irshad et al., 2022) and 29.94% (Thakkar et al., 2022). 32 , 33 The prevalence of physical frailty in low and middle-income countries ranges between 7.7–40.6% according to a systematic review and meta-analysis. 29 However, the prevalence of frailty in Japan was reported to be 7.4% which is significantly lower compared to our study. 34 The lower prevalence of frailty in Japan is attributed to the usage of their healthy lifestyle, robust health care system, social support, cultural practices to promote healthier lifestyle and enhance resilience in elderly, Government policies aimed at promoting healthy aging, including initiatives to encourage physical activity and social participation among seniors and public awareness about the importance of healthy aging and proactive management of health issues. 35 Another notable finding is that using the REFS, the prevalence of frailty was 8.2%. This difference may be attributed to the usage of different criteria and components. The Fried Frailty Criteria focus on physical aspects, the Edmonton Frail Scale, on the other hand, includes broader dimensions such as cognitive function, general health status, functional independence, social support, medication use, and nutrition. Also, the Fried frailty scale uses objective measures whereas the other scale incorporates subjective measures and self-reported information. The Fried Frailty Criteria might be more sensitive in detecting early stages of physical frailty, while the Edmonton Frail Scale might be stricter or more conservative in identifying individuals as frail. This broader approach might result in a lower prevalence of frailty because it requires individuals to meet criteria in multiple domains, not just physical. In this study, low handgrip strength was present in 62.6% of participants, which is a key feature of frailty. Our finding indicates a potential link between frailty and sarcopenia as noted in a previous Indian study. 36 , 37 Several researchers in India and Europe consider the evaluation of sarcopenia as a potentially useful primary step toward the interventional studies in frailty. 38 Using SARC-F screen for sarcopenia, our findings showed a prevalence of 31%.In a recent hospital study in Ooty, sarcopenia was found in 47.69% of the geriatric population. 39 Studies have shown that factors like female gender, reduced physical activity, alcohol consumption, smoking, low socioeconomic status, and decreased nutrition are associated with the development of sarcopenia. 40 Another finding is the low level of physical activity in 62.1% of the population. This may be a contributing factor to sarcopenia. Age is one of the most well-known risk factors for frailty. In this study, evaluation of the Fried Frailty phenotype characteristics with demographic characteristics revealed that no participant over the age of 70 was classified as robust. The study was conducted during the COVID-19 period. Increased physical inactivity, isolation and mental health issues, disruption of healthcare services, nutritional challenges, and caregiver strain likely affected the results. 41 The findings of the current study resonate with that noted in other recent studies which reported an increased prevalence of frailty in the elderly women, and those with lower education and income. 42 Accordingly, a higher prevalence of women was noted in the pre-frail and frail groups in our study. Women are frailer than men, and several hypotheses have been proposed to explain these gender differences. Men generally have a shorter life expectancy than women. As a result, more women are more likely to live to be older, thus increasing the risk of frailty. Additionally, women are more prone to chronic disease burden and disability than men. As a result, in addition to age, gender has a significant influence on the prevalence of frailty. In this study, frailty was observed more frequently in both the lower (40.7%) and upper (45.8%) socioeconomic groups. In contrast, another Indian study found that the prevalence of frailty was higher among the poorest than among the richest. 43 Though education and income have no direct impact on frailty pathophysiology, they can influence a person's lifestyle and nutrition, which can influence frailty progression. 44 Across the Fried Frailty phenotype definition, we found that the underweight elderly were at higher risk of frailty compared with the robust elderly. A cross-sectional study conducted in Netherlands identified a contradictory finding in which both underweight and obesity are associated with physical frailty. 45 Another Korean study discovered that after controlling for covariates, individuals with underweight or normal-weight prefrail/frail status had significantly higher rates of death than their normal-weight non-frail counterparts. 46 We discovered a positive relationship between age and frailty across the Reported Edmonton Frailty after adjusting for confounders (adjusted OR = 4.49), which is consistent with a cross-sectional study from India and a recent systematic review of 21 cohort studies from high-income countries (HICs). 28 , 29 , 43 , 47 After controlling for potential confounders, women had a higher prevalence of frailty than men as per the Reported Edmonton Frailty scale (crude OR = 3.55, adjusted OR = 4.89, p < 0.001). This is almost similar to an Indian cross-sectional study that found women to have twice the risk of frailty as men. 43 , 48 However, there are conflicting findings reported in a systematic review of cohort studies that have noted positive association 49 , 50 or no association with gender. 30 Nevertheless, women are considered to be more frail than men owing to poor grip strength, lower average amounts of lean body mass, and an increased risk of sarcopenia. 51 4.2 Oral frailty and associated factors Research on assessment tools for oral frailty is limited. According to the literature review, only three structured assessment tools: the oral frailty checklist, the oral and maxillofacial frailty index, and OFI-8 are currently available to assess oral frailty. 52 . In our study, we used the adapted OMFI tool 53 and Tanaka oral frailty assessment measures to assess oral frailty. The global prevalence of oral frailty ranged from 4.1–63.7%. 17 The rate of oral frailty in this study was 22.6% as per Tanaka oral frailty assessment while mild oral frailty was noted in 72.19% of the population as per Oral and Maxillofacial Frailty Index. In a recent institutionalized study, the prevalence of oral frailty was found to be 74%, which is similar to our findings. 54 In contrast, several oral frailty studies have been conducted in Japan where the prevalence varied between 4.6–9.5%. 34 This can be attributed to the traditional Japanese diet, robust health care system, public health initiatives, and community supportive systems. Numerous measures for improving oral health have been taken in Japan Including the 80 − 20 movement. 35 Chewing difficulty was noted in 43.7% of the population in the current study. Accordingly, 41.25% with chewing difficulty were pre-frail. Individuals with chewing difficulties tend to consume fewer nutrients than those without chewing difficulties, hence increasing the risk of frailty. Elderly women and individuals aged over 75 years were more vulnerable to chewing difficulties in another study. 55 Low tongue pressure was observed in 59.8% of the study population which can be attributed to age related muscle atrophy and oral health problems.Recent studies discovered that tongue pressure was independently associated with frailty and that it can be used as a simple frailty screening tool. 56 The present study has shown an association between physical frailty and oral frailty similar to another study. 57 Also, there was a significant relationship between fewer teeth and a higher risk of frailty, which was consistent with previous research. 58 , 59 , 60 A cross-sectional study from Brazil suggested that participants with 20 or more teeth had a lower chance of being frail compared to edentulous participants. 59 According to numerous studies, physical frailty is closely associated with oral frailty. 61 , 62 , 24 , 19 Having fewer teeth may alter food preferences, limit intake of essential nutrients, and increase the risk of malnutrition. Strength : The strength of my study lies in its community-based sample, making it the first to evaluate oral frailty in a community setting. Additionally, the study used a validated oral frailty tool, the Oral and Maxillofacial Frailty Index, and employed a Tonguometer for an objective assessment of oral frailty. Limitations : Cross-sectional design: The study is cross-sectional, meaning it can only establish associations and not causality. Longitudinal studies are needed to determine causal relationships between sociodemographic factors and frailty and the association between oral frailty and physical frailty. Sampling Bias: The study used a cluster-sampled area of Thrissur district in Kerala to select a random sample of adults aged 60 years and above, which may limit the generalizability of the findings to other populations. Also, there is a potential bias in the REFS, as it relies on the caregiver or family member’s subjective assessment of the older adult’s health, function, and social support. Conclusion Our study revealed a significant association between physical frailty risk and the presence of oral frailty. Our findings suggest a close association between oral and physical frailty, potentially indicating shared risk factors. This finding, coupled with the observed high prevalence of oral frailty and its link to physical frailty, underscores the importance of identifying frailty within elderly community populations. Utilization of available resources such as using a trained Asha worker to conduct early screening in the community and initiating interventions to prevent or delay frailty in the elderly could play a key role in improving the overall health at community levels. The lower prevalence of oral frailty in Japan suggests that including geriatric oral check-ups as part of routine health examinations for the elderly is beneficial. Integrating these multidisciplinary approaches can promote healthy aging. Declarations Author Contribution Dr Sandhya K N-was involved in the data collection,data analysis,wrote the manuscript and prepared figures 1-2 and tab;eDr Beena Varma -concept and design of study,Data analysis and Manuscript reviewDr Chandrasekar Janakiram-Concept,Design of study,Data analysis and manuscript reviewDr Priya Vijayakumar-Concept,Design of study,Data analysis and manuscript reviewNiveditha Kartha-Data analysis and report preparation Acknowledgement The study was done as a part of PhD project.I want to acknowledge Amrita Vishwa Vidyapeetham for the support throughout the study. Data Availability Dataset available in figshare 10.6084/m9.figshare.22085372. References Bank W. World Population Ageing 2019 [Internet]. World Population Ageing 2019. 2019. 64 p. Available from: http://link.springer.com/chapter/10.1007/978-94-007-5204-7_6 Vellas B, Cesari M, Li J. The White Book of Frailty. 2016. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. Journals Gerontol - Ser A Biol Sci Med Sci. 2001;56(3):146–57. Fried LP, Cohen AA, Xue Q-L, Walston J, Bandeen-Roche K, Varadhan R. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. Nat Aging [Internet]. 2021;1(1):36–46. Available from: http://dx.doi.org/10.1038/s43587-020-00017-z Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care. Journals Gerontol - Ser A Biol Sci Med Sci. 2004;59(3):255–63. Das S. Frailty Syndrome: A problem lurking in indian geriatric population. Indian J Soc Res. 60:269-277. UNFPA. Caring for Our Elders : Early Responses India Ageing Report-2017. United Nations Popul Fund. 2017;33(1):531–40. Gautam K, Krishnan K S, Kumar K V, Nayak MM. Trends in frailty and its associated factors in the community dwelling elderly Indian population during the COVID-19 pandemic: A prospective analytical study. F1000Research. 