{"paper_id":"2a2dd401-ec74-4835-aacc-445bdb0ab94e","body_text":"Influencing factors of oral frailty in elderly patients with type 2 diabetes in China: A cross- sectional study based on the integral model of frailty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Influencing factors of oral frailty in elderly patients with type 2 diabetes in China: A cross- sectional study based on the integral model of frailty Wenyu Luo, Jinfeng Zhou, Lingyu Qiu, Li Zhao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5303792/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Apr, 2025 Read the published version in BMC Oral Health → Version 1 posted 13 You are reading this latest preprint version Abstract Objectives This study aimed to investigate the current status and influencing factors of oral frailty in elderly patients with type 2 diabetes mellitus to inform the development of oral management programs in this population. Methods A total of 431 elderly patients with type 2 diabetes mellitus who visited two tertiary public hospitals in Nanchong City from March 2024 to October 2024 were enrolled in this study. The General Information Questionnaire, Oral Frailty Index-8 (OFI-8), Oral Health Assessment Tool (OHAT), Eating Assessment Questionnaire Tool-10 (EAT-10), Perceived Social Support Scale (PSSS), Geriatric Depression Scale (GDS-5), and Geriatric Self Efficacy Scale for Oral Health Scale (GSEOH) were used to investigate and assess the factors related to oral frailty. Results The prevalence of oral frailty in elderly patients with type 2 diabetes was 32.95% (142/431). Multivariate logistic regression analysis revealed that advanced age(OR = 1.098, 95% CI: 1.054 ~ 1.146), HbA1c ≥ 7%(OR = 3.745, 95% CI: 1.203–12.647), dysphagia(OR = 8.401, 95% CI: 2.276–43.846), and poor oral health status (OR = 2.213, 95% CI: 1.134–4.394 ) were risk factors of oral frailty, and the number of remaining teeth ≥ 20(OR = 0.105, 95% CI: 0.046–0.217) and high oral health-related self-efficacy(OR = 0.934, 95% CI: 0.898–0.970) were protective factors against oral frailty ( P < 0.05). Conclusions The main factors affecting oral frailty in elderly patients with type 2 diabetes mellitus include age, HbA1c, dysphagia, poor oral health status, number of remaining teeth, and oral health-related self-efficacy. Healthcare professionals need to formulate targeted oral health management strategies based on relevant influencing factors and implement early interventions to help prevent and delay the onset and development of oral frailty. type 2 diabetes mellitus older adults oral frailty influencing factors Figures Figure 1 Figure 2 Figure 3 1 Background According to the World Health Organization (WHO), diabetes mellitus is one of the four major non-communicable diseases (NCDs) requiring urgent attention [1] , and as of 2021, data from the International Diabetes Federation (IDF) [2] show that the global prevalence of diabetes mellitus among adults is 10.5% (537 million)，with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the population [3] . China has the highest number of diabetic patients globally, with approximately 30% of the elderly population suffering from diabetes, and type 2 diabetes mellitus (T2DM) accounting for more than 95% of cases [4] . Elderly patients with type 2 diabetes mellitus have become the mainstream population of diabetes mellitus in China, a situation that brings great challenges and far-reaching effects to patients, families, and the development of the country's actively aging society. With the development of global aging, geriatric syndromes have become significant health concerns among older adults. Oral frailty is considered a geriatric syndrome [5] , and it refers to a series of processes that occur in individuals as they age, including a reduction in the number of teeth, decreased oral hygiene and oral function, decreased interest in oral health, decreased physical and mental reserve capacity, and dysfunctional eating [6] . Oral frailty not only seriously affects the physical condition and disease progression in older adults but also significantly increases the risk of a number of adverse outcomes such as physical frailty, malnutrition, falls, disability, infections, incapacitation, and even death [7-9] . Previous studies have shown that the prevalence of oral frailty in diabetic patients ≥75 years of age is 53.2 % [10] ,the risk of oral frailty increases significantly with age, and elderly patients with T2DM face more prevalent and severe oral problems that not only interfere with normal insulin secretion, but also affect their social and psychological health [11] . Although global aging follows a similar trajectory, China's unique lifestyle and dietary culture, along with variations in treatment approaches for oral frailty in diabetic patients both domestically and internationally, may lead to different factors influencing oral frailty among Chinese older adults with T2DM. Compared to other countries, China has a large population of elderly patients with type 2 diabetes mellitus (T2DM), but oral health literacy is low [12] , and there is insufficient awareness of oral frailty. Coupled with the unequal distribution of oral health service resources across regions and limited health insurance coverage, there is currently a lack of targeted oral health management strategies for elderly patients with T2DM. Oral frailty manifests through symptoms such as increased difficulty in chewing food, choking on drinking water, and dry mouth, which are easily overlooked by caregivers and patients [13] . Therefore, investigating the current status and influencing factors of oral frailty in Chinese elderly patients with type 2 diabetes mellitus (T2DM), along with early identification of risk factors and timely intervention, is crucial for improving their oral health and overall health outcomes. However, most current research focuses on the oral frailty of elderly individuals in the community and nursing homes, while insufficient attention is given to oral health issues in elderly patients with Type 2 Diabetes Mellitus (T2DM). In China, studies on oral frailty in elderly T2DM patients are limited, and none have been conducted within a theoretical framework. Therefore, this study employed Gobbens' integrative model of frailty—which encompasses physiological, psychological, and social dimensions—as the theoretical framework to explore the factors influencing oral frailty in elderly patients with type 2 diabetes mellitus (T2DM). The aim is to provide a reference for developing oral health prevention and management strategies for elderly patients with T2DM. The Integral Model of Frailty was proposed by Dutch scholars [14] in 2010, and it indicates that frailty involves an integration of physical, psychological, and social dimensions of frailty and that there are interactions among the dimensions and dynamic changes that can increase the risk of adverse outcomes. It includes life course influencing factors, disease factors, physical frailty, psychological frailty, and social frailty. In this study, we constructed a model of factors influencing oral frailty in elderly patients with T2DM based on the debilitation integration model and adjusted the original model accordingly to derive the hypothesis diagram of this study. We hypothesized that the occurrence of oral frailty in elderly patients with type 2 diabetes mellitus is affected by the following factors: life course influences, including sex, age, marital status, and literacy level; disease factors, including duration of diabetes disease, glycosylated hemoglobin levels, multiple chronic conditions, and polypharmacy; physical frailty includes nutrition, mobility, fall risk, frailty, and oral health; psychological frailty includes depression and self-efficacy; and social frailty includes social support. Figure 1 shows the theoretical model for this study. 2 Methods 2.1 Research target : This was a cross-sectional study, and elderly patients with T2DM who were hospitalized in the Department of Endocrinology of two public tertiary hospitals in Nanchong City, Sichuan Province, from March 2024 to October 2024 were selected for the study by convenience sampling method. The inclusion criteria were as follows: (1) diagnosed with T2DM according to the World Health Organization (WHO) criteria (1999); (2) duration of diabetes mellitus ≥ 1 year; (3) age ≥ 60 years; and (4) no cognitive impairment and with normal expression ability. Exclusion criteria: (1) patients with complete loss of teeth and full dentures; (2) those with combined acute complications of diabetes mellitus or other serious illnesses, who were unable to complete the questionnaire. 2.2 Sample size estimation : The sample size was determined in accordance with the formula for determining the sample size of cross-sectional studies: \\(\\:n=\\frac{{z}_{a/2}^{2}p(1-p)}{{d}^{2}}\\) We assumed an α value of 0.05 and an error (δ) of 0.05. The pre-test yielded a prevalence of oral frailty of 0.53% among elderly patients with T2DM. Therefore, the estimated sample size was 382, and a minimum of 425 cases should be included assuming a 10% dropout rate. The final sample size for the study was 431 cases. 