国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (2): 155-165.doi: 10.7518/gjkq.2026118

• 专家笔谈 • 上一篇    

老年人口腔衰弱：从概念到干预的全面述评

刘畅(),杜民权()   

  1. 口颌系统重建与再生全国重点实验室 口腔生物医学教育部重点实验室 口腔医学湖北省重点实验室 武汉大学口腔医院预防科 武汉 430079
  • 收稿日期:2025-08-01 修回日期:2025-11-25 出版日期:2026-03-01 发布日期:2026-02-13
  • 通讯作者: 杜民权
  • 作者简介:刘畅，博士，武汉大学口腔医学院主任医师，副教授，湖北省首批健康科普专家，中华口腔医学会口腔预防医学专业委员会和教育专业委员会委员，湖北省口腔医学会口腔预防专业委员会和教育专业委员会常务委员。湖北省女医师协会第5届理事。中国牙病防治基金会《康复健康口腔》杂志专栏主编。首届中部口腔医学教育联盟副秘书长。从事口腔预防医学的临床、教学、科研和科普工作。发表中英文论文30余篇，主持国家级、省级和校级等科研项目10余项，获批专利4项，参编论著3部。|刘畅，主任医师，博士，Email：liuc0728@whu.edu.cn|杜民权，博士，教授，主任医师，博士研究生导师。武汉大学口腔医学院预防科主任，兼任中华口腔医学会口腔预防医学专业委员会副主任委员、中华预防医学会口腔卫生保健专业委员会副主任委员、湖北省口腔医学会口腔预防专业委员会主任委员。国家医学考试中心试题专家、“十四五”规划教材《口腔预防医学》第8版副主编。《口腔医学研究》《口腔疾病防治》编委。主要从事口腔预防医学的教学、科研、临床和社区预防保健工作。承担国家及省级科研课题，参与国家科技支撑计划和原卫生部公益行业专项基金等项目，并与丹麦哥本哈根大学牙学院、英国伦敦大学牙学院和荷兰奈梅京大学牙学院等多所大学开展国际合作研究。以第一作者和通信作者发表论文100余篇，其中被《科学引文索引》（science citation index，SCI）数据库收录论文60余篇。
  • 基金资助:
    中国牙病防治基金会项目(ZS202501);2025大学生创新创业项目(S202510486504)

Oral frailty in the elderly: comprehensive review from concept to intervention

Chang Liu(),Minquan Du()   

  1. State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, Dept. of Preventive Dentistry, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
  • Received:2025-08-01 Revised:2025-11-25 Online:2026-03-01 Published:2026-02-13
  • Contact: Minquan Du
  • Supported by:
    Project of China Oral Health Foundation(ZS202501);2025 College Students’ Innovation and Entrepreneurship Project(S202510486504)

RichHTML

2

PDF (PC)

5

摘要：

全球人口老龄化进程加速，老年人口腔健康问题凸显，口腔衰弱（OF）作为新兴的老年综合征，与全身健康存在显著的双向关联，严重影响老年人的功能状态和生活质量。本文系统综述了OF的概念、流行病学现状、标准化评估工具及多学科干预策略，并对未来研究方向提出展望，以期为临床实践和科学研究提供全面的参考依据。

关键词: 老龄化, 口腔衰弱, 评估工具, 综合干预

Abstract:

With the rapid increase in global aging population, oral health challenges among older adults require attention. As an emerging geriatric syndrome, oral frailty (OF) exhibits significant bidirectional associations with systemic health, severely influencing the functional status and quality of life among the elderly. This article presents a comprehensive review of the concept of OF, its epidemiological status, standardized assessment tools, and multidisciplinary intervention strategies. It outlines future research directions to offer comprehensive insights for clinical practice and scientific studies.