2022;11:311. Das S, Mukhopadhyay S. Frailty and health related quality of life in rural elderly population : A micro-level study in West Bengal , India. 2019;(August). Terms and Conditions ( TC ). 2022;(May). Hakeem FF, Bernabé E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontology. 2019;36(3):205–15. Tôrres LHDN, Tellez M, Hilgert JB, Hugo FN, De Sousa MDLR, Ismail AI. Frailty, Frailty Components, and Oral Health: A Systematic Review. J Am Geriatr Soc. 2015;63(12):2555–62. Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. 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Jotheeswaran AT, Bryce R, Prina M, Acosta D, Ferri CP, Guerra M, et al. Frailty and the prediction of dependence and mortality in low- and middle-income countries: A 10/66 population-based cohort study. BMC Med [Internet]. 2015;13(1). Available from: http://dx.doi.org/10.1186/s12916-015-0378-4 Siriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open. 2018;8(3):1–17. Kendhapedi KK, Devasenapathy N. Prevalence and factors associated with frailty among community-dwelling older people in rural Thanjavur district of South India : a cross-sectional study. 2019; 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(1):1–8. Irshad C, Muhammad T, Balachandran A, Sekher T, Dash U. Early life factors associated with old age physical frailty: evidence from India. Aging Heal Res [Internet]. 2022;2(3):100089. Available from: https://doi.org/10.1016/j.ahr.2022.100089 Thakkar S, Muhammad T, Srivastava S. Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018. PLoS One [Internet]. 2022;17(8 August):1–16. Available from: http://dx.doi.org/10.1371/journal.pone.0272669 Kojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: A systematic review and meta-analysis. J Epidemiol [Internet]. 2017;27(8):347–53. Available from: http://dx.doi.org/10.1016/j.je.2016.09.008 Miura H, Tano R. Recent measures in geriatric oral health care in Japan. J Natl Inst Public Heal. 2019;68(1):8–16. Karakelides H, Nair KS. Sarcopenia of Aging and Its Metabolic Impact. Curr Top Dev Biol. 2005;68(05):123–48. Das S, Chandel S. Frailty Pattern among the Elderly Rural Women of India. Indian J Gerontol [Internet]. 2018;32(2):144–5, Table-4. Available from: http://uml.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=gnh&AN=EP129849558&site=ehost-live Rockwood K, Bergman H. FRAILTY: A report from the 3rd joint workshop of IAGG/WHO/SFGG, Athens, January 2012. Can Geriatr J. 2012;15(2):31–6. Reji RE, Nair SB, Subbaiah K, Cynthia DS, Panchagiri S, Ponnusankar S, et al. An epidemiological study on the prevalence and predictors for geriatric sarcopenia from a public hospital of Ooty, India. J Appl Pharm Sci. 2023;13(10):210–6. Hwang J, Park S. Gender-Specific Risk Factors and Prevalence for Sarcopenia among Community-Dwelling Young-Old Adults. Int J Environ Res Public Health. 2022;19(12). Dhama K, Patel SK, Kumar R, Rana J, Yatoo MI, Kumar A, et al. Geriatric Population During the COVID-19 Pandemic: Problems, Considerations, Exigencies, and Beyond. Front Public Heal. 2020;8(September):1–8. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Heal Aging. 2019;23(9):771–87. Africa S. Accepted Manuscript. 2016; Mello A de C, Engstrom EM, Alves LC. Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review. Cad Saude Publica. 2014;30(6):1143–68. Rietman ML, Oostrom SHVAN, Picavet HSJ, Dollé MET. The association between bmi and different frailty domains : a u-shaped curve. Lee Y, Kim J, Han ES, Ryu M, Cho Y, Chae S. Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology. 2014;60(6):475–82. 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. 2017;1–18. Biritwum RB, Minicuci N, Yawson AE, Theou O, Mensah GP, Naidoo N, et al. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas. 2016;91(2016):8–18. Ottenbacher KJ, Graham JE, Al Snih S, Raji M, Samper-Ternent R, Ostir G V., et al. Mexican Americans and frailty: Findings from the hispanic established populations epidemiologic studies of the elderly. Am J Public Health. 2009;99(4):673–9. Myers V, Drory Y, Goldbourt U, Gerber Y. Multilevel socioeconomic status and incidence of frailty post myocardial infarction. Int J Cardiol [Internet]. 2014;170(3):338–43. Available from: http://dx.doi.org/10.1016/j.ijcard.2013.11.009 Cesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: Two sides of the same coin. Front Aging Neurosci. 2014;6(JUL):1–4. Janakiram C, Neelamana SK. Characterizing the Literature on Validity and Assessment Tool of Oral Frailty: A Systematic Scoping Review. J Contemp Dent Pract. 2022;23(6):659–68. Neelamana SK, Varma B, Janakiram C, Vijayakumar P, Karuveettil V. Cross-cultural Adaptation of Oral and Maxillofacial Frailty Assessment Tools for Geriatric Population of Kerala. J Contemp Dent Pract. 2023;24(2):80–8. Ayoob A, Janakiram C. Prevalence of physical and oral frailty in geriatric patients in Kerala, India. J Oral Biol Craniofacial Res [Internet]. 2024;14(2):158–63. Available from: https://doi.org/10.1016/j.jobcr.2024.01.011 Kwon SH, Park HR, Lee YM, Kwon SY, Kim OS, Kim HY, et al. Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty : using data from the Korea National Health and Nutrition Examination Survey 2013 ( 6th ). 2017;11(2):139–46. Yamanashi H, Shimizu Y, Higashi M, Koyamatsu J, Sato S, Nagayoshi M, et al. Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross-sectional study of Japanese community-dwelling older adults. Geriatr Gerontol Int. 2018;18(2):240–9. Ramsay SE, Papachristou E, Watt RG, Tsakos G, Lennon LT, Papacosta AO, et al. Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men. J Am Geriatr Soc. 2018;66(3):473–9. Zhang Y, Ge M, Zhao W, Hou L, Xia X, Liu X, et al. Association Between Number of Teeth, Denture Use and Frailty: Findings from the West China Health and Aging Trend Study. J Nutr Heal Aging. 2020;24(4):423–8. De Andrade FB, Lebrão ML, Santos JLF, De Oliveira Duarte YA. Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. J Am Geriatr Soc. 2013;61(5):809–14. Castrejón-Pérez RC, Jiménez-Corona A, Bernabé E, Villa-Romero AR, Arrivé E, Dartigues JF, et al. Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults. Journals Gerontol - Ser A Biol Sci Med Sci. 2017;72(7):951–7. Kiuchi Y, Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Kimura M, et al. The association between dietary variety and physical frailty in community-dwelling older adults. Healthc. 2021;9(1). Hironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, et al. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr [Internet]. 2020;89(December 2019):104105. Available from: https://doi.org/10.1016/j.archger.2020.104105 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4690073","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":326430262,"identity":"4b9f0492-7dae-4fa6-90ca-c46de0dda177","order_by":0,"name":"Sandhya K N","email":"","orcid":"","institution":"Amrita School of Dentistry,Kochi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sandhya","middleName":"K","lastName":"N","suffix":""},{"id":326430263,"identity":"690ca1a9-df54-44f0-b951-2d9f603889b9","order_by":1,"name":"Beena Varma Varma","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDCCAzzIvAogZmZuIEXLGZAWRlK0MLaBSfxa+G6fPfjg4w67xP7ZpxM/V86rjeZvB2r5UbENpxbJc3nJhjPPJCfOOJe7WfLstuO5Mw4zNjD2nLmNU4vBGR4zad42ZmOGM7wbJBu3HcttAGphZmzDq8X899+2emP5M7ybfzbOOZY7nwgtZkAFh+UMzvBuk2xsqMndQEiL5Bm+ZMnetuNyhkAtlg3HDuRuBGo5iM8vfGd4D3742VbNIwd02M2GmrrceecPH3zwowK3FnRwGEweIFo9ENSRongUjIJRMApGCAAAY0Ze7qX7ck4AAAAASUVORK5CYII=","orcid":"","institution":"Amrita School of Dentistry,Kochi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Beena","middleName":"Varma","lastName":"Varma","suffix":""},{"id":326430264,"identity":"9f3aa6b1-b61a-4557-84c1-9347b799f262","order_by":2,"name":"Chandasekar Janakiram","email":"","orcid":"","institution":"Amrita School of Dentistry,Kochi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chandasekar","middleName":"","lastName":"Janakiram","suffix":""},{"id":326430266,"identity":"77ea8cea-4f21-46a4-93eb-72cfd6fca3c3","order_by":3,"name":"Priya Vijayakumar","email":"","orcid":"","institution":"Amrita School of Dentistry,Kochi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Priya","middleName":"","lastName":"Vijayakumar","suffix":""},{"id":326430268,"identity":"6d101d03-fe08-4f5b-a328-54a050189172","order_by":4,"name":"Niveditha Kartha","email":"","orcid":"","institution":"Amrita Institute of Medical Sciences and Research Centre","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Niveditha","middleName":"","lastName":"Kartha","suffix":""}],"badges":[],"createdAt":"2024-07-05 06:33:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4690073/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4690073/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62127274,"identity":"b64b2ec3-ea6d-40e6-a59d-6afdddada648","added_by":"auto","created_at":"2024-08-09 14:57:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":886998,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSampling frame\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4690073/v1/732c06ba122fde37caf60372.png"},{"id":62127275,"identity":"d24c36ed-5b5d-4839-9af3-c48df95539d7","added_by":"auto","created_at":"2024-08-09 14:57:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":316826,"visible":true,"origin":"","legend":"\u003cp\u003eTonguometer\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4690073/v1/316ede508a18329edf616b27.png"},{"id":62128057,"identity":"751437d7-865e-4979-9af5-5da4b700500e","added_by":"auto","created_at":"2024-08-09 15:05:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2490284,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4690073/v1/51101f8e-b995-4aa8-8836-9ebad37f1a7a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe world's demographic landscape is shifting rapidly, with a marked increase in the elderly population. This trend is evident globally, with the proportion of individuals aged 65 and over rising from 6% in 1990 to 9% in 2019. By 2019, the global elderly population had reached 703\u0026nbsp;million, and projections indicate a staggering increase to over 1.5\u0026nbsp;billion by 2050.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e To navigate this demographic shift effectively, fostering healthy aging practices is paramount. This will ensure a positive balance between the challenges and opportunities presented by an aging population.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFrailty is a relatively new term in the lexicon of age-related health ailments. The term frailty is widely regarded as having originated in 2001, when Fried \u003cem\u003eet al\u003c/em\u003e. introduced the concept of frailty phenotype.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Frailty estimation is critical in healthy aging. Evaluation of frailty with precision can help explore potential interventions for patients according to their different levels of resilience.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndia's demographic transition is leading to a significant increase in older adults, with projections indicating a rise from 8% in 2015 to 19% by 2050.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Existing studies in India report a wide range of frailty prevalence (11\u0026ndash;58%),\u003csup\u003e8,9\u003c/sup\u003e likely due to variations in measurement tools. Notably, Kerala exemplifies this trend, with a sharp rise in the elderly population (16.5% in 2011 compared to 10.5% in 2001).\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e This emphasizes the urgent need for standardized frailty assessment to guide policy interventions for a growing elderly population effectively.\u003c/p\u003e \u003cp\u003ePoor oral health, a common condition among older adults, has been linked to poor overall health and an increased risk of frailty.