2.3 Ethical considerations : All participants provided informed consent and signed a written consent form, and the study was reviewed by the Medical Ethics Committee of Affiliated Hospital of North Sichuan Medical College (Ethics Approval Number: 2024ER132-1). 2.4 Data collection instrument 2.4.1 The General Information Questionnaire This questionnaire was developed by reviewing relevant literature and included both general demographic and disease-related information. General demographic data covered sex, age, education level, marital status, and place of residence. Disease-related information included the duration of illness, the number of chronic diseases (based on the International Classification of Diseases-10 [ICD-10] [ 15 ] , such as cardiovascular diseases, cancers, and chronic respiratory diseases), glycated hemoglobin (HbA1c) levels (defined according to the guidelines [ 4 ] ; a reasonable target for HbA1c control is < 7.0%, and a HbA1c of ≥ 7.0% indicated poor glycemic control), polypharmacy (defined by the WHO as the use of ≥ 5 medications per day [ 16 ] ), the number of remaining teeth, and the severity of dry mouth. 2.4.2 Oral Frailty Index-8 The OFI-8 was developed by Tanaka et al. [ 17 ] , and in this study, we used the Chinese version developed by Chen et al [ 18 ] .The questionnaire has five dimensions and eight items, including greater difficulty eating hard foods than six months ago; sometimes choking on tea or soup; using dentures; dry mouth; going out less than you did six months ago; being able to chew hard foods such as pickled radish and shredded squid; brushing at least twice a day; and visiting the dentist at least once a year. The total score ranges from 0 to 11, with a score of ≥ 4 considered a positive screening result for oral frailty. In the original validation of the Chinese version of the OFI-8, Chen et reported a Cronbach’s alpha coefficient of 0.949, and in the current study, the Cronbach’s alpha coefficient was 0.72. 2.4.3 Oral Health Assessment Tool (OHAT) The OHAT was revised by Chalmers et al. based on the Brief Oral Health Checklist [ 19 ] , and this study, we used the Chinese version developed and validated by Wang et al. [ 20 ] for use in Chinese populations. An eight-item questionnaire was used to assess various aspects of oral health, including the lips, tongue, gingival tissue, saliva, natural teeth, dentures, oral cleanliness, and the presence of toothache. Each item was evaluated based on the current condition and scored as follows: 0 for healthy, 1 for changes, and 2 for unhealthy. The total score ranged from 0 to 16, with a score of < 3 indicating good oral health and a score of ≥ 3 indicating poor oral health. A higher total score reflected a poorer oral health status. The Chinese version of the Oral Health Assessment Tool (OHAT) has previously demonstrated a Cronbach's alpha coefficient of 0.71. In the current study, we obtained a Cronbach's alpha of 0.70, indicating acceptable internal consistency. 2.4.4 The Eating Assessment Tool-10 (EAT-10) The EAT-10, developed by Belafsky et al. [ 21 ] , is primarily used to assess the severity of dysphagia. In this study, we employed the Chinese version of the EAT-10 scale. The instrument comprises 10 items, each rated on a 5-point Likert scale ranging from 0 ('no problem') to 4 ('very severe'), resulting in a total score ranging from 0 to 40. A total score of ≥ 3 indicates indicated dysphagia, with higher scores representing more severe swallowing difficulties. 2.4.5 Visual analog scale (VAS) [ 22 ] The VAS was used to evaluate patients' subjective symptoms of dry mouth. Patients marked a position on a 10-cm VAS strip to reflect the severity of their symptoms, with the researcher recording the corresponding score. The scale ranges from left to right, where 0 indicates a moist mouth with no sensation of dryness, scores from 1 to 3 represent mild dry mouth, 4 to 6 indicate moderate dry mouth, and scores from 7 to 10 represent severe dry mouth. 2.4.6 The Frailty (FRAIL) Screening Scale This FRAIL scale was developed by geriatric experts from the International Society for Nutritional Health and Aging [ 23 ] , and the Chinese version, adapted by Wei Y et al. [ 24 ] was used in this study. It comprises five items: fatigue, reduced resistance/endurance, limited mobility, the presence of more than five comorbidities, and decreased body mass. Each item is scored as 1 point, with a total score ranging from 0 to 5. A score of 0 indicates a healthy status, 1–2 points signify pre-frailty, and a score of 3 or higher indicates frailty. The Cronbach’s alpha coefficient of the original scale was 0.826, while the coefficient in this study was 0.71. 2.4.7 The Geriatric Depression Scale (GDS⁃5) The GDS-5, developed by Hoyl et al. [ 25 ] , is a screening tool designed to detect depression in older adults. it consists of five items, each scored from 0 to 1, with a total score of 2 or higher indicating the presence of depression. The scale has demonstrated good reliability and validity in the elderly population [ 26 ] , and in this study, the Cronbach’s alpha coefficient was 0.77. 2.4.8 The Geriatric Self Efficacy Scale for Oral Health (GSEOH) The GSEOH was developed by Ohara et al. [ 27 ] , and the Chinese version, adapted by Xu Yuxin et al. [ 28 ] was used in this study. The scale comprises three dimensions: oral hygiene habits (items 1–8), oral function (items 9–17), and oral consultation habits (items 18–20), for a total of 20 items. Each item is scored on a 4-point Likert scale, ranging from 1 (“not at all confident”) to 4 (“very confident”), with a total score range of 20 to 80 points. Higher scores indicate greater self-efficacy in oral health. The Cronbach’s alpha coefficient for the Chinese version of the GSEOH was 0.924, and it was 0.90 in this study. 2.4.9 Perceived social support scale (PSSS) The PSSS, developed by Zimet et al. [ 29 ] , is used to assess an individual's level of social support. The scale comprises 12 items divided into three dimensions: support from family, friends, and significant others. Each item is rated on a 7-point Likert scale ranging from 1 (\"strongly disagree\") to 7 (\"strongly agree\"), with higher scores indicating a greater perception of social support. In this study, the Cronbach’s alpha coefficient for the PSSS was 0.902, demonstrating excellent internal consistency. 2.5 Data collection A research team was established, led by the principal investigator. The team included two diabetes specialist nurses, both holding master’s degrees and with over 10 years of experience in endocrinology, as well as two nursing students currently pursuing their master’s degrees. Data and information were collected by the research team using a pre-designed questionnaire on influencing factors. Prior to the study, all team members underwent standardized training. Before the formal survey, the researcher explained the study's purpose, significance, instructions for completing the questionnaire, and estimated time required to the patients. Confidentiality was assured, and after obtaining their informed consent, the questionnaires were distributed on-site. For participants who had difficulty completing the questionnaires, such as individuals with lower levels of education or older adults, the researcher read the questionnaire aloud and assisted them in completing it based on their responses. The average time required to complete each questionnaire was approximately 25–30 minutes. After the survey, health education on diabetic oral health was provided to the participants based on their responses. All questionnaires were distributed and collected on-site. A total of 435 questionnaires were distributed, with four excluded due to a missing data rate exceeding 50%. In total, 431 valid questionnaires were collected, resulting in a valid response rate of 99.1%. The General Information Questionnaire, including age, gender, marital status, and disease-related data, was obtained by the investigator from the hospital's electronic medical records system. Additionally, the risk of falls, risk of malnutrition, and activities of daily living were assessed by endocrinology nurses within 24 hours of the patient's hospital admission. 2.6 Statistical methods The questionnaire data of this study were entered using EpiData 3.1 software, and the data were organized and analyzed using R 4.3.1 software. The “tableone” program package was used to describe the data. Normally distributed variables were presented using the mean and standard deviation and compared using the t-test. Variables that were not normally distributed were presented using the median and interquartile range, and the Mann-Whitney U-test was used to compare them. Categorical variables were expressed as frequency and percentage, and the chi-square test or Fisher’s test was used to compare them. Correlation analysis and visualization were performed using the “corrplot” package. Logistic regression and stepwise regression analyses were performed using the “glm” package, and the logistic regression model was constructed by screening with backward stepwise culling. The logistic regression model was screened by the backward stepwise elimination method, and the forest plot was drawn using the “forestploter” package. A p-value of < 0.05 was considered statistically significant, and the significance level was set at α = 0.05. 