Multidimensional frailty assessment integrating physical, mental and oral health: a multicentric study

Frailty is a complex and multidimensional condition commonly observed in older adults and associated with increased risks of falls, hospitalization, disability, and mortality. Traditionally, frailty assessments have focused primarily on physical performance and biomedical parameters. However, emerging evidence highlights the importance of psychological, social, and oral health domains, which are often excluded from standard assessment models. These omissions may limit the accuracy and clinical utility of frailty screening, particularly in diverse aging populations. To evaluate the effectiveness of an extended frailty assessment model with up to 10 predictive variables, including Bite force and the Oral Frailty Index (OFI-8/PT), in distinguishing between levels of frailty (non-frail, pre-frail, and frail), and to compare its performance with traditional models. The sample included 499 community-dwelling older adults (295 from Brazil and 204 from Portugal), aged ≥ 60 years, with at least 20 functional teeth and no cognitive or neurological impairments. Participants underwent functional tests (Timed Up and Go, Sit-to-Stand, handgrip strength), body composition measurements (BMI, body fat percentage, waist-to-hip ratio), psychological assessment (CES-D for depression), physical activity evaluation (IPAQ), Bite force testing (dynamometry), and oral health screening (OFI-8/PT). Discriminant analysis was used to identify which variables best differentiated the frailty groups. Results: In the model with 8 predictors, the main discriminators were the Sit-to-Stand test (STS), handgrip strength, and CES-D depression scores. Discriminant Function 1 (DF1) effectively separated non-frail and frail individuals, while Function 2 (DF2) helped distinguish pre-frail participants. The classification performance of the extended model with 10 variables—adding Bite force and OFI-8/PT—showed no statistically meaningful deterioration, justifying the use of the model with additional predictors of clinical interest. Bite force showed a positive correlation with handgrip strength and a negative correlation with oral frailty scores, indicating its value as an independent functional marker. Including mental and oral health markers significantly enhances frailty assessment models, supporting a more comprehensive and sensitive approach. The 10-variable model proved effective in identifying distinct frailty profiles, highlighting depression and masticatory function as crucial components. These findings emphasize the need for adaptable, integrative assessment tools in geriatric practice, enabling early, individualized interventions and guiding public health strategies to promote healthy aging across diverse cultural settings.