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Oral frailty is a new concept introduced in Japan.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Oral frailty is the age-related functional decline of orofacial structures according to the latest definition.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In frail patients, there is a swift reduction in occlusal force, masseter muscle thickness, the rate of oral diadochokinesis, and oral motor skills related to speech.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003eThe prevalence of oral frailty varies significantly across the globe, with estimates ranging from 4.1\u0026ndash;63.7%.\u003csup\u003e17\u003c/sup\u003e In Japan, oral and physical frailty has been extensively studied.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eImpaired perception of oral health can be indicative of a broader decline in overall health status.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003eSimilarly, Physical frailty can affect oral hygiene and the condition of the remaining teeth in elderly patients. In effect, the relationship between the two is bidirectional. Poor oral health significantly predicted the onset of negative health outcomes, including mortality, among elderly individuals living in the community. Functional, physiological, psychosocial, and therapeutic factors comprise the connections between oral and physical frailty.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePhysical and oral frailty assessment in Kerala can help in tailoring individualized care plans that improve the overall quality of life for the elderly by addressing their specific health needs and promoting independence. Data from frailty assessments can inform policymakers about the healthcare needs of the elderly population, leading to more effective health policies and programs.\u003c/p\u003e \u003cp\u003eTherefore, the current study was planned to give baseline information on the prevalence of physical and oral frailty in the community-dwelling geriatric population of Thrissur, Kerala.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003e\u003cem\u003e2.1 Study Design and Participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA community-based cross-sectional study to assess the prevalence of physical, oral, and social frailty among the geriatric population of Thrissur, Kerala.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe proposed study was conducted in an area within a radius of 12km from the study center, Government Medical College, Thrissur. The demarcated area included six panchayats, one municipality, and one corporation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe employed a two-stage stratified random cluster sampling method to select participants. Stratification occurred at the rural-urban level (level 1) and the level of individual local self-governing units (LSGs, level 2). Thirty-six clusters were randomly chosen from all available clusters within the designated geographical area. Each cluster encompassed an electoral ward within an LSG. We aimed to interview 30 individuals from each cluster, resulting in a target sample size of 1080 older adults. The identified individuals were approached with the help of ASHA worker (Accredited Social Health Activist) after getting permission from concerned Panchayat/Municipality/corporation authority. Figure 1 demonstrates the sampling frame.\u003c/p\u003e\n\u003cp\u003eAny ambulant adult above the age group of 60 years attending the OPD of selected health centers, irrespective of any medical conditions and responsive to questionnaire was included. Participants who were unresponsive to the questionnaire and not willing to participate in the study were excluded. Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences, Kerala, India before the conduct of the study. (ECASM-AIMS-2021-176, date:28-09- 2021). Informed consent forms explaining the study details, as well as the oral and physical examination were given to all volunteering participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire for Interview\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured questionnaire, along with oral and physical examinations, was developed to assess frailty and its associated factors during the interview.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea) Socio-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe socio-demographic characteristics included age, gender, marital status, socio-economic status(Kuppuswamy assessment) \u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eb) Nutritional status:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) by Nestle Nutritional Institute on which a score of \u0026le; 17 is considered to indicate a risk of malnutrition.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ec) Anthropometric Measurements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The body weight and height were recorded using the SKnol 7227 weighing scale and fiber-reinforced tape, respectively, and the body mass index (BMI) was calculated. Asian cut-off values were used for BMI classification.\u003csup\u003e22,23\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ed) \u0026nbsp;Physical Frailty Assessment:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrailty was measured using three scales including Fried\u0026rsquo;s Frailty Phenotype, Reported Edmonton Frail Scale (EFS), and SARC-F sarcopenia scale.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e1. Fried\u0026rsquo;s Frailty Phenotype\u003c/em\u003e: This scale is used for recording five domains \u0026ndash; weight loss, weakness, endurance /exhaustion, slowness, and low level of physical activity.\u003c/p\u003e\n\u003cp\u003eWeakness and slowness\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eare measured using the dominant handgrip strength (handheld dynamometer) and the usual gait speed (time to walk 5 m)\u003c/p\u003e\n\u003cp\u003eExhaustion is measured as a positive answer to either of the following two self-reported questions:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;(i) In the last 2 weeks, have you felt tired without a reason?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; (ii) In the last 2 weeks, have you felt difficulty in doing what you could do easily before?\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLow physical activity was defined as less than 30 min of moderate exercise like walking or less than 20 min of vigorous exercise three days a week.\u003c/p\u003e\n\u003cp\u003eThe scoring is as follows:\u003c/p\u003e\n\u003cp\u003eFrail -impairments in at least three of the five domains, Prefrail-impairments in one or two of the five domains, Robust -without impairments in any of the five domains)\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2. Reported Edmonton Frail Scale (REFS):\u003c/em\u003e Cognition, general health status, functional independence, social support, medication use, nutrition, mood and self-reported performance are the domains evaluated in this scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTotal Score =18. No frail= 0-5, Apparently Vulnerable =6-7, Mildly frail =8-9, Moderately frail= 10-11, and severe frailty= 12-18.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3. SARC-F \u0026ndash;Sarcopenia scale:\u003c/em\u003e This scale is based on the following criteria: strength, assistance in walking, rising from a chair, climbing stairs, and falls. The scores range from 0 to 10, with 0 to 2 points for each component. A score equal to or greater than 4 is predictive of sarcopenia and poor outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ee) Assessment of oral frailty:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOral frailty was assessed by the Tanka 6-measure method and oral frailty was assessed by the Oral and Maxillofacial Frailty Index.\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ea) Tanaka\u0026rsquo;s 6 measures\u003c/em\u003e\u003csup\u003e24\u003c/sup\u003e\u003cem\u003e\u0026nbsp;:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe parameters measured\u0026ndash;\u003c/p\u003e\n\u003col style=\"list-style-type: lower-roman;\"\u003e\n \u003cli\u003eChewing ability status (Assessed subjectively using the question-Are you able to chew at least five peanuts?)\u003c/li\u003e\n \u003cli\u003eRepetitive saliva swallowing test (RSST): The RSST, is a screening test introduced in Japan by Oguchi et al.,\u003csup\u003e25\u003c/sup\u003e here the patient is asked to swallow their saliva as many times as possible in 30 seconds while the assessor counts the number of swallows by palpating the larynx, or by just looking at the larynx. The outcomes are categorised as \u0026lt;2 swallows/ per 30 seconds, and \u0026gt;3 swallows per 30 seconds.\u003c/li\u003e\n \u003cli\u003eDry mouth: frequency of dry mouth categorized as never, occasionally, or frequently\u003c/li\u003e\n \u003cli\u003eTongue pressure: Tongue pressure was assessed using a tonguometer.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eFigure 2\u003c/p\u003e\n\u003cp\u003eThe tongue pressure probe was placed between the tongue and palate, and the participant was asked to apply tongue pressure with maximal voluntary muscular effort for approximately 7 seconds. The readings were collected from the mobile phone application connected to the device using Bluetooth. Three measurements were taken, and the maximum value was used. The normal tongue pressure values: Male\u0026lt;21.4 Kg, Female\u0026gt;26.5 Kg. Figure 2 demonstrates the Tonguometer.\u003c/p\u003e\n\u003cp\u003ev) Oral diadochokinesis (ODK) represents the dexterity of the tongue. The Count-by-Time test was used for data collection. The syllables \u0026ldquo;pa\u0026rdquo;, \u0026ldquo;ta\u0026rdquo; and \u0026ldquo;ka\u0026rdquo; is asked to be repeated for 15 seconds and recorded. Normal values: Pa-Male:12.3\u0026plusmn;1.6, Female-12.3\u0026plusmn;1.8; Ta- Male: 13.1\u0026plusmn;1.6, Female 13.2\u0026plusmn;1.8; Ka-Male:13.5\u0026plusmn;2.1, Female 13.4\u0026plusmn;2.3.\u003c/p\u003e\n\u003cp\u003evi) The Kihon checklist is a 25-item questionnaire comprising seven categories\u003csup\u003e26\u003c/sup\u003e:Three items in the Kihon checklist were assessed for recording the oral frailty score. As a subjective evaluation, participants who responded \u0026quot;yes\u0026quot; to \u0026quot;Do you have any difficulties eating tough foods compared to 6 months ago?\u0026quot; were considered to have decreased masticatory performance and those who responded \u0026quot;yes\u0026quot; to \u0026quot;Have you choked on your tea or soup recently?\u0026quot; was considered to have decreased swallowing function.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIndividuals who did not respond positively to any relevant items were regarded as robust. Those who responded positively to 1\u0026ndash;2 items and \u0026ge; 3 items were categorized as having oral prefrailty and oral frailty, respectively. An oral frailty score of 0/6 at baseline, an oral frailty score of 1 or 2 was associated with an increased risk of physical frailty, and a score of 3 or more was significantly associated with an increased risk of new onset of all two outcomes (physical frailty and sarcopenia).\u003c/p\u003e\n\u003cp\u003eDental status\u003cstrong\u003e:\u003c/strong\u003e Number of teeth present and absent, presence or absence of denture,etc. were examined.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eb) Oral and Maxillofacial Index:\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe OMFI includes 10 items - pain and/or bleeding in the tooth or gum, difficulties in chewing, the necessity of water when eating dry food, jaw pain or difficulties in opening the mouth, intra‐oral pain or ulcer, taste alteration or difficulties in taste perception, difficulties in jaw or tongue movements, difficulties in speaking or pronunciation, difficulties in swallowing and difficulties in facial expression. The scoring was: 1-Never,2-Occasionally,3-Fairly often,4-Very often. Based on the total score, participants were categorized as Normal- 0 to 20, Mild-20-40, Moderate-40-60, and Severe-60-80.