3 Results 3.1 General characteristics A total of 431 elderly patients with type 2 diabetes mellitus (T2DM) were included in the study. Oral frailty was identified in 142 patients, representing 32.95% of the cohort. The mean age of participants was 71.44 ± 7.47 years. Among them, 197 patients (45.71%) were male, and 234 (54.29%) were female. Most participants were married (n = 355, 82.37%) and resided in towns or cities (n = 268, 62.18%). Sixty-two patients (14.39%) lived alone. Regarding monthly household income, 207 patients (48.03%) earned less than 3,000 yuan, 112 patients (25.99%) earned between 3,000 and 5,000 yuan, and another 112 patients (25.99%) earned 5,000 yuan or more. Health insurance coverage included residents’ health insurance for 231 patients (53.60%), employees’ health insurance for 195 patients (45.23%), and self-payment or other types of health financing for 5 patients (1.16%). Lifestyle factors revealed that 159 patients (36.89%) were current smokers, and 153 patients (35.50%) consumed alcohol. Polypharmacy (use of multiple medications) was observed in 230 patients (53.36%). In terms of xerostomia (dry mouth), 78 patients (18.09%) reported no symptoms, 211 patients (48.96%) had mild symptoms, 137 patients (31.79%) had moderate symptoms, and 5 patients (1.16%) experienced severe symptoms. Additionally, 59 patients (13.69%) had swallowing dysfunction, and 172 patients (39.91%) had fewer than 20 remaining teeth. Concerning comorbidities, 25 patients (5.80%) had no other chronic diseases, 90 patients (20.88%) had one chronic disease, 107 patients (24.83%) had two chronic diseases, and 209 patients (48.49%) had three or more chronic diseases. 3.2 Analysis of the correlation between the risk of developing oral frailty and other factors in elderly patients with type 2 diabetes mellitus We calculated the correlation coefficient matrix between oral frailty and other factors, along with the matrix of significant p -values (Fig. 2). The results indicated that age had the strongest positive correlation with oral frailty (r = 0.44, P < 0.001), while the number of remaining teeth showed the strongest negative correlation (r = − 0.48, P < 0.001). These findings are illustrated in Fig. 2. 3.3 Univariate analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus Univariate analysis indicated that several factors were significantly associated with the occurrence of oral frailty in elderly patients with type 2 diabetes mellitus ( P < 0.05). These factors included age, gender, educational level, marital status, polypharmacy, dysphagia, number of remaining teeth, multiple comorbidities, glycated hemoglobin (HbA1c) levels, risk of falls, activities of daily living (ADL), risk of malnutrition, physical frailty, depression, oral health status, social support, and oral health-related self-efficacy scores. The occurrence of these important factors and the difference were statistically significant (P < 0.05) (Table 1 ). Table 1 Univariate analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus Variables Level Overall (n = 431) OF group (n = 142) Non-OF group (n = 289) P Age, years (mean [SD]) 71.44 (7.47) 66.86 (6.32) 73.69 (6.96) < 0.001 Duration (mean [SD]) 11.48 (8.28) 10.56 (7.36) 11.94 (8.67) 0.106 Sex, number (%) Male 197 (45.71) 76 (53.52) 121 (41.87) 0.029 Female 234 (54.29) 66 (46.48) 168 (58.13) Education, number (%) Less than lower primary school 261 (60.56) 70 (49.30) 191 (66.09) 0.005 Middle school 100 (23.20) 46 (32.39) 54 (18.69) Upper secondary or vocational training 49 (11.37) 19 (13.38) 30 (10.38) College degree or above 21 (4.87) 7 (4.93) 14 (4.84) Marital status, number (%) Currently married 355 (82.37) 126 (88.73) 229 (79.24) 0.022 Unmarried/divorced/widowed 76 (17.63) 16 (11.27) 60 (20.76) Residence, number (%) Rural 268 (62.18) 98 (69.01) 170 (58.82) 0.052 Urban 163 (37.82) 44 (30.99) 119 (41.18) Living alone, number (%) No 369 (85.61) 124 (87.32) 245 (84.78) 0.574 Yes 62 (14.39) 18 (12.68) 44 (15.22) Monthly family income (RMB) (%) < 3000 207 (48.03) 63 (44.37) 144 (49.83) 0.561 3000–5000 112 (25.99) 39 (27.46) 73 (25.26) > 5000 112 (25.99) 40 (28.17) 72 (24.91) Medicare, number (%) Residents’ medical insurance 231 (53.60) 69 (48.59) 162 (56.06) 0.181 Employee medical insurance 195 (45.24) 70 (49.30) 125 (43.25) Private expense and other types 5 (1.16) 3 (2.11) 2 (0.69) Smoking, number (%) No 272 (63.11) 84 (59.15) 188 (65.05) 0.277 Yes 159 (36.89) 58 (40.85) 101 (34.95) Drinking, number (%) No 278 (64.50) 84 (59.15) 194 (67.13) 0.129 Yes 153 (35.50) 58 (40.85) 95 (32.87) Polypharmacy, number (%) No, < 4 kinds 201 (46.64) 82 (57.75) 119 (41.18) 0.002 Yes, ≥ 5 kinds 230 (53.36) 60 (42.25) 170 (58.82) Xerostomia, number (%) No dry mouth symptoms 78 (18.09) 31 (21.83) 47 (16.27) 0.107 Slight dry feeling in the mouth 211 (48.96) 76 (53.52) 135 (46.71) Noticeable dryness and some discomfort 137 (31.79) 33 (23.24) 104 (35.99) Intense dryness, significantly affecting speaking and eating 5 (1.16) 2 (1.41) 3 (1.04) Dysphagia, number (%) No 372 (86.31) 139 (97.89) 233 (80.62) < 0.001 Yes 59 (13.69) 3 (2.11) 56 (19.38) Remaining teeth, number (%) < 20 172 (39.91) 9 (6.34) 163 (56.40) < 0.001 ≥ 20 259 (60.09) 133 (93.66) 126 (43.60) Number of chronic diseases, number (%) 0 25 (5.80) 13 (9.15) 12 (4.15) 0.005 1 90 (20.88) 40 (28.17) 50 (17.30) 2 107 (24.83) 30 (21.13) 77 (26.64) ≥ 3 209 (48.49) 59 (41.55) 150 (51.90) HbA1c, number (%) < 7% 29 (6.73) 15 (10.56) 14 (4.84) 0.043 ≥ 7% 402 (93.27) 127 (89.44) 275 (95.16) Fall risk, number (%) Low risk 95 (22.04) 39 (27.46) 56 (19.38) 0.031 Moderate risk 259 (60.09) 86 (60.56) 173 (59.86) High risk 77 (17.87) 17 (11.97) 60 (20.76) Barthel index, number (%) No dependency 91 (21.11) 43 (30.28) 48 (16.61) 0.003 Mild dependency 263 (61.02) 83 (58.45) 180 (62.28) Moderate dependency 60 (13.92) 13 (9.15) 47 (16.26) Severe dependency 17 (3.94) 3 (2.11) 14 (4.84) Nutrition, number (%) Normal nutritional status 351 (81.44) 124 (87.32) 227 (78.55) 0.038 At risk of malnutrition 80 (18.56) 18 (12.68) 62 (21.45) Frailty, number (%) Robust 143 (33.18) 75 (52.82) 68 (23.53) < 0.001 Pre-frailty 207 (48.03) 55 (38.73) 152 (52.60) Frailty 81 (18.79) 12 (8.45) 69 (23.88) Depression, number (%) No 271 (62.88) 119 (83.80) 152 (52.60) < 0.001 Yes 160 (37.12) 23 (16.20) 137 (47.40) OHAT, number (%) < 3 points, healthy 83 (19.26) 52 (36.62) 31 (10.73) < 0.001 ≥ 3 points, unhealthy 348 (80.74) 90 (63.38) 258 (89.27) Social support (mean [SD]) 55.23 (11.02) 58.18 (10.35) 53.78 (11.07) < 0.001 OHSE (mean [SD]) 52.91 (9.04) 58.25 (7.57) 50.28 (8.54) < 0.001 Notes: SD , standard deviation;OHAT, Oral Health Assessment Tool ;OHSE, Geriatric Self Efficacy Scale for Oral Health Scale Insert Table 1 here 3.4 Multifactorial analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus To further investigate the factors influencing oral frailty, we conducted a logistic regression analysis using oral frailty occurrence (score ≥ 4) as the dependent variable. Variables that showed statistical significance in the univariate analysis were included in the regression model, and a backward elimination method was applied for variable selection. The results indicated that age (OR = 1.098, 95% CI: 1.054–1.146, P < 0.001), presence of dysphagia (OR = 8.401; 95% CI: 2.276–43.846; P = 0.004), glycated hemoglobin (HbA1c) ≥ 7% (OR = 3.745; 95% CI: 1.203–12.647; P = 0.027), and poor oral health status (OR = 2.213; 95% CI: 1.134–4.394; P = 0.021) were significant risk factors for oral frailty in elderly patients with type 2 diabetes mellitus. Conversely, having ≥ 20 remaining teeth (OR = 0.105; 95% CI: 0.046–0.217; P < 0.001) and higher levels of oral health-related self-efficacy (OR = 0.934; 95% CI: 0.898–0.970; P = 0.001) were significant protective factors against oral frailty in this population. ( P < 0.05) (Table 2 and Fig. 3). Table 2. Multifactorial analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes (n = 431) Variables Beta SE P OR (95% CI) Education (ref=1) (ref=2) −0.579 0.336 0.085 0.56 (0.289–1.082) (ref=3) 0.559 0.436 0.200 1.749 (0.749–4.173) (ref=4) 0.704 0.589 0.232 2.022 (0.647–6.671) Age 0.093 0.021 <0.001 1.098 (1.054–1.146) Dysphagia (ref=1) 2.128 0.739 0.004 8.401 (2.276–43.846) HbA1c (ref=1) 1.320 0.597 0.027 3.745 (1.203–12.647) OHAT (ref=1) 0.795 0.344 0.021 2.213 (1.134–4.394) Teeth (ref=1) −2.257 0.394 <0.001 0.105 (0.046–0.217) OHSE −0.068 0.020 0.001 0.934 (0.898–0.970) Notes: SE : standard error; OR : odds ratio; 95% CI : 95% confidence interval; ref : reference group 5 Discussion In this study, 142 out of 431 elderly patients with type 2 diabetes mellitus (T2DM) had oral frailty (OFI-8 score ≥ 4), representing an incidence of 32.95%. This rate is lower than that reported among diabetic patients in the Japanese study by Ishii et al.