Key words: aging, oral frailty, assessment tool, comprehensive intervention

中图分类号: 

  • R787

图 1

OF的危险因素"

图 2

OF——身体衰弱路径"

图 3

OF——社会心理路径"

表 1

OF工具"

名称内容标准应用局限性
OF-6[5]

1）牙数减少（<20颗）；

2）咀嚼力减弱（男性<14.2，女性<10.8）；

3）舌压降低（男性<27.4 kPa，女性<26.5 kPa）；

4）发音技能减退（男性<5.2次/s，女性<5.4次/s）；

5）主观进食硬食物困难：询问“与半年前相比吃硬的东西是否比较困难”，若答“是”，则为阳性；

6）主观吞咽流质食物困难：询问“喝茶或汤是否会呛”，若答“是”则为阳性

符合1~2项指标为OF前期，3项及以上指标为OF用于快速筛查老年人OF情况；国外常用

1）需要专业的仪器和牙科卫生人员，耗时长，不易在社区普及进行大样本调查；

2）该量表主要基于日本老年人群开发，其跨文化适用性及对其他国家和地区老年人群的适用程度仍需后续研究验证

OFI-8[8]

1）与6个月前相比吃硬食物更困难；

2）最近喝茶喝汤会出现呛咳；

3）使用义齿；

4）经常感到口干；

5）外出次数是否比半年前少；

6）不能够咀嚼硬食物；

7）不是每天至少刷牙2次；

8）不是每年至少看1次牙医

前3项每项2分，其余5项每项1分，总分11分，≤2分为低风险，3分为中风险，≥4分为高风险即OF。量表评分每增加1分，就会导致OF发病率升高至原来的2.3倍，残疾发生风险提升至2.1倍

1）汉化OFI-8的信效度较好；

2）操作简易，无设备依赖；

3）筛查时效性；

4）场景适配度高；

5）中国最常用OFI-8

缺乏客观指标，若需确切诊断口腔问题，需更精确、更客观的口腔功能数据评估指标
OF-5[7]

1）牙数减少（<20颗）；

2）与6个月前相比吃硬食物更困难；

3）最近喝茶喝汤会呛咳；

4）经常感到口干；

5）最近在发音清晰方面遇到困难，如果条件允许，测量重复发音（“ta”）频率

2项及以上即可诊断，发音（“ta”）频率<6.0次/s对身体虚弱、身体残疾和死亡率具有很强的预测效度，用于确定OF的患病率及其与多种不良健康结局相关性需要考虑地区差异
OMFI[36]

1）咀嚼困难；

2）进食干硬食物时需饮水；

3）下颌及舌运动困难；

4）语音障碍；

5）不能做面部表情

每个条目1~4分，分数越高表示口腔及颌面衰弱情况越严重具有良好的效度和信度，主要关注评估口腔及颌面部的功能，涵盖口腔干燥、牙齿状况及颌面部肌力等，详细评估口腔和颌面部的功能状态，并包括多个与OF相关的具体指标

1）该量表对吞咽功能及牙齿、舌头等部位的健康状况评估不足；

2）评估内容较为复杂，耗时长，需要专业操作

韩国老年牙科学会（Korean Academy of Geriatric Dentistry，KAGD）OF诊断量表[32]

1）咀嚼能力：通过咀嚼变色口香糖获得的色卡值被判定为1级或2级；

2）咬合力：使用Dental Pre-scaleⅡ?测量的咬合力低于500 N；

3）舌压：通过JMS舌压仪?测得的最大舌压低于30 kPa；

4）口腔干燥度：使用Mucus?仪器测得数值低于27.0；

5）吞咽困难：改良饮水测试得分≤3分；

6）口腔卫生：口腔健康评价工具（oral health assessment tool，OHAT）评分≥2分

2项及以上为OF该筛查问卷筛查OF具有显著效力（受试者工作特征曲线下面积为0.783；敏感性为87.8%；特异性为52.5%），诊断标准诊断准确性可接受（敏感性为95.1%；特异性为42.4%）诊断需要工具，耗时长