\u003c/p\u003e\n\u003cp\u003eBefore the study commenced, the above tools were validated for use in Kerala Population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Sample size estimation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBecause there are no Indian studies to assess oral/social frailty, a pilot study with 30 patients was conducted first. Based on the results, the final sample estimation was done. Based on the proportion of oral frailty (70%) among geriatric patients observed in the pilot study conducted with 30 samples and with 20% allowable error and 95% confidence, the minimum sample size for the study was 384. We enrolled a total of 1079 participants anticipating significant subgroup differences within the study sample. (As one participant was omitted due to missing data)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe collected data were entered in a Microsoft Excel spreadsheet and later transferred for analysis to Statistical Package of Social Sciences IBM (SPSS) version 23 (IBM SPSS for Windows, SPSS INC., Chicago, IL, USA). The characteristics of the subject\u0026rsquo;s variables were described using frequency distribution for categorical variables and mean and standard deviation for continuous variables. Chi- Square test was used to test the statistical significance between the physical and oral frailty measures. The percentage prevalence rate of prevalence and association of physical, oral, and social frailty among the geriatric population was computed with a 95% confidence level. Univariate analysis was used to assess the Crude Odd\u0026rsquo;s ratio. Multivariate analysis using binary logistic regression was performed to explore the effect of age, sex, weight, number of teeth, and oral frailty on physical frailty and sarcopenia. A p-value of \u0026lt; 0.05 was considered statistically significant.\u0026nbsp;\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eData collection involved face-to-face interviews conducted in participants\u0026apos; homes between October 2021 and April 2022. A pretested questionnaire, translated into Malayalam (the local language), guided the interviews. A single trained field investigator (SKN) ensured standardized measurement of all parameters throughout the data collection process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Descriptive statistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included 1079 people, with 55.2% females. Table 1 shows the demographic characteristics of the study population. The average age of the study population was 68.06 years. According to the Kuppuswamy socioeconomic status scale, 29.7% belonged to the upper middle class. Around 64.9 % of the population were in normal weight category. H/o Diabetes was reported by 51.9% while a history of hypertension was there in 43.4% of the population.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of the study population:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"48.98989898989899%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003e60-70 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Above 70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e44.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e1056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e97.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving alone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocioeconomic status (Kuppuswamy Scale)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eUpper middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eLower middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eUpper lower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eLower\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eH/o Diabetes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e76.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eH/O Hypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003ePresent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eAbsent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.589225589225588%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (Weight in Kg/Height in m\u003csup\u003e2\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.4006734006734%\" valign=\"top\"\u003e\n \u003cp\u003eUnderweight (\u0026lt;18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.885521885521886%\" valign=\"top\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.124579124579125%\" valign=\"top\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eNormal weight (18.5-24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eOverweight (25-29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e20.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.447963800904976%\" valign=\"top\"\u003e\n \u003cp\u003eObese (more than 30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.41176470588235%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.14027149321267%\" valign=\"top\"\u003e\n \u003cp\u003e7.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2 lists the outcomes related to physical frailty assessed using three scales: Fried Frailty phenotype, Edmonton Frail scale, and Sarc-F screen for Sarcopenia. According to Fried\u0026apos;s Frailty Phenotype classification, 35.2% and 62.2% of the population were categorized as frail and prefrail, respectively. According to the Reported Edmonton Frail Scale, 68.2% of participants were classified as \u0026lsquo;no frail\u0026rsquo;. According to the SARC-F screening, 31.8% of participants were at risk of sarcopenia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Physical frailty status of the population\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"50.7563025210084%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.058823529411764%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFried\u0026rsquo;s frailty Phenotype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Self reported unintentional weight loss of \u0026ge;2Kg or \u0026ge;5%over the previous 6 months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.689075630252102%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\" valign=\"top\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.1764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e83.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeakness (low handgrip strength was determined based on a sex-specific cut off value-men\u0026lt;26kg, women\u0026lt;17kg)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eNot weak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.689075630252102%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\" valign=\"top\"\u003e\n \u003cp\u003e37.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eWeak\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.1764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e62.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eExhaustion (CES-D Depression scale)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eNot frail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.689075630252102%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\" valign=\"top\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eFrail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e662\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.1764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlowness\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Time taken to walk 5m) Height/male (cm) Cut-off (s): \u0026le;173 \u0026ge;7 (0.65 m/s) ,\u0026gt;173 \u0026ge;6 (0.76 m/s)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Height Female: \u0026le;159 \u0026ge;7 (0.65 m/s)\u0026gt;159 \u0026ge;6 (0.76 m/s)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eNot slow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.689075630252102%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e504\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\" valign=\"top\"\u003e\n \u003cp\u003e46.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eSlow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.1764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e53.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow level of physical activity (less than 30 mins of moderate exercise like walking or less than 20 mins of vigorous exercise three days a week)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.689075630252102%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\" valign=\"top\"\u003e\n \u003cp\u003e37.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.764705882352942%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.1764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e62.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFried frailty score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eFrail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.058823529411764%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003ePre-frail\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eRobust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEdmonton Frail Scale (EFS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003eNo frail= (0-5 score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.058823529411764%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eApparently Vulnerable = (6-7 score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e231\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eMildly frail = (8-9 score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eModerately frail= (10-11 score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eSevere frailty= (12-18 score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSARC-F Screen for Sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;No risk of sarcopenia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\" valign=\"top\"\u003e\n \u003cp\u003e736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.058823529411764%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e68.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003eRisk of sarcopenia (More than 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.058823529411764%\" valign=\"top\"\u003e\n \u003cp\u003e343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.88235294117647%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e31.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.571428571428573%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.18487394957983%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.5042016806722689%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"26.554621848739497%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3 highlights the findings related to oral frailty. About 43.7% of the population had difficulty chewing, 86.7% had more than three swallows in 30 seconds in the repetitive saliva swallowing test, and 33.2% had dry mouth. The pa/ta/ka values were 59.8% less than the normal ODK rates, while 59.8% had less tongue pressure, and 73.6% population had difficulties in subjective measures based on the Kihon checklist. Based on the overall score of the oral frailty status, 22.6% had an increased risk of new onset of physical frailty and sarcopenia. About 65.2% of the population had fewer than 20 teeth in their oral cavity (35.1% had 0-9 teeth and 30.1% had 10-19 teeth), while 34.8 percent had more than 20 teeth in their oral cavity.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3: Oral Frailty Status of the study population:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.26890756302521%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral frailty Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDifficulty in Chewing\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e43.