Development of Guidelines on the Primary Prevention of Frailty in Community-Dwelling Older Adults.

BACKGROUND: Despite the increasing number of older adults as the population ages, there is a lack of frailty prevention guidelines for community-dwelling older adults. The Korean Frailty and Aging Cohort Study conducted systematic review on contributors to frailty and developed guidelines on the primary prevention of frailty in community-dwelling older adults. METHODS: This study updated a previous systematic review of contributors to frailty by adding the most recent articles. Based on this updated systematic review, experts in geriatrics and gerontology developed guidelines for preventing frailty using the Delphi method. RESULTS: These guidelines categorized the recommendations into physical activity, resilience, oral health, management of non-communicable diseases, involvement in society, smoking cessation, and eating various kinds of food. CONCLUSION: Unlike previous frailty-related guidelines, this study developed evidence-based frailty prevention guidelines based on a systematic review. The guidelines are expected to contribute to the healthy aging of community-dwelling older adults by the primary prevention of frailty.

Dietary Patterns and Frailty in Older Korean Adults: Results from the Korean Frailty and Aging Cohort Study.

There are few studies on dietary patterns and frailty in Asians, and the results are controversial. Therefore, this study examined the association between dietary patterns and frailty in older Korean adults using the Korean Frailty and Aging Cohort Study (KFACS). The sample consisted of 511 subjects, aged 70-84 years, community-dwelling older people from the KFACS. Dietary data were obtained from the baseline study (2016-2017) using two nonconsecutive 24-h dietary recalls, and dietary patterns were extracted using reduced rank regression. Frailty was measured by a modified version of the Fried Frailty Phenotype (FFP) in both the baseline (2016) and the first follow-up study (2018). A logistic regression analysis was used to examine the association between dietary patterns and frailty status in 2018. The "meat, fish, and vegetables" pattern was inversely associated with pre-frailty (OR = 0.41, 95% CI = 0.21-0.81, p for trend = 0.009) and exhaustion (OR = 0.41, 95% CI = 0.20-0.85, p for trend = 0.020). The "milk" pattern was not significantly associated with frailty status or the FFP components. In conclusion, a dietary pattern with a high consumption of meat, fish, and vegetables was associated with a lower likelihood of pre-frailty.

Relationships between cognitive function and frailty in older Korean adults: The moderating effect of the number of teeth.

BACKGROUND: Cognitive function and physical frailty are known to be closely related. Among older adults with dementia, those who wear dentures have a higher mortality rate than those who do not wear them. This suggests the possibility that oral health may affect the cognitive-frailty relationship. This study aims to investigate whether the number of teeth present, acts as a moderating variable in the cognitive function-frailty relationship. METHODS: Data were obtained from the cross-sectional baseline study of the Korean Frailty Aging Cohort Study (2016-2017). Cognitive function was assessed using the Mini-Mental State Examination. Frailty score was based on the Cardiovascular Health Study Index. Oral condition was evaluated by the number of teeth present and analyzed using categories of 0-9 teeth, 10-19 teeth, and ≥20. The moderation effect was analyzed using the ordinary least squares (OLS) regression. RESULTS: Data on 2,310 older adults (1,110 men; mean age 75.9 ± 3.9 years) was analyzed. Adjusting for age, sex, income, education, alcohol drinking, body mass index, and number of comorbidities, cognitive function and frailty showed a negative association (B=-.030, p = .011). In the 10-19 teeth category, compared to the 0-9 teeth category, a negative association with frailty was found (B=-.152, p = .026). A significant interaction effect between the number of teeth and cognitive function was detected (p = .007). CONCLUSION: The number of teeth may modify the degree of the association between cognitive function and frailty. For effective frailty management of older persons, cognitive function management and oral management should be considered and performed together.

The Predictive Value of Social Frailty on Adverse Outcomes in Older Adults Living in the Community.

OBJECTIVES: Older people are often socially deprived, which may predispose them to frailty. The aim of the study was to identify the independent effects of social deficits and their combined effects with frailty ("social frailty") in predicting functional decline, institutionalization, and mortality in older adults living in the community. DESIGN: Longitudinal study with a 3-year follow-up. SETTING AND PARTICIPANTS: A nationally representative sample of community-dwelling older people aged 65 years or older in South Korea (N = 11,241). METHODS: Social deficits were defined as deficiencies in socioeconomic status, living situation, social network size, contact with social networks, social support, and social activities. The number of social deficits was categorized as none (0), low (1-2), and high (3 or more), based on the summated score. Frailty status was defined using the Fried criteria. Cox proportional hazards model was used to analyze the effects of the increasing levels of social deficits on functional decline, institutionalization, and mortality. The combined effects of both social deficits and physical frailty were also assessed, controlling for covariates. RESULTS: The prevalence of frailty was 7.7%, with 49.1% being prefrail at baseline. Overall, the presence of social deficits tended to elevate the risk of adverse outcomes, where acquiring 1 social deficit was associated with an 11% to 27% increase in their risks. In the multivariable analysis, those with a high level of social deficits demonstrated a significantly elevated mortality risk [hazard ratio (HR) = 1.45, 95% confidence interval (CI): 1.07, 1.97). There was a trend toward increasing hazards when social deficits were combined with physical frailty, with the group having a high level of social deficits and being frail exhibiting the highest mortality risk (HR = 3.14, 95% CI: 1.81, 5.46). CONCLUSIONS AND IMPLICATIONS: Social adversity independently predicted mortality. When combined with physical frailty, an accumulation of social deficits increased the predictive value.

Association Between Dental Implants and Cognitive Function in Community-dwelling Older Adults in Korea.

OBJECTIVES: This study aimed to evaluate the association between dental implants and cognitive function in community-dwelling older adults. METHODS: Data were collected from the baseline survey (2016-2017) of the Korean Frailty and Aging Cohort Study. The study sample comprised 1115 community-dwelling people aged 70 years to 84 years who had 0-19 natural teeth. Dental implants and natural teeth were identified by panoramic radiography, while the cognitive function was assessed by the Korean version of the Mini-Mental State Examination (MMSE-KC). The association between dental implants and cognitive function was analyzed by multiple linear regression. Sensitivity analysis was performed to test for potential bias. RESULTS: The mean number of natural teeth in the study population was 9.50 (standard deviation [SD], 6.42), and the mean MMSE-KC score was 24.93 (SD, 3.55). In the simple univariate analysis, tooth replacement, age, sex, smoking status, alcohol consumption, body mass index, osteoporosis, number of natural teeth, periodontitis, chewing discomfort, tooth-brushing frequency, education level, monthly household income, participation in economic activity, living alone, and marital status had a significant impact on the association. After adjusting for confounders, the association between dental implants and cognitive function remained significant (B, 0.85; standard error, 0.40; p<0.05). Age, body mass index, periodontitis, tooth-brushing frequency, and education level were also significantly associated with cognitive function. The results of the sensitivity analyses were consistent with those of the primary analysis. CONCLUSIONS: Dental implants were associated with cognitive function in older adults living in the community. Dental implants as tooth replacements may play a role in preserving cognitive function.