(53.2%) [ 10 ] , and also lower than the incidence observed in hospitalized cancer patients (64.3%) [ 30 ] and elderly patients undergoing maintenance hemodialysis (45.2%) [ 31 ] . Several factors may contribute to the lower incidence observed in our study:(1) Compared to participants in foreign studies, our study population was younger and excluded patients with complete tooth loss or full dentures. A significant proportion of our participants resided in urban areas (62.18%) and had employee medical insurance (45.23%). The urban environment offers more opportunities to access professional oral health knowledge and advice. Additionally, having employee medical insurance may provide more financial resources to invest in oral health care. (2) Compared with patients suffering from other diseases, individuals with T2DM often consume whole grains rich in dietary fiber, which may help maintain chewing and swallowing functions. Lifestyle interventions involving regular physical activity are fundamental in diabetes management and may help delay the onset of oral frailty. Furthermore, the hypoglycemic medication metformin has been reported to alleviate oral lesions and reduce tooth loss [ 32 ] , potentially contributing to a lower incidence of oral frailty. 5.1 Oral Frailty in Elderly Patients with Type 2 Diabetes Is Influenced by Multiple Factors Advanced age was a risk factor for the development of oral frailty in elderly patients with T2DM, the older the age, the higher the risk of developing oral frailty (OR = 1.098, P < 0.001). This finding aligns with the predictions of the integrated frailty model, which suggests that life-course influencing factors impact the occurrence of oral frailty. It is also consistent with the results of a previous study by Ishii et al, which noted that the oral frailty questionnaire scores of patients with T2DM ≥ 75 years of age were positively correlated with age, and the prevalence of oral frailty increased with age [ 10 ] . Several reasons may explain this association. As age increases, there is a progressive decline in both the structure and function of the oral cavity among the elderly. Common issues include tooth wear, enamel thinning or demineralization, degenerative changes in periodontal tissues, and a weakened oral immune system. These problems lead to decreased masticatory efficiency and reduced saliva synthesis and secretion, resulting in conditions like periodontitis and oral mucositis, which in turn induce oral frailty [ 33 ] . Additionally, oral health literacy in elderly T2DM patients gradually decreases with age [ 12 ] , Low health literacy is closely associated with more severe periodontitis, higher plaque indices, and increased tooth loss [ 34 ] . Furthermore, as the duration of diabetes extends, glycemic control becomes more challenging, and the incidence of diabetes-related complications rises. These complications are risk factors for oral diseases, which may also contribute to the higher susceptibility to oral frailty in older T2DM patients. Therefore, healthcare professionals should emphasize the assessment and screening of oral frailty in elderly T2DM patients. By providing health education to improve oral health literacy and highlighting the importance of oral health, the progression of oral frailty can be delayed. Subjective dysphagia was also a risk factor for oral frailty in elderly patients with T2DM(OR = 8.401, P < 0.001). This finding is consistent with the results of Nishida et al. [ 35 ] and aligns with the predictions of the frailty integration model, which suggests that dysphagia exacerbates the occurrence of oral frailty. The possible reasons for this include: (1) The prevalence of sarcopenia in patients with T2DM can be as high as 29.3% [ 36 ] , When sarcopenia affects the swallowing muscle groups, it manifests as reduced pharyngeal contraction and upper esophageal sphincter dysfunction, leading to difficulty in swallowing. Additionally, the reduction of pharyngeal muscle mass decreases pharyngeal pressure, increasing the risk of choking when drinking water [ 37 ] . (2) Patients with T2DM often have a narrower choice of foods and less dietary diversity due to necessary dietary restrictions. Patients with dysphagia may also suffer from malnutrition because they have difficulty meeting their nutritional requirements with a conventional diet. Ultimately, poorer nutritional status elevates the risk of developing oral frailty [ 38 ] . Therefore, it is recommended that healthcare professionals assess the eating habits and chewing and swallowing functions of patients with T2DM. Developing targeted dietary plans and providing instruction on oral and swallowing function training for patients with subjective dysphagia can improve swallowing ability, increase the likelihood of oral intake, and prevent malnutrition. In this study, A HbA1c of ≥ 7.0% was identified as a risk factor for the development of oral frailty in elderly patients with type 2 diabetes mellitus (OR = 3.745, P = 0.027), which is consistent with the findings of Demmer et al. [ 39 ] , This aligns with the prediction of the frailty integration model that oral health status is compromised in patients with chronic diseases. Specifically, patients with HbA1c levels ≥ 7.0% exhibited poorer oral health compared to those with adequate glycemic control. HbA1c, as the gold standard for reflecting glycemic control levels, is an important factor affecting the oral health of diabetic patients [ 40 ] . The underlying reason may be that long-term poor glycemic control alters the oral microenvironment due to hyperglycemia, significantly increasing the risk of dental caries and periodontitis. [ 41 ] Furthermore, the development of periodontitis promotes the release of inflammatory mediators, which may enhance insulin resistance and elevate blood glucose levels. Particularly, the elevation of blood glucose may delay the timing of periodontal treatment in patients with T2DM who require it, affecting the effectiveness of periodontal treatment and in turn affecting oral health. Therefore, it is recommended that healthcare professionals assist patients in setting individualized glycemic control goals, emphasizing the significant impact of blood glucose levels on oral health to ensure it receives adequate attention. Poor oral health was identified as a risk factor for developing oral frailty (OR = 2.213, P < 0.001),, aligning with the findings of Hanako et al. [ 42 ] , who suggested that elderly individuals with poor oral health are more likely to develop oral frailty. These results are consistent with the hypothesized model predicting an association between oral health status and oral frailty. Poor oral health is characterized by reduced saliva production (dry mouth), worn or missing teeth, inadequate oral cleanliness, and oral pain. Firstly, reduced saliva production increases the risk of oral fungal infections, and diabetes mellitus heightens susceptibility to opportunistic oral infections. Secondly, a decreased number of teeth leads to reduced tongue pressure and impaired oral motor function Additionally, microbial dysbiosis in dental plaque resulting from insufficient oral hygiene can induce oral frailty [ 43 ] , and dental pain can further exacerbate this condition. Therefore, it is recommended that nursing staff assess and care for the patients' oral cavity according to the Oral Health Management Program, develop good oral hygiene habits, and ensure adequate oral cleaning and health care to improve the oral status. The number of retained teeth ≥ 20 was a protective factor against oral frailty in elderly patients with T2DM (OR = 0.105, P < 0.001),, consistent with the findings of Kurinami et al. [ 44 ] , This study proposed that the number of remaining or healthy teeth in patients with T2DM was significantly lower than in patients without T2DM and that the number of remaining teeth ≥ 20 was an important indicator of a favorable prognosis in patients with T2DM. Zhang et al. [ 45 ] also observed a significant correlation between the number of remaining teeth and the degree of periodontal inflammation in patients with periodontitis and type 2 diabetes. Those with ≥ 20 remaining teeth exhibited significantly lower levels of periodontal inflammation and HbA1c compared to those with fewer than 20 teeth. The reduction in the number of remaining teeth not only exacerbates periodontal inflammation but also impairs normal chewing and occlusal functions, potentially leading to masticatory dysfunction [ 46 ] ,defined in the study as having fewer than 20 teeth .Therefore, it is recommended that elderly patients with T2DM undergo regular dental examinations, periodontitis treatment should be standardized. One of the treatment goals should be to maintain at least 20 teeth and ensure adequate masticatory function, which can contribute to better overall management of their condition. A high level of oral health-related self-efficacy was a protective factor for the