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e56.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRepetitive saliva-swallowing test (RSST)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;2 swallows/30sec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;3 swallows/30sec\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDry Mouth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eNever\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e62.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eOccasionally\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e33.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eFrequently\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral diadochokinetic rate (ODK)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.915966386554622%\" colspan=\"2\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.80672268907563%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003epa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eLess than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e41.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eMore than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e58.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.65671641791045%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.35820895522388%\" valign=\"top\"\u003e\n \u003cp\u003eLess than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.761194029850746%\" valign=\"top\"\u003e\n \u003cp\u003e401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.223880597014926%\" valign=\"top\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eMore than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e678\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e62.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.65671641791045%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eka\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.35820895522388%\" valign=\"top\"\u003e\n \u003cp\u003eLess than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.761194029850746%\" valign=\"top\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.223880597014926%\" valign=\"top\"\u003e\n \u003cp\u003e34.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eMore than normal ODK *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e65.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTongue pressure\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026lt;21.4 kpa for males, \u0026lt;26.5 kpa for females)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eLess than normal**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e59.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eNormal**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e40.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubjective measures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"7.744107744107744%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.855218855218855%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDifficulties eating tough foods\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.589225589225588%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.53872053872054%\" valign=\"top\"\u003e\n \u003cp\u003e794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"top\"\u003e\n \u003cp\u003e73.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.437956204379564%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eDifficulties in swallowing on tea or soup\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.73722627737226%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.26277372262774%\" valign=\"top\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.562043795620436%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e987\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.437956204379564%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eExperience having a dry mouth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.73722627737226%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.26277372262774%\" valign=\"top\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.562043795620436%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral Frailty Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eNo oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e77.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003ePresence of oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProsthesis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of prosthesis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eNot using denture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e79.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eUsing Partial denture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eUsing Complete denture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of teeth present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003e0-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003e10-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eAbove 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.722689075630253%\" colspan=\"3\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral and Maxillofacial Frailty Index (OMFI)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.54621848739496%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.50420168067227%\" valign=\"top\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.22689075630252%\" valign=\"top\"\u003e\n \u003cp\u003e27.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e72.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.862385321100916%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.98165137614679%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.15596330275229%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e*Normal ODK rates- pa: M-12.88 \u0026plusmn; 1.96, F:13.33 \u0026plusmn; 2.1; ta- M:12.89 \u0026plusmn; 2.67, F:12.2 \u0026plusmn; 3.875, ka- M:13.82\u0026plusmn; 2.36, F:12.51 \u0026plusmn; 2.45\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e**Normal tongue pressure values- M: \u0026lt; 21.4 kg, F: 26.5 kg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eM = Males, W=Women\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFrailty was higher in females (21.6%) compared to males (13.6%). Frailty was also noted in 37.9% of diabetics, 2.3% of underweight people, and 2.9% of obese people.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Association between oral frailty and physical frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe result showed that the people with physical frailty were 1.58 times more likely to experience oral frailty compared to those without oral frailty and it was statistically significant. (OR=1.58,95% CI=1.16-2.17, p-value-0.004) Association between the oral and maxillofacial index and physical frailty showed that according to the Fried Frailty Phenotype, individuals with physical frailty had 5 times\u0026nbsp;more chance of getting mild oral frailty. (OR=5.17, CI=2.5-10.47, p-value-0.01) than individuals without physical frailty.\u0026nbsp;Also, people with sarcopenia were likely to experience oral frailty 2.75 times (OR=2.73,95%CI=1.45-5.17, p value-0.002) as compared to those without sarcopenia, as shown in Table 4.\u003c/p\u003e\n\u003cp\u003eMultivariate logistic regression revealed that in the adjusted model, (Model 1) individuals with oral frailty had 1.4 times more likely to have physical frailty than individuals without oral frailty (OR=1.42,95%CI=1.02-1.99, p value-1.03) which was statistically significant. Individuals with number of teeth below 20 had 1.12 times more likely to have physical frailty than individuals with more than 20 teeth (OR=1.12, CI=0.841-1.480, p value-0.03) In Model 2, individuals with oral frailty had 2.14 times more likely to have sarcopenia than individuals without oral frailty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: Multivariate analysis with Oral frailty status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"666\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.00900900900901%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.561561561561561%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.84084084084084%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1(Fried Frailty Phenotype and Oral Frailty Status)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.588588588588586%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2(Sarcopenia and Oral Frailty Status)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR (95%C.I)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e(60-70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e(Above 70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003cp\u003e(0.384-0.682)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e.44\u003c/p\u003e\n \u003cp\u003e(0.331-0.584)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003cp\u003e(0.379-0.650)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003cp\u003e(0.26-0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003cp\u003e(0.53-0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e.60\u003c/p\u003e\n \u003cp\u003e(0.46-0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e0.33\u003c/p\u003e\n \u003cp\u003e(0.250-0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003cp\u003e(0.17-0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003cp\u003e(underweight)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e2.26\u003c/p\u003e\n \u003cp\u003e(1.19-4.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003cp\u003e(0.66-1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003cp\u003e(0.24-0.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of teeth present\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Below 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003eAbove 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003cp\u003e(.710-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e(0.84-1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003cp\u003e(0.82-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003cp\u003e(1.20-2.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"9.022556390977444%\" valign=\"top\"\u003e\n \u003cp\u003eOral Frailty Score\u003c/p\u003e\n \u003cp\u003e(Less than 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003eLess than 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12781954887218%\" valign=\"top\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003cp\u003e(1.16-2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.676691729323307%\" valign=\"top\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003cp\u003e(1.02-1.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.421052631578947%\" valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.172932330827068%\" valign=\"top\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003cp\u003e(1.58-3.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\" valign=\"top\"\u003e\n \u003cp\u003e2.14\u003c/p\u003e\n \u003cp\u003e(1.44-3.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.87218045112782%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003eModel 1-Dependent variable is physical frailty categorised to frail and pre frail.\u003c/p\u003e\n \u003cp\u003eModel 2-Dependent variable is sarcopenia\u003c/p\u003e\n \u003cp\u003eAdjusted model prepared after adjusting the confounding factors age,gender,BMI,Number of teeth and oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Multivariate analysis with OMFI\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals with number of teeth below 20 had higher risk of physical frailty than individual with more than 20 teeth as shown in Model 3.