表 2

OF干预的口腔功能训练方法"

名称作用方法适用人群
张口训练[39]增强口腔肌肉灵活性和力量尽可能张大嘴保持10 s，休息10 s，早晚各2次，共5周期/d咀嚼、发音或吞咽困难者，尤其推荐给30 s内重复唾液吞咽试验（repeated saliva swallowing test，RSST）评分<3分者
舌压（抗阻）训练[39,42]可增强舌骨上肌群力量，显著提升舌压、吞咽功能及舌唇协调性，改善OF状态

1）器械辅助训练：使用硅胶舌压训练器推压硬腭，使器械头部受压塌陷保持后复位，每日训练3组（每组5次）；

2）徒手训练：用力推舌抵上腭维持10 s（10次/组，2组/d），或结合舌部定向旋转（左/上/右/下）及吞咽练习（3组/次，2次/d，每周3 d），持续12周

吞咽/发音困难或颞下颌关节症状者，舌压<30 kPa者
韵律训练[39]最大化唇舌运动，改善舌骨运动、舌压和食管上括约肌宽度快速清晰响亮地发/ma/、/ba/、/ta/、/te/、/ka/音，每日2次，每次5遍口头轮替运动速率<6次/s者适宜
咀嚼训练[39]提升咀嚼能力，改善OF