occurrence of oral frailty in elderly patients with T2DM (OR = 0.934, P < 0.001), consistent with the findings of Wen et al. [ 47 ] . This observation aligns with the predictions of the frailty integrative model, which suggests that psychological factors influence the onset of oral frailty. Oral health-related self-efficacy refers to an individual's subjective perception or judgment of their ability to effectively maintain oral health [ 27 ] , It is a critical factor in personal oral health maintenance and plays a decisive role in oral health behaviors. Research has demonstrated that high levels of oral health-related self-efficacy enhance self-care capabilities in patients with type 2 diabetes [ 48 ] . Additionally, it triggers greater demands for oral hygiene and motivates positive health behaviors [ 47 ] , encouraging these patients to prioritize oral hygiene. This focus effectively improves oral diseases and glycated hemoglobin levels, thereby reducing the risk of oral frailty. Conversely, patients with low self-efficacy are more prone to oral health-related problems [ 49 ] , increasing their risk of developing oral frailty. Therefore, it is recommended that healthcare providers enhance communication with elderly patients with type 2 diabetes to better understand their oral care needs, correct any misconceptions, and establish accurate beliefs regarding oral health management. By improving oral health-related self-efficacy and self-care abilities in these patients, the prevention of oral frailty can be effectively achieved. 5.2 Limitations Firstly, the cross-sectional design of this observational study limits the ability to infer causal relationships from the findings. Future research should employ multicenter longitudinal or qualitative studies with larger sample sizes and extended follow-up periods to thoroughly investigate the relevant influencing factors in greater depth. Secondly, the study aggregated the number of chronic diseases, which precluded the assessment of how the severity of these conditions influences oral frailty. Lastly, the present study relied on subjective scales to evaluate the degree of oral debilitation and oral health status among patients. Objective indicators, such as the looseness of remaining teeth, the number of caries, and the presence of dentures, were not assessed; these factors may also influence the study's outcomes. Therefore, future research is recommended to incorporate these objective measures to more comprehensively address the aforementioned issues. 6 Conclusion Oral frailty is more prevalent among elderly patients with type 2 diabetes mellitus (T2DM). Advanced age, dysphagia, HbA1c levels ≥ 7%, and poor oral health status are identified as risk factors for oral frailty, whereas having 20 or more remaining teeth and high oral health-related self-efficacy serve as protective factors. However, the specific impact and mechanisms by which these four risk factors and two protective factors influence oral frailty require further investigation. The findings of this study provide valuable insights for developing preventive and management strategies for oral health in elderly T2DM patients. Additionally, the results emphasize the need for clinical healthcare professionals to prioritize oral frailty in elderly T2DM patients by conducting early assessments and interventions targeting these risk factors. Providing personalized, long-term oral health management services is essential to prevent and reduce the occurrence of oral frailty in this population. Abbreviations GSEOH Geriatric Self Efficacy Scale for Oral Health IDF International Diabetes Federation NCD Non-communicable diseases OHAT Oral Health Assessment Tool PSSS Perceived Social Support Scale SHIP Study of Health in Pomerania VAS Visual analog scale WHO World Health Organization Declarations Ethics approval and consent to participate This study was approved by the Affiliated Hospital of North Sichuan Medical College (Approval No. 2024ER132-1). All participants provided informed consent by signing the consent form prior to participation. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding None. Authors' contributions WY Land and LZ contributed to the study concept and design. WY L, JF Z, and LY Q were responsible for data acquisition. WY L conducted the analysis and interpretation of data. WY L and LZ drafted the manuscript. LZ critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript Acknowledgements The authors thank all the participants for their valuable contributions to this study. Authors' information Not applicable. References World HO. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization. 2013. Federation ID. IDF diabetes atlas, tenth. Int Diabetes. 2021. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119, PMID 34879977. Zhao W. Interpretation on clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in china; 2022 Edition. Med J Peking Union Med College Hospital 2022;13:574-80. Payne M, Morley JE. Editorial: Dysphagia, dementia and frailty. J Nutr Health Aging. 2018;22:562-5. doi: 10.1007/s12603-018-1033-5, PMID 29717753. Watanabe Y, Okada K, Kondo M, Matsushita T, Nakazawa S, Yamazaki Y. Oral Health for achieving longevity. Geriatr Gerontol Int. 2020;20:526-38. doi: 10.1111/ggi.13921, PMID 32307825. Yokoyama H, Kitano Y. Oral frailty as a risk factor for fall incidents among community-dwelling people. Geriatrics (Basel). 2024;9. doi: 10.3390/geriatrics9020054, PMID 38667521. Izutsu M, Hirayama K, Su Y, et al. Risk factors for oral frailty among community-dwelling pre-frail older adults in Japan: A cross-sectional analysis. Community Dent Hlth. 2023;40:221-6. Kugimiya Y, Motokawa K, Yamamoto K, Hayakawa M, Mikami Y, Iwasaki M, et al. Relationship between the rate of a decreased oral function and the nutrient intake in community-dwelling older persons: an examination using oral function-related items in a questionnaire for latter-stage elderly people. Nihon Ronen Igakkai Zasshi. 2021;58:91-100. doi: 10.3143/geriatrics.58.91, PMID 33627567. Ishii M, Yamaguchi Y, Hamaya H, Iwata Y, Takada K, Ogawa S, et al. Influence of oral health on frailty in patients with type 2 diabetes aged 75 years or older. BMC Geriatr. 2022;22:145. doi: 10.1186/s12877-022-02841-x, PMID 35183107. Rohani B. Oral manifestations in patients with diabetes mellitus. World J Diabetes. 2019;10:485-9. doi: 10.4239/wjd.v10.i9.485, PMID 31558983. Chen MQ, Zhou ZQ, Liu H, et al. The status quo of oral health literacy among elderly patients with type 2 diabetes and analysis of influencing factors. J Qiqihar Med Coll. 2024;45(17):1688–1692. Parisius KG, Wartewig E, Schoonmade LJ, Aarab G, Gobbens R, Lobbezoo F. Oral frailty dissected and conceptualized: A scoping review. Arch Gerontol GERIATr. 2022;100:104653. doi: 10.1016/j.archger.2022.104653, PMID 35176531.. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc. 2010;11:338-43. doi: 10.1016/j.jamda.2009.09.015, PMID 20511101. Glasgow RE, Toobert DJ, Barrera MJ, Strycker LA. The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention. Health Educ Res. 2005;20:402-9. doi: 10.1093/her/cyg140. Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. doi: 10.1186/s12877-017-0621-2, PMID 29017448. Tanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci. 2018;73:1661-7. doi: 10.1093/gerona/glx225, PMID 29161342. Chen ZM, Tan Y, Liang YJ, et al. Shi GF. Chinesization of the Oral Frailty Index-8 and its reliability and validity test. Chin Nur Res. 2023;37:3808-12. Chalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The oral health assessment tool--validity and reliability. Aust Dent J. 2005;50:191-9. doi: 10.1111/j.1834-7819.2005.tb00360.x, PMID 16238218. Wang JQ, Zhu SZ, Zhan Y, et al. Reliability and validity test of Chinese version of the oral Health Assessment Tool. Chin J Mod Nurs. 2019;25:3607-10. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919-24. doi: 10.1177/000348940811701210, PMID 19140539. Colquhoun AN, Ferguson MM. An association between oral lichen planus and a persistently dry mouth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 2004;98(1):60–68.doi: 10.1016 /j.tripleo. 2003.11.003 . van Kan GA, Rolland YM, Morley JE, Vellas B. Frailty: Toward a clinical definition. J Am Med Dir Assoc. 2008;9:71-2. doi: 10.1016/j.jamda.2007.11.005. Wei Y, Cao YP, Yang XL, et al. Frailty syndrome in hospitalized geriatric patients and its risk factors. Fudan Univ J Med Sci. 2018;45:496-502. Hoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five‐item version of the Geriatric Depression Scale. J Am Geriatr Soc. 1999;47:873-8. doi: 10.1111/j.1532-5415.1999.tb03848.x, PMID 10404935. Rinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc. 2003;51:694-8. doi: 10.1034/j.1600-0579.2003.00216.x, PMID 12752847. Ohara Y, Yoshida N, Kawai H, Obuchi S, Yoshida H, Mataki S, et al. Development of an oral health‐related self‐efficacy scale for use with older adults. Geriatr Gerontol Int. 2017;17:1406-11. doi: 10.1111/ggi.12873, PMID 27531046. Yuxin X, Hongmei W, Junchi M, et al. Sinicization and reliability and validity test of the Geriatric self-efficacy Scale for Oral Health. Chin Nurs Res. 2021;35:2858-63. Blumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G. Social support, type A behavior, and coronary artery disease. Psychosom Med. 1987;49:331-40. doi: 10.1097/00006842-198707000-00002, PMID 3615762. Yi L, Ziyan Z, Yanling Z, et al. Oral frailty and its influencing factors among hospitalized cancer patients. J Nurs Sci. 2024;39:49-52. Chen M, He M, Gu Q, Gao X, Lu G. The current status and influencing factors of oral frailty in elderly maintenance hemodialysis patients based on the Andersen Oral Health Outcome Model. BMC Oral Health. 