\u003cstrong\u003e\u0026nbsp;(\u003c/strong\u003eAdjusted OR=1.12(0.84-1.48), p value\u0026lt;0.001\u003cstrong\u003e)\u0026nbsp;\u003c/strong\u003eIndividuals with underweight had higher risk of Physical frailty than individual with normal BMI as shown in Model 4. (adjusted OR=5.35(3.71-7.72),p value-\u0026lt;0.001)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"677\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.19202363367799%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.37370753323486%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.62038404726736%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3(Fried\u0026rsquo;s Frailty Phenotype (FFP) and Oral and Maxillofacial Index (OMFI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.813884785819795%\" colspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 4 (Reported Edmonton Frail Scale (REFS) and Oral and Maxillofacial Index (OMFI)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReference category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR (95%C.I)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e(60-70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003cp\u003e(Above 70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e0.500\u003c/p\u003e\n \u003cp\u003e(0.384-0.682)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e.440\u003c/p\u003e\n \u003cp\u003e(0.325-0.574)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e3.064\u003c/p\u003e\n \u003cp\u003e(2.33-4.03)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003cp\u003e(0.255-0.472)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003cp\u003e(0.529-0.879)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e.599\u003c/p\u003e\n \u003cp\u003e(0.443-0.771)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e3.550\u003c/p\u003e\n \u003cp\u003e(2.65-4.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003cp\u003e(0.167-0.311)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003cp\u003e(underweight)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e2.26\u003c/p\u003e\n \u003cp\u003e(1.191-4.286)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e1.100\u003c/p\u003e\n \u003cp\u003e(0.654-1.830)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003cp\u003e(0.023-0.084)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e5.350\u003c/p\u003e\n \u003cp\u003e(3.7-7.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of teeth present\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Below 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003eAbove 20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e0.923\u003c/p\u003e\n \u003cp\u003e(0.710-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e0.550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003cp\u003e(0.841-1.480)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"10.222222222222221%\" valign=\"top\"\u003e\n \u003cp\u003eOral Frailty Score\u003c/p\u003e\n \u003cp\u003e(Less than 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.407407407407407%\" valign=\"top\"\u003e\n \u003cp\u003eLess than 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.814814814814815%\" valign=\"top\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003cp\u003e(0.366-0.668)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.518518518518519%\" valign=\"top\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.037037037037036%\" valign=\"top\"\u003e\n \u003cp\u003e4.132\u003c/p\u003e\n \u003cp\u003e(2.958-5.771)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.25925925925926%\" valign=\"top\"\u003e\n \u003cp\u003e1.352\u003c/p\u003e\n \u003cp\u003e(1.003-1.823)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.74074074074074%\" valign=\"top\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003eModel 1-dependent variable is physical frailty categorised to frail and pre frail.\u003c/p\u003e\n \u003cp\u003eModel 2-Dependent variable is sarcopenia\u003c/p\u003e\n \u003cp\u003eAdjusted model prepared after adjusting the confounding factors age,gender,BMI,Number of teeth and oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e The current study assessed the prevalence of oral and physical frailty among the community-dwelling geriatric population and the association between oral and physical frailty.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Physical Frailty and associated factors\u003c/h2\u003e \u003cp\u003eAs per available literature, the Fried physical phenotype model remains a reference standard for the assessment of frailty in many studies.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e Accordingly, the Fried frailty phenotype was followed in the current study. We have also assessed physical frailty using different scales like the reported Edmonton frail scale and the SARC-F scale(sarcopenia). Using the Fried frailty phenotype, the prevalence of physical frailty in our study was 35.5%. The physical frailty prevalence is comparable to previous studies conducted in India.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003eIn the Thanjavur community study, the rate of frailty prevalence was 28%.\u003csup\u003e30\u003c/sup\u003e The prevalence is comparable to the Hyderabad study where the prevalence was 37%.\u003csup\u003e21\u003c/sup\u003e A study by Kamdem et al. found that the prevalence of frailty was 35.4%, which closely aligns with our findings.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e The data from the Longitudinal Ageing Study in India, covering 35 states and union territories, revealed that the prevalence of physical frailty was 35.5% (Irshad et al., 2022) and 29.94% (Thakkar et al., 2022).\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e The prevalence of physical frailty in low and middle-income countries ranges between 7.7–40.6% according to a systematic review and meta-analysis.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e However, the prevalence of frailty in Japan was reported to be 7.4% which is significantly lower compared to our study.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003eThe lower prevalence of frailty in Japan is attributed to the usage of their healthy lifestyle, robust health care system, social support, cultural practices to promote healthier lifestyle and enhance resilience in elderly, Government policies aimed at promoting healthy aging, including initiatives to encourage physical activity and social participation among seniors and public awareness about the importance of healthy aging and proactive management of health issues.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother notable finding is that using the REFS, the prevalence of frailty was 8.2%. This difference may be attributed to the usage of different criteria and components. The Fried Frailty Criteria focus on physical aspects, the Edmonton Frail Scale, on the other hand, includes broader dimensions such as cognitive function, general health status, functional independence, social support, medication use, and nutrition. Also, the Fried frailty scale uses objective measures whereas the other scale incorporates subjective measures and self-reported information. The Fried Frailty Criteria might be more sensitive in detecting early stages of physical frailty, while the Edmonton Frail Scale might be stricter or more conservative in identifying individuals as frail. This broader approach might result in a lower prevalence of frailty because it requires individuals to meet criteria in multiple domains, not just physical.\u003c/p\u003e \u003cp\u003eIn this study, low handgrip strength was present in 62.6% of participants, which is a key feature of frailty. Our finding indicates a potential link between frailty and sarcopenia as noted in a previous Indian study.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e,\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003eSeveral researchers in India and Europe consider the evaluation of sarcopenia as a potentially useful primary step toward the interventional studies in frailty.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003eUsing SARC-F screen for sarcopenia, our findings showed a prevalence of 31%.In a recent hospital study in Ooty, sarcopenia was found in 47.69% of the geriatric population.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e Studies have shown that factors like female gender, reduced physical activity, alcohol consumption, smoking, low socioeconomic status, and decreased nutrition are associated with the development of sarcopenia.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Another finding is the low level of physical activity in 62.1% of the population. This may be a contributing factor to sarcopenia.\u003c/p\u003e \u003cp\u003eAge is one of the most well-known risk factors for frailty. In this study, evaluation of the Fried Frailty phenotype characteristics with demographic characteristics revealed that no participant over the age of 70 was classified as robust. The study was conducted during the COVID-19 period. Increased physical inactivity, isolation and mental health issues, disruption of healthcare services, nutritional challenges, and caregiver strain likely affected the results.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe findings of the current study resonate with that noted in other recent studies which reported an increased prevalence of frailty in the elderly women, and those with lower education and income.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003eAccordingly, a higher prevalence of women was noted in the pre-frail and frail groups in our study. Women are frailer than men, and several hypotheses have been proposed to explain these gender differences. Men generally have a shorter life expectancy than women. As a result, more women are more likely to live to be older, thus increasing the risk of frailty. Additionally, women are more prone to chronic disease burden and disability than men. As a result, in addition to age, gender has a significant influence on the prevalence of frailty.\u003c/p\u003e \u003cp\u003eIn this study, frailty was observed more frequently in both the lower (40.7%) and upper (45.8%) socioeconomic groups. In contrast, another Indian study found that the prevalence of frailty was higher among the poorest than among the richest.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e Though education and income have no direct impact on frailty pathophysiology, they can influence a person's lifestyle and nutrition, which can influence frailty progression.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAcross the Fried Frailty phenotype definition, we found that the underweight elderly were at higher risk of frailty compared with the robust elderly. A cross-sectional study conducted in Netherlands identified a contradictory finding in which both underweight and obesity are associated with physical frailty.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e Another Korean study discovered that after controlling for covariates, individuals with underweight or normal-weight prefrail/frail status had significantly higher rates of death than their normal-weight non-frail counterparts.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe discovered a positive relationship between age and frailty across the Reported Edmonton Frailty after adjusting for confounders (adjusted OR = 4.49), which is consistent with a cross-sectional study from India and a recent systematic review of 21 cohort studies from high-income countries (HICs).\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAfter controlling for potential confounders, women had a higher prevalence of frailty than men as per the Reported Edmonton Frailty scale (crude OR = 3.55, adjusted OR = 4.89, p \u0026lt; 0.001). This is almost similar to an Indian cross-sectional study that found women to have twice the risk of frailty as men.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e However, there are conflicting findings reported in a systematic review of cohort studies that have noted positive association\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e or no association with gender.