Oral health and frailty in older people: Perceptions, priorities, and prediction in primary care

The aim of this thesis is twofold. First, we aimed to gain an understanding of perspectives, priorities, and needs of older people themselves and stakeholders (like caregivers, health professionals and insurance companies) concerning oral health (care), and to provide tools for non-dental healthcare professionals to assess the oral cavity. Second, we aimed to gain an understanding of associations between oral health and frailty, and if oral health indicators contribute to the prediction of adverse outcomes of frailty (nursing home admission or death) in community-dwelling older people. Despite the fact that the majority of our study participants experienced little to no oral health problems, older people indicated that oral health is important to maintain dignity and autonomy. We also concluded that there is a need for more awareness of the importance of oral health in older people at risk for frailty among non-dental healthcare professionals.
Our systematic review on oral health assessments for use by non-dental health professionals in older people showed that the Oral Health Assessment Tool (OHAT) and Revised Oral Assessment Guide (ROAG) are most complete in their included oral health items and are of best methodological quality in combination with positive quality criteria on their measurement properties.
Cross-sectional analyses revealed that dental emergency visits and self-reported oral health problems were associated with frailty, as measured by frailty based on Electronical Medical Record data, and the Groningen Frailty Indicator. However, our analysis demonstrated that after 2-year follow-up, oral health indicators did not increase the accuracy of frailty prediction.