1）直立状态下早晚咀嚼无糖口香糖，先节律性咀嚼2 min，后自由咀嚼3 min，持续12周；

2）每月1次的特殊粗制午餐（选用坚硬或粗糙的谷类、果蔬配料，切成大块，缩短烹饪时间并减少用水量），连续6个月

牙龈测试评分<3分者
[1] Zhu SR, Feng XJ, Zheng WK, et al. Unfavourable outcomes in older adults with oral frailty: a scoping review[J]. Clin Interv Aging, 2024, 19: 1979-1995.
[2] Huang PP, Wu LJ, Zhang RX, et al. Systematic review and meta-analysis on the prevalence and risk factors of oral frailty among older adults[J]. Front Med (Lausanne), 2025, 12: 1512927.
[3] Kugimiya Y, Watanabe Y, Ueda T, et al. Rate of oral frailty and oral hypofunction in rural community-dwelling older Japanese individuals[J]. Gerodonto-logy, 2020, 37(4): 342-352.
[4] Tanaka T, Hirano H, Ikebe K, et al. Consensus statement on “oral frailty” from the Japan geriatrics so-ciety, the Japanese society of gerodontology, and the Japanese association on sarcopenia and frailty[J]. Geriatr Gerontol Int, 2024, 24(11): 1111-1119.
[5] Tanaka T, Takahashi K, Hirano H, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly[J]. J Gerontol A Biol Sci Med Sci, 2018, 73(12): 1661-1667.
[6] Parisius KGH, Wartewig E, Schoonmade LJ, et al. Oral frailty dissected and conceptualized: a scoping review[J]. Arch Gerontol Geriatr, 2022, 100: 104653.
[7] Tanaka T, Hirano H, Ikebe K, et al. Oral frailty five-item checklist to predict adverse health outcomes in community-dwelling older adults: a Kashiwa cohort study[J]. Geriatr Gerontol Int, 2023, 23(9): 651-659.
[8] Tanaka T, Hirano H, Ohara Y, et al. Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwel-ling older adults[J]. Arch Gerontol Geriatr, 2021, 94: 104340.
[9] Li T, Shen YL, Leng YJ, et al. The prevalence of oral frailty among older adults: a systematic review and meta-analysis[J]. Eur Geriatr Med, 2024, 15(3): 645-655.
[10] Zhou YT, Zhou L, Zhang W, et al. Prevalence and influencing factors of oral frailty in older adults: a systematic review and meta-analysis[J]. Front Public Health, 2024, 12: 1457187.
[11] Dou JK, Liu H, Mei Y, et al. Prevalence of oral frailty in community-dwelling older adults: a systematic review and meta-analysis[J]. Front Public Health, 2025, 13: 1423387.
[12] Ayoob A, Janakiram C. Prevalence of physical and oral frailty in geriatric patients in Kerala, India[J]. J Oral Biol Craniofac Res, 2024, 14(2): 158-163.
[13] Dou JK, Liu H, Min JH, et al. Prevalence and associated factors with oral frailty in middle-aged and older hospitalized patients: a cross-sectional study[J]. Front Public Health, 2025, 13: 1446862.
[14] Iwasaki M, Shirobe M, Motokawa K, et al. Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: results from the Oral Frailty 5-Item Checklist[J]. Ge-riatr Gerontol Int, 2024, 24(4): 371-377.
[15] Zhu SR, Wei LY, Jia K, et al. Prevalence and unfavourable outcome of oral frailty in older adult: a systematic review and meta-analysis[J]. Front Public Health, 2024, 12: 1501793.
[16] Yang CC, Chen HT, Iijima K, et al. Establishment of a mandarin Chinese version of the oral frailty index-8 and exploration of the association between oral frailty and sarcopenia[J]. Geriatrics (Basel), 2025, 10(2): 47.
[17] Yin YH, Zhao Y, Fei Y, et al. Epidemiology and risk factors of oral frailty among older people: an observational study from China[J]. BMC Oral Health, 2024, 24(1): 368.
[18] Dong XH, Chen DF, Peng WL, et al. Meta-analysis of risk factors for oral frailty in older adults[J]. Ge-riatr Nurs, 2025, 62(Pt A): 7-12.
[19] Ramsay SE, Papachristou E, Watt RG, et al. In-fluence of poor oral health on physical frailty: a po-pulation-based cohort study of older British men[J]. J Am Geriatr Soc, 2018, 66(3): 473-479.
[20] Zupo R, Castellana F, Bortone I, et al. Nutritional domains in frailty tools: working towards an operational definition of nutritional frailty[J]. Ageing Res Rev, 2020, 64: 101148.