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Nevertheless, women are considered to be more frail than men owing to poor grip strength, lower average amounts of lean body mass, and an increased risk of sarcopenia.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Oral frailty and associated factors\u003c/h2\u003e \u003cp\u003e Research on assessment tools for oral frailty is limited. According to the literature review, only three structured assessment tools: the oral frailty checklist, the oral and maxillofacial frailty index, and OFI-8 are currently available to assess oral frailty.\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e. In our study, we used the adapted OMFI tool\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e and Tanaka oral frailty assessment measures to assess oral frailty. The global prevalence of oral frailty ranged from 4.1–63.7%.\u003csup\u003e17\u003c/sup\u003e The rate of oral frailty in this study was 22.6% as per Tanaka oral frailty assessment while mild oral frailty was noted in 72.19% of the population as per Oral and Maxillofacial Frailty Index. In a recent institutionalized study, the prevalence of oral frailty was found to be 74%, which is similar to our findings.\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e In contrast, several oral frailty studies have been conducted in Japan where the prevalence varied between 4.6–9.5%.\u003csup\u003e34\u003c/sup\u003e This can be attributed to the traditional Japanese diet, robust health care system, public health initiatives, and community supportive systems. Numerous measures for improving oral health have been taken in Japan Including the 80 − 20 movement.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eChewing difficulty was noted in 43.7% of the population in the current study. Accordingly, 41.25% with chewing difficulty were pre-frail. Individuals with chewing difficulties tend to consume fewer nutrients than those without chewing difficulties, hence increasing the risk of frailty. Elderly women and individuals aged over 75 years were more vulnerable to chewing difficulties in another study.\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLow tongue pressure was observed in 59.8% of the study population which can be attributed to age related muscle atrophy and oral health problems.Recent studies discovered that tongue pressure was independently associated with frailty and that it can be used as a simple frailty screening tool.\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study has shown an association between physical frailty and oral frailty similar to another study.\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003eAlso, there was a significant relationship between fewer teeth and a higher risk of frailty, which was consistent with previous research. \u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e,\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e,\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u003c/sup\u003e A cross-sectional study from Brazil suggested that participants with 20 or more teeth had a lower chance of being frail compared to edentulous participants.\u003csup\u003e\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003eAccording to numerous studies, physical frailty is closely associated with oral frailty.\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e,\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003eHaving fewer teeth may alter food preferences, limit intake of essential nutrients, and increase the risk of malnutrition.\u003c/p\u003e \u003cp\u003e \u003cb\u003eStrength\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e The strength of my study lies in its community-based sample, making it the first to evaluate oral frailty in a community setting. Additionally, the study used a validated oral frailty tool, the Oral and Maxillofacial Frailty Index, and employed a Tonguometer for an objective assessment of oral frailty.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e:\u003c/p\u003e \u003cp\u003eCross-sectional design: The study is cross-sectional, meaning it can only establish associations and not causality. Longitudinal studies are needed to determine causal relationships between sociodemographic factors and frailty and the association between oral frailty and physical frailty. Sampling Bias: The study used a cluster-sampled area of Thrissur district in Kerala to select a random sample of adults aged 60 years and above, which may limit the generalizability of the findings to other populations.\u003c/p\u003e \u003cp\u003eAlso, there is a potential bias in the REFS, as it relies on the caregiver or family member’s subjective assessment of the older adult’s health, function, and social support.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study revealed a significant association between physical frailty risk and the presence of oral frailty. Our findings suggest a close association between oral and physical frailty, potentially indicating shared risk factors. This finding, coupled with the observed high prevalence of oral frailty and its link to physical frailty, underscores the importance of identifying frailty within elderly community populations. Utilization of available resources such as using a trained Asha worker to conduct early screening in the community and initiating interventions to prevent or delay frailty in the elderly could play a key role in improving the overall health at community levels. The lower prevalence of oral frailty in Japan suggests that including geriatric oral check-ups as part of routine health examinations for the elderly is beneficial. Integrating these multidisciplinary approaches can promote healthy aging.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDr Sandhya K N-was involved in the data collection,data analysis,wrote the manuscript and prepared figures 1-2 and tab;eDr Beena Varma -concept and design of study,Data analysis and Manuscript reviewDr Chandrasekar Janakiram-Concept,Design of study,Data analysis and manuscript reviewDr Priya Vijayakumar-Concept,Design of study,Data analysis and manuscript reviewNiveditha Kartha-Data analysis and report preparation\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe study was done as a part of PhD project.I want to acknowledge Amrita Vishwa Vidyapeetham for the support throughout the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDataset available in figshare 10.6084/m9.figshare.22085372.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBank W. World Population Ageing 2019 [Internet]. World Population Ageing 2019. 2019. 64 p. Available from: http://link.springer.com/chapter/10.1007/978-94-007-5204-7_6\u003c/li\u003e\n\u003cli\u003eVellas B, Cesari M, Li J. The White Book of Frailty. 2016. \u003c/li\u003e\n\u003cli\u003eFried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. Journals Gerontol - Ser A Biol Sci Med Sci. 2001;56(3):146\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003eFried LP, Cohen AA, Xue Q-L, Walston J, Bandeen-Roche K, Varadhan R. The physical frailty syndrome as a transition from homeostatic symphony to cacophony. Nat Aging [Internet]. 2021;1(1):36\u0026ndash;46. Available from: http://dx.doi.org/10.1038/s43587-020-00017-z\u003c/li\u003e\n\u003cli\u003eFried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the Concepts of Disability, Frailty, and Comorbidity: Implications for Improved Targeting and Care. Journals Gerontol - Ser A Biol Sci Med Sci. 2004;59(3):255\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eDas S. Frailty Syndrome: A problem lurking in indian geriatric population. Indian J Soc Res. 60:269-277. \u003c/li\u003e\n\u003cli\u003eUNFPA. Caring for Our Elders : Early Responses India Ageing Report-2017. United Nations Popul Fund. 2017;33(1):531\u0026ndash;40. \u003c/li\u003e\n\u003cli\u003eGautam K, Krishnan K S, Kumar K V, Nayak MM. Trends in frailty and its associated factors in the community dwelling elderly Indian population during the COVID-19 pandemic: A prospective analytical study. F1000Research. 2022;11:311. \u003c/li\u003e\n\u003cli\u003eDas S, Mukhopadhyay S. Frailty and health related quality of life in rural elderly population : A micro-level study in West Bengal , India. 2019;(August). \u003c/li\u003e\n\u003cli\u003eTerms and Conditions ( TC ). 2022;(May). \u003c/li\u003e\n\u003cli\u003eHakeem FF, Bernab\u0026eacute; E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontology. 2019;36(3):205\u0026ndash;15. \u003c/li\u003e\n\u003cli\u003eT\u0026ocirc;rres LHDN, Tellez M, Hilgert JB, Hugo FN, De Sousa MDLR, Ismail AI. Frailty, Frailty Components, and Oral Health: A Systematic Review. J Am Geriatr Soc. 2015;63(12):2555\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003ePetersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005;33(2):81\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eMinakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, et al. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology. 2018;35(4):317\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eParisius KGH, Wartewig E, Schoonmade LJ, Aarab G, Gobbens R, Lobbezoo F. Oral frailty dissected and conceptualized : A scoping review. 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Available from: https://doi.org/10.1016/j.archger.2020.104105\u003c/li\u003e\n\u003cli\u003eCastrej\u0026aacute;n-P\u0026eacute;rez RC, Borges-Y\u0026aacute;̃ez SA, Guti\u0026eacute;rrez-Robledo LM, \u0026Aacute;vila-Funes JA. Oral health conditions and frailty in Mexican community-dwelling elderly: A cross sectional analysis. BMC Public Health. 2012;12(1). \u003c/li\u003e\n\u003cli\u003eChalittikul W, Kassim S, Sabbah W. The association between number of teeth and physical function limitation among older adults in the USA. Gerodontology. 2020;37(4):389\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eChowdhury S, Chakraborty P pratim. Universal health coverage ‑ There is more to it than meets the eye. J Fam Med Prim Care [Internet]. 2017;6(2):169\u0026ndash;70. Available from: http://www.jfmpc.com/article.asp?issn=2249-4863;year=2017;volume=6;issue=1;spage=169;epage=170;aulast=Faizi\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation (WHO). WHO | Waist Circumference and Waist\u0026ndash;Hip Ratio. Report of a WHO Expert Consultation. Geneva, 8-11 December 2008. 2008;(December):8\u0026ndash;11. Available from: http://www.who.int\u003c/li\u003e\n\u003cli\u003eBarba C, Cavalli-Sforza T CJ, Darnton-Hill I, Deurenberg P, Deurrenberg YM et al. Appropriate body-mass index for Asian populations and its implications. Lancet. 2004;363:157\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eTanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, et al. Oral frailtyasa risk factor for physical frailty and mortality in community-dwelling elderly. Journals Gerontol - Ser A Biol Sci Med Sci. 2018;73(12):1661\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eOuguchi K, Saitoh E, Baba M, Kusudo S, Tanaka T OK. The repetitive saliva swllowing test(RSST)as a screening test of functional dysphagia. Jpn J Rehabil Med. 2000;37(6):383\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSewo Sampaio PY, Sampaio RAC, Yamada M, Arai H. Systematic review of the Kihon Checklist: Is it a reliable assessment of frailty? Geriatr Gerontol Int. 2016;16(8):893\u0026ndash;902. \u003c/li\u003e\n\u003cli\u003eBieniek J, Wilczyński K, Szewieczek J. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging. 2016;11:453\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eJotheeswaran AT, Bryce R, Prina M, Acosta D, Ferri CP, Guerra M, et al. Frailty and the prediction of dependence and mortality in low- and middle-income countries: A 10/66 population-based cohort study. BMC Med [Internet]. 