Mouth to Mobility: Oral Frailty as a Predictor for Lower-Limb Decline in Community-dwelling Older Adults

Introduction:

Physical frailty and musculoskeletal decline are significant public health challenges in ageing populations. Although oral health and mobility are often assessed separately, the concept of sarcopenic dysphagia suggests they may be linked. Reduced mastication in older adults may shift diets away from protein-rich foods, lowering protein intake, and accelerating sarcopenia and lower-limb weakness. However, it remains unclear if oral frailty relates to specific domains of physical performance. This study evaluated whether oral frailty predicts domain-specific physical performance in community-dwelling older adults.

Methods:

A cross-sectional analysis used data from community health screenings of adults aged ≥50 years across two urban towns. The analytical cohort included participants with complete oral frailty and musculoskeletal datasets (n = 458). Oral frailty was measured using the 5-item Oral Frailty Checklist (OF-5) and the 8-item Oral Frailty Index (OFI-8). Musculoskeletal performance was assessed using handgrip strength, the Short Physical Performance Battery (SPPB), and the Timed Up and Go (TUG) test. Multivariate linear regression models, adjusted for age and gender, examined associations between oral frailty and each musculoskeletal outcome.

Results:

Our cohort had a mean age of 64.8 ± 9.2 years (62.3% female, 92.2% Chinese). Higher scores were associated with poorer lower-limb performance: higher OFI-8 scores were associated with poorer SPPB scores (β = -0.13, p = 0.0066) and longer TUG times (β = 0.32 seconds/point, p < 0.001), similar to OF-5 (SPPB: β = -0.32, p < 0.001; TUG: β = 0.25, p = 0.042). Conversely, no association was found with handgrip strength (p > 0.50), suggesting oral frailty tracks lower-limb mobility-related decline rather than global muscle strength.

Conclusions:

Oral frailty was a predictor of lower-limb performance and mobility deficits, but not global strength. Oral health questionnaires could be incorporated into community screening programmes to identify older adults at risk of mobility decline.