[21] Sacha J, Sacha M, Soboń J, et al. Is it time to begin a public campaign concerning frailty and pre-frailty? A review article[J]. Front Physiol, 2017, 8: 484.
[22] Tsakos G, Sabbah W, Chandola T, et al. Social re-lationships and oral health among adults aged 60 years or older[J]. Psychosom Med, 2013, 75(2): 178-186.
[23] Corovic S, Janicijevic K, Radovanovic S, et al. Socioeconomic inequalities in the use of dental health care among the adult population in Serbia[J]. Front Public Health, 2023, 11: 1244663.
[24] Huang CR, Shi GC. Smoking and microbiome in oral, airway, gut and some systemic diseases[J]. J Transl Med, 2019, 17(1): 225.
[25] Carra MC, Schmitt A, Thomas F, et al. Sleep disorders and oral health: a cross-sectional study[J]. Clin Oral Investig, 2017, 21(4): 975-983.
[26] Park J, Choi J, Kim JE, et al. Network of biomar-kers and their mediation effects on the associations between regular exercise and the incidence of cardiovascular & metabolic diseases[J]. Sci Rep, 2021, 11(1): 12802.
[27] Adam M, Wooton J. Menopause and oral health[J]. Br Dent J, 2022, 233(3): 170.
[28] Soysal P, Stubbs B, Lucato P, et al. Inflammation and frailty in the elderly: a systematic review and meta-analysis[J]. Ageing Res Rev, 2016, 31: 1-8.
[29] Chen YC, Ku EN, Tsai PF, et al. The relationship between oral frailty and oral dysbiosis among hospita-lized patients aged older than 50 years[J]. Clin Exp Dent Res, 2024, 10(3): e890.
[30] Minakuchi S, Tsuga K, Ikebe K, et al. Oral hypofunction in the older population: position paper of the Japanese society of gerodontology in 2016[J]. Gerodontology, 2018, 35(4): 317-324.
[31] Sewo Sampaio PY, Sampaio RAC, Yamada M, et al. Systematic review of the kihon checklist: is it a re-liable assessment of frailty[J]. Geriatr Gerontol Int, 2016, 16(8): 893-902.
[32] Kang JH, Park SC, Jung HI, et al. Validation of the Korean Academy of Geriatric Dentistry screening questionnaire and oral frailty diagnostic criteria in community-dwelling older adults[J]. Epidemiol Health, 2024, 46: e2024008.
[33] Yang C, Li XK, An R, et al. Oral frailty assessment tool: instrument development and cross-sectional validation study[J]. J Oral Rehabil, 2025, 52(10): 1608-1618.
[34] Huang HL, Matsuo K, Huang ST, et al. Chinese version of the oral frailty five-item checklist[J]. Geriatr Gerontol Int, 2025, 25(5): 709-710.
[35] 陈宗梅, 谭莹, 梁远俊, 等. 老年人口腔衰弱筛查量表的汉化及信效度检验[J]. 护理研究, 2023, 37(21): 3808-3812.
Chen ZM, Tan Y, Liang YJ, et al. Translation and validation of the Chinese version of the Oral Frailty Screening Scale in elderly population[J]. Chin Nurs Res, 2023, 37(21): 3808-3812.
[36] Choi JH, Kang JH, Koh SB, et al. Development of an oral and maxillofacial frailty index: a preliminary study[J]. J Oral Rehabil, 2020, 47(2): 187-195.
[37] Suzuki R, Nagano A, Wakabayashi H, et al. Assignment of dental hygienists improves outcomes in Ja-panese rehabilitation wards: a retrospective cohort study[J]. J Nutr Health Aging, 2020, 24(1): 28-36.
[38] 丁治国, 孟庆慧, 唐鲁, 等. 美日荷三国口腔卫生士发展现状及对我国护理的启示[J]. 解放军护理杂志, 2020, 37(6): 54-57.
Ding ZG, Meng QH, Tang L, et al. Development status of dental hygienists in the United States, Japan, and the Netherlands and its enlightenment to nur-sing in China[J]. Nurs J Chin PLA, 2020, 37(6): 54-57.
[39] Shirobe M, Watanabe Y, Tanaka T, et al. Effect of an oral frailty measures program on community-dwel-ling elderly people: a cluster-randomized controlled trial[J]. Gerontology, 2022, 68(4): 377-386.
[40] Ibayashi H, Fujino Y, Pham TM, et al. Intervention study of exercise program for oral function in heal-thy elderly people[J]. Tohoku J Exp Med, 2008, 215(3): 237-245.
[41] Sugiyama T, Ohkubo M, Honda Y, et al. Effect of swallowing exercises in independent elderly[J]. Bull Tokyo Dent Coll, 2013, 54(2): 109-115.