2015;13(1). Available from: http://dx.doi.org/10.1186/s12916-015-0378-4\u003c/li\u003e\n\u003cli\u003eSiriwardhana DD, Hardoon S, Rait G, Weerasinghe MC, Walters KR. Prevalence of frailty and prefrailty among community-dwelling older adults in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open. 2018;8(3):1\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eKendhapedi KK, Devasenapathy N. Prevalence and factors associated with frailty among community-dwelling older people in rural Thanjavur district of South India : a cross-sectional study. 2019; \u003c/li\u003e\n\u003cli\u003eKamdem B, Seematter-Bagnoud L, Botrugno F, Santos-Eggimann B. Relationship between oral health and Fried\u0026rsquo;s frailty criteria in community-dwelling older persons. BMC Geriatr. 2017;17(1):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eIrshad C, Muhammad T, Balachandran A, Sekher T, Dash U. Early life factors associated with old age physical frailty: evidence from India. Aging Heal Res [Internet]. 2022;2(3):100089. Available from: https://doi.org/10.1016/j.ahr.2022.100089\u003c/li\u003e\n\u003cli\u003eThakkar S, Muhammad T, Srivastava S. Cross-sectional associations of physical frailty with fall, multiple falls and fall-injury among older Indian adults: Findings from LASI, 2018. PLoS One [Internet]. 2022;17(8 August):1\u0026ndash;16. Available from: http://dx.doi.org/10.1371/journal.pone.0272669\u003c/li\u003e\n\u003cli\u003eKojima G, Iliffe S, Taniguchi Y, Shimada H, Rakugi H, Walters K. Prevalence of frailty in Japan: A systematic review and meta-analysis. J Epidemiol [Internet]. 2017;27(8):347\u0026ndash;53. Available from: http://dx.doi.org/10.1016/j.je.2016.09.008\u003c/li\u003e\n\u003cli\u003eMiura H, Tano R. Recent measures in geriatric oral health care in Japan. J Natl Inst Public Heal. 2019;68(1):8\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eKarakelides H, Nair KS. Sarcopenia of Aging and Its Metabolic Impact. Curr Top Dev Biol. 2005;68(05):123\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eDas S, Chandel S. Frailty Pattern among the Elderly Rural Women of India. Indian J Gerontol [Internet]. 2018;32(2):144\u0026ndash;5, Table-4. Available from: http://uml.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true\u0026amp;db=gnh\u0026amp;AN=EP129849558\u0026amp;site=ehost-live\u003c/li\u003e\n\u003cli\u003eRockwood K, Bergman H. FRAILTY: A report from the 3rd joint workshop of IAGG/WHO/SFGG, Athens, January 2012. Can Geriatr J. 2012;15(2):31\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eReji RE, Nair SB, Subbaiah K, Cynthia DS, Panchagiri S, Ponnusankar S, et al. An epidemiological study on the prevalence and predictors for geriatric sarcopenia from a public hospital of Ooty, India. J Appl Pharm Sci. 2023;13(10):210\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eHwang J, Park S. Gender-Specific Risk Factors and Prevalence for Sarcopenia among Community-Dwelling Young-Old Adults. Int J Environ Res Public Health. 2022;19(12). \u003c/li\u003e\n\u003cli\u003eDhama K, Patel SK, Kumar R, Rana J, Yatoo MI, Kumar A, et al. Geriatric Population During the COVID-19 Pandemic: Problems, Considerations, Exigencies, and Beyond. Front Public Heal. 2020;8(September):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodr\u0026iacute;guez-Ma\u0026ntilde;as L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Heal Aging. 2019;23(9):771\u0026ndash;87. \u003c/li\u003e\n\u003cli\u003eAfrica S. Accepted Manuscript. 2016; \u003c/li\u003e\n\u003cli\u003eMello A de C, Engstrom EM, Alves LC. Health-related and socio-demographic factors associated with frailty in the elderly: a systematic literature review. Cad Saude Publica. 2014;30(6):1143\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eRietman ML, Oostrom SHVAN, Picavet HSJ, Doll\u0026eacute; MET. The association between bmi and different frailty domains : a u-shaped curve. \u003c/li\u003e\n\u003cli\u003eLee Y, Kim J, Han ES, Ryu M, Cho Y, Chae S. Frailty and body mass index as predictors of 3-year mortality in older adults living in the community. Gerontology. 2014;60(6):475\u0026ndash;82. \u003c/li\u003e\n\u003cli\u003eFeng 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. 2017;1\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eBiritwum RB, Minicuci N, Yawson AE, Theou O, Mensah GP, Naidoo N, et al. Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa. Maturitas. 2016;91(2016):8\u0026ndash;18. \u003c/li\u003e\n\u003cli\u003eOttenbacher KJ, Graham JE, Al Snih S, Raji M, Samper-Ternent R, Ostir G V., et al. Mexican Americans and frailty: Findings from the hispanic established populations epidemiologic studies of the elderly. Am J Public Health. 2009;99(4):673\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eMyers V, Drory Y, Goldbourt U, Gerber Y. Multilevel socioeconomic status and incidence of frailty post myocardial infarction. Int J Cardiol [Internet]. 2014;170(3):338\u0026ndash;43. Available from: http://dx.doi.org/10.1016/j.ijcard.2013.11.009\u003c/li\u003e\n\u003cli\u003eCesari M, Landi F, Vellas B, Bernabei R, Marzetti E. Sarcopenia and physical frailty: Two sides of the same coin. Front Aging Neurosci. 2014;6(JUL):1\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eJanakiram C, Neelamana SK. Characterizing the Literature on Validity and Assessment Tool of Oral Frailty: A Systematic Scoping Review. J Contemp Dent Pract. 2022;23(6):659\u0026ndash;68. \u003c/li\u003e\n\u003cli\u003eNeelamana SK, Varma B, Janakiram C, Vijayakumar P, Karuveettil V. Cross-cultural Adaptation of Oral and Maxillofacial Frailty Assessment Tools for Geriatric Population of Kerala. J Contemp Dent Pract. 2023;24(2):80\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAyoob A, Janakiram C. Prevalence of physical and oral frailty in geriatric patients in Kerala, India. J Oral Biol Craniofacial Res [Internet]. 2024;14(2):158\u0026ndash;63. Available from: https://doi.org/10.1016/j.jobcr.2024.01.011\u003c/li\u003e\n\u003cli\u003eKwon SH, Park HR, Lee YM, Kwon SY, Kim OS, Kim HY, et al. Difference in food and nutrient intakes in Korean elderly people according to chewing difficulty : using data from the Korea National Health and Nutrition Examination Survey 2013 ( 6th ). 2017;11(2):139\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eYamanashi H, Shimizu Y, Higashi M, Koyamatsu J, Sato S, Nagayoshi M, et al. Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross-sectional study of Japanese community-dwelling older adults. Geriatr Gerontol Int. 2018;18(2):240\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eRamsay SE, Papachristou E, Watt RG, Tsakos G, Lennon LT, Papacosta AO, et al. Influence of Poor Oral Health on Physical Frailty: A Population-Based Cohort Study of Older British Men. J Am Geriatr Soc. 2018;66(3):473\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eZhang Y, Ge M, Zhao W, Hou L, Xia X, Liu X, et al. Association Between Number of Teeth, Denture Use and Frailty: Findings from the West China Health and Aging Trend Study. J Nutr Heal Aging. 2020;24(4):423\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eDe Andrade FB, Lebr\u0026atilde;o ML, Santos JLF, De Oliveira Duarte YA. Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. J Am Geriatr Soc. 2013;61(5):809\u0026ndash;14. \u003c/li\u003e\n\u003cli\u003eCastrej\u0026oacute;n-P\u0026eacute;rez RC, Jim\u0026eacute;nez-Corona A, Bernab\u0026eacute; E, Villa-Romero AR, Arriv\u0026eacute; E, Dartigues JF, et al. Oral Disease and 3-Year Incidence of Frailty in Mexican Older Adults. Journals Gerontol - Ser A Biol Sci Med Sci. 2017;72(7):951\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eKiuchi Y, Makizako H, Nakai Y, Tomioka K, Taniguchi Y, Kimura M, et al. The association between dietary variety and physical frailty in community-dwelling older adults. Healthc. 2021;9(1). \u003c/li\u003e\n\u003cli\u003eHironaka S, Kugimiya Y, Watanabe Y, Motokawa K, Hirano H, Kawai H, et al. Association between oral, social, and physical frailty in community-dwelling older adults. Arch Gerontol Geriatr [Internet]. 2020;89(December 2019):104105. Available from: https://doi.org/10.1016/j.archger.2020.104105\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-ageing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejoa","sideBox":"Learn more about [European Journal of Ageing](http://link.springer.com/journal/10433)","snPcode":"10433","submissionUrl":"https://submission.nature.com/new-submission/10433/3","title":"European Journal of Ageing","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Physical frailty, Oral frailty, Geriatric, Older adults, Healthy Aging, Oral health","lastPublishedDoi":"10.21203/rs.3.rs-4690073/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4690073/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Data on the prevalence of frailty in Kerala is sparse. The objective of this study was to estimate the prevalence of frailty among community-dwelling elderly people in Kerala and explore the sociodemographic factors associated with physical and oral frailty among this population. We further explored the associations between physical and oral frailty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign:\u003c/strong\u003e Community based cross-sectional study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e Cluster sampled area of Thrissur District, Kerala.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants:\u003c/strong\u003e Random sample0 of adults aged 60 years and above, from the cluster sampled\u003c/p\u003e\n\u003cp\u003earea of Thrissur district.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We sampled 1079 community-dwelling adults aged ≥60 years from the Thrissur district of Kerala, using stratified random cluster sampling. Physical frailty was defined and recorded based on Fried’s Frailty Phenotype, Reported Edmonton Frail Scale (REFS), and SARC-F sarcopenia scales. Oral frailty was recorded based on Tanaka measures and Oral and Maxillofacial Frailty Index (OMFI). Logistic regressions with robust standard errors were utilized to examine the associations between socio-demographic determinants and frailty, and between physical frailty and oral frailty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Overall, 35.2% were classified as physically frail and 62.2% as prefrail, while 22% of population had oral frailty. In the unadjusted model, individuals with oral frailty showed greater odds of being physically frail than those without oral frailty. (Crude OR= 1.584, 95% CI=1.157-2.169, p-value= 0.004). This association persisted after controlling for socio demographic variables and number of teeth. (Adjusted OR=1.423,95% CI=1.020-1.987, p value;0.038).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIntegrating the multidisciplinary approaches like oral frailty assessment along with general frailty assessment can promote healthy aging.\u003c/p\u003e","manuscriptTitle":"Prevalence of Physical and Oral Frailty Among the Community Dwelling Geriatric Population -a Cross Sectional Study From South India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 14:57:23","doi":"10.21203/rs.3.rs-4690073/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-07-13T07:51:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-06T06:29:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Journal of Ageing","date":"2024-07-05T06:31:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-journal-of-ageing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejoa","sideBox":"Learn more about [European Journal of Ageing](http://link.springer.com/journal/10433)","snPcode":"10433","submissionUrl":"https://submission.nature.com/new-submission/10433/3","title":"European Journal of Ageing","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"9f064b2e-7c0b-49aa-bba1-397ac46e3ee7","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-08-09T14:57:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-09 14:57:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4690073","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4690073","identity":"rs-4690073","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}