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Frailty, Old Age, and Their Link to Periodontal Diseases - An Overview

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Read this article to learn about the impact of aging and its consequences on periodontal health, especially in individuals suffering from systemic diseases.

Medically reviewed by

Dr. Durgapriya M

Published At April 13, 2023
Reviewed AtAugust 18, 2023

Introduction

Frailty is a critical condition of aged people increasing the risk for various systemic conditions. There is an association between frailty, gum diseases, and aging. Frailty and periodontal diseases are a two-way relationship and It is an impact of aging. Several chronic conditions are usually seen in older populations and predispose an individual to low periodontal immunity because of several risk factors.

How Are Frailty and Periodontal Disease Linked?

The term frailty refers to being weak and delicate. Frailty is a clinical condition that is seen globally in most older adults. This is rather an age-related phenomenon that increases the risk of adverse health outcomes leading to mortality risks. Hence, current scientific research is further investigating the bi-directional relationship between periodontal disease and the age-related phenomenon of frailty.

The presence of co-morbid systemic diseases due to age would result in poor physical functioning. Systemic disease status is now directly related to periodontal disease according to medical research. The following conditions are increasingly associated with the rising risk for oral diseases and vice versa.

  • Individuals who are suffering from immunocompromised conditions.

  • Patients under systemic medications.

  • Rheumatoid arthritis.

  • Diabetes.

  • Crohn's disease (a chronic inflammatory bowel disorder).

  • Inflammatory bowel diseases.

  • Blood dyscrasias (blood-related conditions).

  • Hypertension.

  • Cancers.

Currently, various research and studies are undergoing to assess the potential link between Alzheimer’s patients and individuals who suffer from periodontal diseases. Clinical findings of the above-mentioned conditions are indeed globally useful in signifying the direct link between oral and systemic health. This is particularly more noted in older Individuals as a result of frailty that occurs because of aging.

Also, these Individuals may have limited ability for self-care which in turn can initiate a sequence of events such as inflammatory dysregulation, age-related pathophysiological changes, and eventually their progression predisposing them to systemic health conditions. It is important to study the age-related changes in oral immune cells that would give dental clinicians and researchers an insight into the understanding of age-related diseases and their therapeutic management strategies so that they can effectively reduce periodontal disease in frail or aged population groups.

What Is the Frailty Phenotype?

The frailty phenotype defines frailty not just as a phenomenon but rather as a clinical syndrome. The frailty phenotype is characterized based on an individual’s suffering from one or more of the age-related characteristics. The following criteria are used in the characterization of the frailty phenotype.

  • Unintentional weight loss or age-related weight decline.

  • Exhaustion, malaise, or fatigue is reported by the individual as a chief or clinical complaint.

  • Bodily weakness or weak grip, low strength.

  • Reduced walking speed.

  • Inability to exercise or low physical activity.

Only when an individual has three or more of these criteria, they are identified as frail Individuals. If the number of characteristics mentioned above are less noticeable, then it denotes that the Individual does not suffer from frailty and is just undergoing the natural age-related physiologic changes that happen in the body.

Frailty becomes more common usually with increasing age. Case reports of frailty demonstrate that the widespread prevalence of frailty is around four percent in those who are 60 to 65 years old. 16 percent of individuals with frailty are aged between 80 to 84 years and approximately around 26 percent of those are greater than 85 years old. This data is in reference to the global health status of community-dwelling aged populations.

Why Is Periodontal Disease a Growing Concern Amongst Aged People?

Periodontal disease is of concern in older adults because of the following reasons:

  • Age-associated physiologic root caries.

  • Tooth loss or mobility.

  • Reduced or worsening masticatory inefficiency directly impacts the nutrition status and speech of the older individual.

  • The impact on the patient’s psychosocial abilities due to reduced esthetic or dental functionality.

  • The impact of periodontal disease on systemic health is more concerning amongst the older populations because they are directly or indirectly correlated to many systemic diseases.

  • Periodontal disease markers demonstrate an association with increased systemic inflammation in the body which would be a sign of cardiovascular diseases, poor or reduced nutritional status, cognitive decline, disability as well as decreased physical functions and other comorbidities.

Frailty not only influences but also increases the risk of oral diseases in these predisposed population groups. Systemic conditions like diabetes mellitus and arthritis are also more commonly prevalent in frail older people. In both diabetes and arthritis, the common link is periodontal disease in most cases. Various research and studies have also examined the direct influence of periodontal disease on the risk of developing frailty in an aged individual. This occurs because of lowered immune defenses, an increase in bacterial ingress, or pathologic species that infiltrate the oral microbiome leading to systemic disease processes.

Several research studies are currently focused on periodontal disease causing tooth loss, chewing or masticatory difficulties, orofacial pain, dental caries, occlusion forces, etc. These detrimental effects are mostly impacting the frailty of the elderly.

Conclusion

In the current scenario, because of the global increase in lifespan and the reduced mortality rates linked with age due to the advent of medical technology, the global statistics of the aged and the frail population is increasing in numbers. This makes the aged population group the most suffering from periodontal disease and severe compromise both in dental function and esthetics. Therefore there is a growing need for dental healthcare professionals or dentists to communicate with the frail or aged population groups and implement timely strategies to prevent the risk of systemic infections in these individuals. Oral awareness, timely dental management, and regular dental follow-ups with the dentist may not only improve oral and systemic health but also improves the quality of life in older people.

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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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periodontal gum diseaseolder adults
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