OBJECTIVES: Oral frailty (OF) is defined as a transitional stage between a healthy oral condition and functional decline. The condition is characterized by subtle impairments in oral function and may precipitate physical frailty and long term care need. As a preventive measure against OF, we have developed the Comprehensive Awareness Modification of Mouth, Chewing, and Meal Program (CAMCAM-P) integrated with a social networking service (SNS) portal app. This study examined whether the CAMCAM-P improved OF and reduced care dependency risk (CDR) among community-dwelling older adults in Japan. DESIGN: Single-arm pre-post comparison study. SETTING AND PARTICIPANTS: Community-dwelling adults aged ≥50 years were recruited from 18 regions across Japan to participate in the CAMCAM-P. INTERVENTION: The CAMCAM-P involved a 6-month program consisting of monthly education sessions on oral health and nutrition paired with a "CAMCAM textured lunch", supplemented by information delivery via an SNS app. Participants completed pre- and post-intervention assessments. MEASUREMENTS: Outcome measures included the Oral Frailty Index (OFI-8), Kihon Checklist (KCL), and KCL-based CDR score. Pre-post changes were evaluated using multilevel mixed-effects models with repeated observations nested within individuals, adjusting for baseline sociodemographic, behavioral, and clinical covariates. Mediation analysis using a generalized structural equation model assessed whether OF changes impacted changes in CDR. RESULTS: Of 651 enrolled participants, 518 (median age 72 years, 74.5% women) with complete paired data and were included. OFI-8 scores decreased significantly from 2.56 to 2.27 (p < 0.001). In adjusted multilevel models, post-intervention OFI-8 score (β = -0.29; 95% CI - 0.51 to -0.16; p < 0.001) and CDR score (β = -0.33; 95% CI -0.56 to -0.10; p = 0.006) were significantly lower than pre-intervention scores. Multilevel mediation analysis indicated that changes in OF scores accounted for 30.2% of the total effect of the intervention on the pre-post change in CDR scores (indirect effect -0.10; 95% CI -0.16 to -0.04; p = 0.002). CONCLUSION: CAMCAM-P participation was associated with favorable improvement in OF and CDR in community-dwelling adults, with approximately one-third of this association mediated through changes in OF.
Tanaka et al. (Thu,) studied this question.