2024;24:1085. doi: 10.1186/s12903-024-04872-9, PMID 39272094. Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Madathil SA, Mali M, et al. Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis. Saudi Pharm J. 2018;26:634-42. doi: 10.1016/j.jsps.2018.02.029, PMID 29991907. Dibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, et al. Oral frailty and its determinants in older age: a systematic review. Lancet Healthy Longev. 2021;2:e507-20. doi: 10.1016/S2666-7568(21)00143-4, PMID 36098000. Jingjing Y, Shengkai L. Investigation on the current state of oral health literacy and the influencing factors among residents in Fuyang city. Chin J Gen Pract. 2024;22:97-100. Nishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology. 2020;37:185-90. doi: 10.1111/ger.12455, PMID 31874118. Feng L, Gao Q, Hu K, Wu M, Wang Z, Chen F, et al. Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis. J Clin Endocrinol Metab. 2022;107:1470-83. doi: 10.1210/clinem/dgab884, PMID 34904651. Butler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011;26:225-31. doi: 10.1007/s00455-010-9290-4, PMID 20623303. Nomura Y, Ishii Y, Suzuki S, Morita K, Suzuki A, Suzuki S, et al. nutritional status and oral frailty: A community based study. Nutrients. 2020j;12. doi: 10.3390/nu12092886, PMID 32967313. Demmer RT, Holtfreter B, Desvarieux M, Jacobs DR, Kerner W, Nauck M, et al. The influence of type 1 and type 2 diabetes on periodontal disease progression: Prospective results from the Study of Health in Pomerania (SHIP). Diabetes Care. 2012;35:2036-42. doi: 10.2337/dc11-2453, PMID 22855731. Yu SY, Lee SK, Yang B, Lee H, Jeon HJ, Lee DH. Glycemic control and oral health outcomes in patients with diabetes: insights from a nationwide Korean survey. J Korean Med Sci. 2024;39:e209. doi: 10.3346/jkms.2024.39.e209, PMID 38915285. Yuan CX, Chen X, Yan J. Research progress of oral health quality and influencing factors in elderly patients with diabetes. J Nurs Sci. 2018;33:20-2. Sato H, Yano A, Shimoyama Y, Sato T, Sugiyama Y, Kishi M. Associations of streptococci and fungi amounts in the oral cavity with nutritional and oral health status in institutionalized elders: A cross sectional study. BMC Oral Health. 2021;21:590. doi: 10.1186/s12903-021-01926-0, PMID 34798863. Kimura C, Miura K, Watanabe Y, Baba H, Ozaki K, Hasebe A, et al. Association between oral frailty and Prevotella percentage in the oral microbiota of community-dwelling older adults who participated in the CHEER Iwamizawa project, Japan. J Oral Rehabil. 2024;51:1721-9. doi: 10.1111/joor.13767, PMID 38850071. Kurinami N, Ashida K, Sugiyama S, Morito Y, Hasuzawa N, Yoshida A, et al. Reduced number of remaining or healthy teeth in patients with type 2 diabetes mellitus: A cross-sectional study assessed by dentists or dental hygienists in Japan. Intern Med. 2023;62:987-93. doi: 10.2169/internalmedicine.9773-22, PMID 37005297. Zhang DX, Xu S, Li WY, et al. Systemic influencing factors of dentition defect in type 2 diabetes mellitus patients with periodontitis. Sichuan Da Xue Xue Bao Yi Xue Ban. 2023;54:97-101. Alvarenga MO, Ferreira RO, Magno MB, Fagundes NC, Maia LC, Lima RR. Masticatory dysfunction by extensive tooth loss as a risk factor for cognitive deficit: A systematic review and meta-analysis. Front Physiol. 2019;10:832. doi: 10.3389/fphys.2019.00832, PMID 31333490. Zhifei W, Xiangeng Z, Hongyan W, et al. Investigation of the oral health-related quality of life in elderly patients with Type ２ diabetes in community based on Andersen. Mil Nurs. 2022;39:1-4. Zhang XY, Lin YX, Jiang Y, Zhang LC, Dong MY, Chi HY, et al. [Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus]. Beijing Da Xue Xue Bao Yi Xue Ban. 2023;55:450-5. doi: 10.19723/j.issn.1671-167X.2023.03.010, PMID 37291920. Allen F, Fan SY, Loke WM, Na TM, Keng Yan GL, Mittal R. The relationship between self-efficacy and oral health status of older adults. J Dent. 2022;122:104085. doi: 10.1016/j.jdent.2022.104085, PMID 35248673. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 11 Apr, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 05 Feb, 2025 Reviews received at journal 23 Jan, 2025 Reviewers agreed at journal 18 Jan, 2025 Reviews received at journal 09 Dec, 2024 Reviewers agreed at journal 03 Dec, 2024 Reviews received at journal 26 Nov, 2024 Reviewers agreed at journal 12 Nov, 2024 Reviewers agreed at journal 11 Nov, 2024 Reviewers invited by journal 06 Nov, 2024 Editor invited by journal 29 Oct, 2024 Editor assigned by journal 29 Oct, 2024 Submission checks completed at journal 24 Oct, 2024 First submitted to journal 21 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5303792\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":369932312,\"identity\":\"202ae0c8-f587-4cb4-8d68-0186c8488a2a\",\"order_by\":0,\"name\":\"Wenyu Luo\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYBACNvnznx8k/LCRAzIePkioqCGshU+CwczgY0+aMb8ED7PBgzPHCGuRk2AwkJzBdjhRcgYPm+TDFmYiHCbdkGDMw3M4weB277GKxAY2Bv727gT8WmQOHHjMY5GeZ3DnXNqNxB0yDBJnzm7Ar4UhsQFoi3WxwYEEsxuJZ9gYDCRyCWlJZpDmYWNO3ADUUpDYxkyEFok0BqD3nRNnzsgxYyBOC88ZNkgg8xxLlkg4c4yHoF/k23uYIVHJ3nzw44+KGjn+9l78WjAAD2nKR8EoGAWjYBRgBQBlGEnoBDTdPAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"North Sichuan Medical College\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Wenyu\",\"middleName\":\"\",\"lastName\":\"Luo\",\"suffix\":\"\"},{\"id\":369932313,\"identity\":\"61f45984-6358-4ee5-a264-c743e617b278\",\"order_by\":1,\"name\":\"Jinfeng Zhou\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"North Sichuan Medical College\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jinfeng\",\"middleName\":\"\",\"lastName\":\"Zhou\",\"suffix\":\"\"},{\"id\":369932314,\"identity\":\"ac5bf28e-8da8-4093-a3bd-b6e6ba44db01\",\"order_by\":2,\"name\":\"Lingyu Qiu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"North Sichuan Medical College\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lingyu\",\"middleName\":\"\",\"lastName\":\"Qiu\",\"suffix\":\"\"},{\"id\":369932315,\"identity\":\"224674d0-10d3-42e9-9d25-ebbd2a7d5aeb\",\"order_by\":3,\"name\":\"Li Zhao\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"North Sichuan Medical College\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Li\",\"middleName\":\"\",\"lastName\":\"Zhao\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-10-21 11:08:19\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-5303792/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5303792/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1186/s12903-025-05815-8\",\"type\":\"published\",\"date\":\"2025-04-11T16:05:18+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":67660954,\"identity\":\"a3a32895-2005-4599-b534-00221ba646bd\",\"added_by\":\"auto\",\"created_at\":\"2024-10-28 12:59:27\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":297742,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eTheoretical model diagram\\u003c/p\\u003e\\n\\u003cp\\u003eNotes: green box: influencing factors; blue box: results; gray box: timing for prevention and management\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5303792/v1/00484a2c343317fd23d7971e.png\"},{\"id\":67660956,\"identity\":\"86adeb6a-58eb-41a8-9acf-de879fea6cf2\",\"added_by\":\"auto\",\"created_at\":\"2024-10-28 12:59:27\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":187596,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eHeat map of correlation\\u003c/p\\u003e\\n\\u003cp\\u003eOF: oral frailty; ADL: activities of daily living; FR: fall risk; Support: social support\\u003c/p\\u003e\\n\\u003cp\\u003eBlue represents a positive correlation, and red represents a negative correlation. Darker colors indicate a stronger correlation. Significant correlations are indicated by **.