Influence of Oral Health on Frailty in Patients with Type 2 Diabetes Aged 75 Years or Older

Background Poor oral health conditions are known to affect frailty in the elderly. Diabetes is a risk factor for both poor oral health and frailty, and, therefore, oral health status may affect frailty in diabetic patients more than in the general population. The purpose of this study was to evaluate the influence of oral health on frailty in elderly patients with type 2 diabetes. Methods Patients with type 2 diabetes aged 75 years or older were included in this retrospective study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty score categories were evaluated. Results Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 12 cases (4.5 %) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were found to be factors influencing pre-frailty or frailty. In the evaluation of individual frailty score categories, BMI only had an influence on those with a frailty score ≤ 2. The cognitive and living functions score was a factor influencing those with frailty scores ≤ 3. The oral frailty index was found to have a significant influence on all frailty score categories. Conclusion Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥ 75. In this patient population, as frailty progresses, the impact of oral health on frailty may increase. Trial registration: This study was retrospectively registered in UMIN-CTR (UMIN000044227).

Influence of Oral Health on Frailty in Patients With Type 2 Diabetes Aged 75 Years or Older

Background: The purpose of this study was to evaluate the influence of oral health on frailty in elderly patients with type 2 diabetes.Methods: Patients with type 2 diabetes aged 75 years or older were included in this retrospective study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty score categories were evaluated. Results: Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 5 cases (4.5 %) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were factors influencing pre-frailty or frailty. In the evaluation by individual frailty score categories, BMI was found to only influence those with a frailty score ≤2. The cognitive and living functions score was a factor influencing those with frailty scores ≤3. The oral frailty index was found to have a significant influence on all frailty score categories.Conclusion: Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥75. The management of oral health is an important consideration in the prevention of the frailty of elderly patients with diabetes.

The Heritability of CHD Mortality in Danish Twins After Controlling for Smoking and BMI

Cause-specific mortality data on Danish monozygotic and dizygotic twins are used to analyze heritability estimates of susceptibility to coronary heart disease (CHD) after controlling for smoking and Body Mass Index (BMI). The sample includes 1209 like-sexed twin pairs born between 1890 and 1920, where both individuals were still alive in 1966. The participants completed a questionnaire in 1966 which included questions on smoking, height and weight. The analysis was conducted with both sexes pooled due to the relatively small number of twin pairs. Follow-up was conducted from January 1, 1966 to December 31, 1993. The correlated gammafrailty model with observed covariates was used for the genetic analysis of frailty to account for censoring and truncation in the lifetime data. During the follow-up, 1437 deaths occurred, including 435 deaths due to CHD. Proportions of variance of frailty attributable to genetic and environmental factors were analyzed using the structural equation model approach. Different standard biometric models are fitted to the data to evaluate the magnitude and nature of genetic and environmental factors on mortality. Using the best-fitting model without covariates, heritability of frailty to CHD was found to be 0.45 (0.11). This result changes only slightly to 0.55 (0.13) in a DE model after controlling for smoking and BMI. This analysis underlines the existence of a substantial genetic influence on individual frailty associated with mortality caused by CHD.

Genetic nature of individual frailty: comparison of two approaches

The traditional frailty models used in genetic analysis of bivariate survival data assume that individual frailty (and longevity) is influenced by thousands of genes, and that the contribution of each separate gene is small. This assumption, however, does not have a solid biological basis. It may just happen that one or a small number of genes makes a major contribution to determining the human life span. To answer the questions about the nature of the genetic influence on life span using survival data, models are needed that specify the influence of major genes on individual frailty and longevity. The goal of this paper is to test the nature of genetic influences on individual frailty and longevity using survival data on Danish twins. We use a new bivariate survival model with one major gene influencing life span to analyse survival data on MZ (monozygotic) and DZ (dizygotic) twins. The analysis shows that two radically different classes of model provide an equally good fit to the data. However, the asymptotic behaviour of some conditional statistics is different in models from different classes. Because of the limited sample size of bivariate survival data we cannot draw reliable conclusions about the nature of genetic effects on life span. Additional information about tails of bivariate distribution or risk factors may help to solve this problem. Twin Research (2000) 3, 51–57.

Making One Family out of Strangers: Re-Imagining the Catholic Church

In order to renew the Catholic Church, we need to re-imagine it as inclusive rather than exclusive, as offering to each of us, in community, healing for our shared neediness. Out of our individual frailty a whole community can be re-imagined, particularly in the context of worship and eucharistic sharing.