[42] Wakabayashi H, Matsushima M, Momosaki R, et al. The effects of resistance training of swallowing mu-scles on dysphagia in older people: a cluster, rando-mized, controlled trial[J]. Nutrition, 2018, 48: 111-116.
[43] Satake A, Kobayashi W, Tamura Y, et al. Effects of oral environment on frailty: particular relevance of tongue pressure[J]. Clin Interv Aging, 2019, 14: 1643-1648.
[44] 麻红梅, 邓璐, 李月美, 等. 口腔健康与老年衰弱相关性的Meta分析[J]. 中华老年口腔医学杂志, 2024, 22(4): 230-235.
Ma HM, Deng L, Li YM, et al. Association between oral health and frailty in older adults: a Meta-analysis[J]. Chin J Geriatr Dent, 2024, 22(4): 230-235.
[45] Horibe Y, Ueda T, Watanabe Y, et al. A 2-year longitudinal study of the relationship between masticatory function and progression to frailty or pre-frailty among community-dwelling Japanese aged 65 and older[J]. J Oral Rehabil, 2018, 45(11): 864-870.
[46] Kashiwazaki K, Komagamine Y, Wu SL, et al. Improvements in maximum bite force with gum-che-wing training in older adults: a randomized control-led trial[J]. J Clin Med, 2023, 12(20): 6534.
[47] Kashiwazaki K, Komagamine Y, Uehara Y, et al. Effect of gum-chewing exercise on maintaining and improving oral function in older adults: a pilot randomized controlled trial[J]. J Dent Sci, 2024, 19(2): 1021-1027.
[48] Hidaka R, Masuda Y, Ogawa K, et al. Impact of the comprehensive awareness modification of mouth, chewing and meal (CAMCAM) program on the attitude and behavior towards oral health and eating habits as well as the condition of oral frailty: a pilot study[J]. J Nutr Health Aging, 2023, 27(5): 340-347.
[49] Park HS, Nam HS, Seo HS, et al. Change of pe-riodontal inflammatory indicators through a 4-week weight control intervention including caloric restriction and exercise training in young Koreans: a pilot study[J]. BMC Oral Health, 2015, 15(1): 109.
[50] Shimizu A, Fujishima I, Maeda K, et al. Nutritional management enhances the recovery of swallowing ability in older patients with sarcopenic dysphagia[J]. Nutrients, 2021, 13(2): 596.
[51] Dupont J, Dedeyne L, Dalle S, et al. The role of omega-3 in the prevention and treatment of sarcopenia[J]. Aging Clin Exp Res, 2019, 31(6): 825-836.
[52] Kito N, Matsuo K, Ogawa K, et al. Positive effects of “textured lunches” gatherings and oral exercises combined with physical exercises on oral and physical function in older individuals: a cluster randomi-zed controlled trial[J]. J Nutr Health Aging, 2019, 23(7): 669-676.
[53] Matsuo K, Kito N, Ogawa K, et al. Improvement of oral hypofunction by a comprehensive oral and phy-sical exercise programme including textured lunch gatherings[J]. J Oral Rehabil, 2021, 48(4): 411-421.
[54] Iwao Y, Shigeishi H, Takahashi S, et al. Improvement of physical and oral function in community-dwelling older people after a 3-month long-term care prevention program including physical exerci-se, oral health instruction, and nutritional guidance[J]. Clin Exp Dent Res, 2019, 5(6): 611-619.
[55] Nomura Y, Ishii Y, Suzuki S, et al. Nutritional status and oral frailty: a community based study[J]. Nu-trients, 2020, 12(9): 2886.
[56] Lin YC, Huang SS, Yen CW, et al. Physical frailty and oral frailty associated with late-life depression in community-dwelling older adults[J]. J Pers Med, 2022, 12(3): 459.
[57] Masutomi K, Bando M, Inagaki Y, et al. Relationship between oral hypofunction and salivary biomarkers in older adults: a cross-sectional study[J]. BMC Oral Health, 2024, 24(1): 766.
[1] 曾欣,邓思成,黄姝绮,陈燕茹,刘帆. 应用Rodgers演化概念分析法界定口腔衰弱[J]. 国际口腔医学杂志, 2025, 52(6): 783-790.
[2] 赵南洋,吴娟娟,周洲,陈欣月,张旭彤,徐逸飞,戴泰鸣. 贵州省实施儿童口腔疾病综合干预项目地区与非干预地区12岁儿童口腔健康状况调查分析[J]. 国际口腔医学杂志, 2025, 52(4): 484-489.
[3] 易颖煜 赵宁 沈刚. 牙周组织老龄化变化及其对正畸牙移动的影响[J]. 国际口腔医学杂志, 2014, 41(4): 492-496.
[4] 程倩综述 吴红崑审校. 人口老龄化及口腔健康对策[J]. 国际口腔医学杂志, 2012, 39(2): 184-186.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!