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5303792/v1/f9b58e41471714620d5f61e5.png\"},{\"id\":67660955,\"identity\":\"4bab69e0-6ea5-4310-a23e-556f5650822e\",\"added_by\":\"auto\",\"created_at\":\"2024-10-28 12:59:27\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":51384,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eForest plot of the results of the logistic regression analysis\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5303792/v1/98edab1c8c828fa879cf916e.png\"},{\"id\":80558595,\"identity\":\"6994af9a-d262-49c3-ba6e-545d9bf5e86c\",\"added_by\":\"auto\",\"created_at\":\"2025-04-14 16:14:45\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1898496,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5303792/v1/1e5dd8bb-a514-4660-ad21-a546bdf8a22e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Influencing factors of oral frailty in elderly patients with type 2 diabetes in China: A cross- sectional study based on the integral model of frailty\",\"fulltext\":[{\"header\":\"1 Background\",\"content\":\"\\u003cp\\u003eAccording to the World Health Organization (WHO), diabetes mellitus is one of the four major non-communicable diseases (NCDs) requiring urgent attention\\u003csup\\u003e[1]\\u003c/sup\\u003e,\\u0026nbsp;and as of 2021, data from the International Diabetes Federation (IDF)\\u0026nbsp;\\u003csup\\u003e[2]\\u003c/sup\\u003e show that the global\\u0026nbsp;prevalence of diabetes mellitus among adults is 10.5% (537 million)，with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the population\\u003csup\\u003e[3]\\u003c/sup\\u003e.\\u0026nbsp;China has the highest number of diabetic patients globally, with approximately 30% of the elderly population suffering from diabetes, and type 2 diabetes mellitus (T2DM) accounting for more than 95% of cases\\u003csup\\u003e[4]\\u003c/sup\\u003e. Elderly patients with type 2 diabetes mellitus have become the mainstream population of diabetes mellitus in China, a situation that brings great challenges and far-reaching effects to patients, families, and the development of the country\\u0026apos;s actively aging society.\\u003c/p\\u003e\\n\\u003cp\\u003eWith the development of global aging, geriatric syndromes have become significant health concerns among older adults. Oral frailty is considered a geriatric syndrome\\u003csup\\u003e[5]\\u003c/sup\\u003e, and it refers to a series of processes that occur in individuals as they age, including a reduction in the number of teeth, decreased oral hygiene and oral function, decreased interest in oral health, decreased physical and mental reserve capacity, and dysfunctional eating\\u003csup\\u003e[6]\\u003c/sup\\u003e. Oral frailty not only seriously affects the physical condition and disease progression in older adults but also significantly increases the risk of a number of adverse outcomes such as physical frailty, malnutrition, falls, disability, infections, incapacitation, and even death\\u003csup\\u003e[7-9]\\u003c/sup\\u003e. Previous studies have shown that the prevalence of oral frailty in diabetic patients\\u0026nbsp;\\u0026ge;75 years of age is 53.2 %\\u003csup\\u003e[10]\\u003c/sup\\u003e,the risk of oral frailty increases significantly with age, and elderly patients with T2DM face more prevalent and severe oral problems that not only interfere with normal insulin secretion, but also affect their social and psychological health\\u003csup\\u003e[11]\\u003c/sup\\u003e .\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough global aging follows a similar trajectory, China\\u0026apos;s unique lifestyle and dietary culture, along with variations in treatment approaches for oral frailty in diabetic patients both domestically and internationally, may lead to different factors influencing oral frailty among Chinese older adults with T2DM.\\u0026nbsp;Compared to other countries, China has a large population of elderly patients with type 2 diabetes mellitus (T2DM), but oral health literacy is low\\u003csup\\u003e[12]\\u003c/sup\\u003e, and there is insufficient awareness of oral frailty. Coupled with the unequal distribution of oral health service resources across regions and limited health insurance coverage, there is currently a lack of targeted oral health management strategies for elderly patients with T2DM. Oral frailty manifests through symptoms such as increased difficulty in chewing food, choking on drinking water, and dry mouth, which are easily overlooked by caregivers and patients\\u003csup\\u003e[13]\\u003c/sup\\u003e.\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003eTherefore, investigating the current status and influencing factors of oral frailty in Chinese elderly patients with type 2 diabetes mellitus (T2DM), along with early identification of risk factors and timely intervention, is crucial for improving their oral health and overall health outcomes. However, most current research focuses on the oral frailty of elderly individuals in the community and nursing homes, while insufficient attention is given to oral health issues in elderly patients with Type 2 Diabetes Mellitus (T2DM). In China, studies on oral frailty in elderly T2DM patients are limited, and none have been conducted within a theoretical framework. Therefore, this study employed Gobbens\\u0026apos; integrative model of frailty\\u0026mdash;which encompasses physiological, psychological, and social dimensions\\u0026mdash;as the theoretical framework to explore the factors influencing oral frailty in elderly patients with type 2 diabetes mellitus (T2DM). The aim is to provide a reference for developing oral health prevention and management strategies for elderly patients with T2DM.\\u003c/p\\u003e\\n\\u003cp\\u003eThe Integral Model of Frailty was proposed by Dutch scholars\\u003csup\\u003e[14]\\u003c/sup\\u003e in 2010, and it indicates that frailty involves an integration of physical, psychological, and social dimensions of frailty and that there are interactions among the dimensions and dynamic changes that can increase the risk of adverse outcomes. It includes life course influencing factors, disease factors, physical frailty, psychological frailty, and social frailty. In this study, we constructed a model of factors influencing oral frailty in elderly patients with T2DM based on the debilitation integration model and adjusted the original model accordingly to derive the hypothesis diagram of this study. We hypothesized that the occurrence of oral frailty in elderly patients with type 2 diabetes mellitus is affected by the following factors: life course influences, including sex, age, marital status, and literacy level; disease factors, including duration of diabetes disease, glycosylated hemoglobin levels, multiple chronic conditions, and polypharmacy; physical frailty includes nutrition, mobility, fall risk, frailty, and oral health; psychological frailty includes depression and self-efficacy; and social frailty includes social support. Figure 1 shows the theoretical model for this study.\\u003c/p\\u003e\"},{\"header\":\"2 Methods\",\"content\":\"\\u003cp\\u003e\\u003cspan\\u003e\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.1 Research target\\u003c/strong\\u003e: This was a cross-sectional study, and elderly patients with T2DM who were hospitalized in the Department of Endocrinology of two public tertiary hospitals in Nanchong City, Sichuan Province, from March 2024 to October 2024 were selected for the study by convenience sampling method. The inclusion criteria were as follows: (1) diagnosed with T2DM according to the World Health Organization (WHO) criteria (1999); (2) duration of diabetes mellitus\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 year; (3) age\\u0026thinsp;\\u0026ge;\\u0026thinsp;60 years; and (4) no cognitive impairment and with normal expression ability. Exclusion criteria: (1) patients with complete loss of teeth and full dentures; (2) those with combined acute complications of diabetes mellitus or other serious illnesses, who were unable to complete the questionnaire.\\u003c/p\\u003e\\u003cspan\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e2.2 Sample size estimation\\u003c/strong\\u003e: The sample size was determined in accordance with the formula for determining the sample size of cross-sectional studies:\\u003cspan class=\\\"InlineEquation\\\"\\u003e\\u003cspan class=\\\"mathinline\\\"\\u003e\\\\(\\\\:n=\\\\frac{{z}_{a/2}^{2}p(1-p)}{{d}^{2}}\\\\)\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/p\\u003e\\n\\u003c/span\\u003e\\n\\u003cp\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe assumed an \\u0026alpha; value of 0.05 and an error (\\u0026delta;) of 0.05. The pre-test yielded a prevalence of oral frailty of 0.53% among elderly patients with T2DM. Therefore, the estimated sample size was 382, and a minimum of 425 cases should be included assuming a 10% dropout rate. The final sample size for the study was 431 cases.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e2.3 Ethical considerations\\u003c/strong\\u003e: All participants provided informed consent and signed a written consent form, and the study was reviewed by the Medical Ethics Committee of Affiliated Hospital of North Sichuan Medical College (Ethics Approval Number: 2024ER132-1).\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003e2.4 Data collection instrument\\u003c/h2\\u003e\\n \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.1 The General Information Questionnaire\\u003c/h2\\u003e\\n \\u003cp\\u003eThis questionnaire was developed by reviewing relevant literature and included both general demographic and disease-related information. General demographic data covered sex, age, education level, marital status, and place of residence. Disease-related information included the duration of illness, the number of chronic diseases (based on the International Classification of Diseases-10 [ICD-10]\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e, such as cardiovascular diseases, cancers, and chronic respiratory diseases), glycated hemoglobin (HbA1c) levels (defined according to the guidelines\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e; a reasonable target for HbA1c control is \\u0026lt;\\u0026thinsp;7.0%, and a HbA1c of \\u0026ge;\\u0026thinsp;7.0% indicated poor glycemic control), polypharmacy (defined by the WHO as the use of \\u0026ge;\\u0026thinsp;5 medications per day\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]\\u003c/sup\\u003e), the number of remaining teeth, and the severity of dry mouth.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.2 Oral Frailty Index-8\\u003c/h2\\u003e\\n \\u003cp\\u003eThe OFI-8 was developed by Tanaka et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]\\u003c/sup\\u003e, and in this study, we used the Chinese version developed by Chen et al\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e.The questionnaire has five dimensions and eight items, including greater difficulty eating hard foods than six months ago; sometimes choking on tea or soup; using dentures; dry mouth; going out less than you did six months ago; being able to chew hard foods such as pickled radish and shredded squid; brushing at least twice a day; and visiting the dentist at least once a year. The total score ranges from 0 to 11, with a score of \\u0026ge;\\u0026thinsp;4 considered a positive screening result for oral frailty. In the original validation of the Chinese version of the OFI-8, Chen et reported a Cronbach\\u0026rsquo;s alpha coefficient of 0.949, and in the current study, the Cronbach\\u0026rsquo;s alpha coefficient was 0.72.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e\\u003cstrong\\u003e2.4.3 Oral Health Assessment Tool (OHAT)\\u003c/strong\\u003e\\u003c/h2\\u003e\\n \\u003cp\\u003eThe OHAT was revised by Chalmers et al. based on the Brief Oral Health Checklist\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e, and this study, we used the Chinese version developed and validated by Wang et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]\\u003c/sup\\u003e for use in Chinese populations. An eight-item questionnaire was used to assess various aspects of oral health, including the lips, tongue, gingival tissue, saliva, natural teeth, dentures, oral cleanliness, and the presence of toothache. Each item was evaluated based on the current condition and scored as follows: 0 for healthy, 1 for changes, and 2 for unhealthy. The total score ranged from 0 to 16, with a score of \\u0026lt;\\u0026thinsp;3 indicating good oral health and a score of \\u0026ge;\\u0026thinsp;3 indicating poor oral health. A higher total score reflected a poorer oral health status. The Chinese version of the Oral Health Assessment Tool (OHAT) has previously demonstrated a Cronbach\\u0026apos;s alpha coefficient of 0.71. In the current study, we obtained a Cronbach\\u0026apos;s alpha of 0.70, indicating acceptable internal consistency.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.4 The Eating Assessment Tool-10 (EAT-10)\\u003c/h2\\u003e\\n \\u003cp\\u003eThe EAT-10, developed by Belafsky et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/sup\\u003e, is primarily used to assess the severity of dysphagia. In this study, we employed the Chinese version of the EAT-10 scale. The instrument comprises 10 items, each rated on a 5-point Likert scale ranging from 0 (\\u0026apos;no problem\\u0026apos;) to 4 (\\u0026apos;very severe\\u0026apos;), resulting in a total score ranging from 0 to 40. A total score of \\u0026ge;\\u0026thinsp;3 indicates indicated dysphagia, with higher scores representing more severe swallowing difficulties.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e\\u003cstrong\\u003e2.4.5 Visual analog scale (VAS)\\u003c/strong\\u003e\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/h2\\u003e\\n \\u003cp\\u003eThe VAS was used to evaluate patients\\u0026apos; subjective symptoms of dry mouth. Patients marked a position on a 10-cm VAS strip to reflect the severity of their symptoms, with the researcher recording the corresponding score. The scale ranges from left to right, where 0 indicates a moist mouth with no sensation of dryness, scores from 1 to 3 represent mild dry mouth, 4 to 6 indicate moderate dry mouth, and scores from 7 to 10 represent severe dry mouth.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.6 The Frailty (FRAIL) Screening Scale\\u003c/h2\\u003e\\n \\u003cp\\u003eThis FRAIL scale was developed by geriatric experts from the International Society for Nutritional Health and Aging\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]\\u003c/sup\\u003e, and the Chinese version, adapted by Wei Y et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]\\u003c/sup\\u003e was used in this study. It comprises five items: fatigue, reduced resistance/endurance, limited mobility, the presence of more than five comorbidities, and decreased body mass. Each item is scored as 1 point, with a total score ranging from 0 to 5. A score of 0 indicates a healthy status, 1\\u0026ndash;2 points signify pre-frailty, and a score of 3 or higher indicates frailty. The Cronbach\\u0026rsquo;s alpha coefficient of the original scale was 0.826, while the coefficient in this study was 0.71.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.7 The Geriatric Depression Scale (GDS⁃5)\\u003c/h2\\u003e\\n \\u003cp\\u003eThe GDS-5, developed by Hoyl et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]\\u003c/sup\\u003e, is a screening tool designed to detect depression in older adults. it consists of five items, each scored from 0 to 1, with a total score of 2 or higher indicating the presence of depression. The scale has demonstrated good reliability and validity in the elderly population\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]\\u003c/sup\\u003e, and in this study, the Cronbach\\u0026rsquo;s alpha coefficient was 0.77.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.8 The Geriatric Self Efficacy Scale for Oral Health (GSEOH)\\u003c/h2\\u003e\\n \\u003cp\\u003eThe GSEOH was developed by Ohara et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e, and the Chinese version, adapted by Xu Yuxin et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]\\u003c/sup\\u003e was used in this study. The scale comprises three dimensions: oral hygiene habits (items 1\\u0026ndash;8), oral function (items 9\\u0026ndash;17), and oral consultation habits (items 18\\u0026ndash;20), for a total of 20 items. Each item is scored on a 4-point Likert scale, ranging from 1 (\\u0026ldquo;not at all confident\\u0026rdquo;) to 4 (\\u0026ldquo;very confident\\u0026rdquo;), with a total score range of 20 to 80 points. Higher scores indicate greater self-efficacy in oral health. The Cronbach\\u0026rsquo;s alpha coefficient for the Chinese version of the GSEOH was 0.924, and it was 0.90 in this study.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section3\\\"\\u003e\\n \\u003ch2\\u003e2.4.9 Perceived social support scale (PSSS)\\u003c/h2\\u003e\\n \\u003cp\\u003eThe PSSS, developed by Zimet et al.\\u003csup\\u003e[\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]\\u003c/sup\\u003e, is used to assess an individual\\u0026apos;s level of social support. The scale comprises 12 items divided into three dimensions: support from family, friends, and significant others. Each item is rated on a 7-point Likert scale ranging from 1 (\\u0026quot;strongly disagree\\u0026quot;) to 7 (\\u0026quot;strongly agree\\u0026quot;), with higher scores indicating a greater perception of social support. In this study, the Cronbach\\u0026rsquo;s alpha coefficient for the PSSS was 0.902, demonstrating excellent internal consistency.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003e2.5 Data collection\\u003c/h2\\u003e\\n \\u003cp\\u003eA research team was established, led by the principal investigator. The team included two diabetes specialist nurses, both holding master\\u0026rsquo;s degrees and with over 10 years of experience in endocrinology, as well as two nursing students currently pursuing their master\\u0026rsquo;s degrees. Data and information were collected by the research team using a pre-designed questionnaire on influencing factors. Prior to the study, all team members underwent standardized training. Before the formal survey, the researcher explained the study\\u0026apos;s purpose, significance, instructions for completing the questionnaire, and estimated time required to the patients. Confidentiality was assured, and after obtaining their informed consent, the questionnaires were distributed on-site. For participants who had difficulty completing the questionnaires, such as individuals with lower levels of education or older adults, the researcher read the questionnaire aloud and assisted them in completing it based on their responses. The average time required to complete each questionnaire was approximately 25\\u0026ndash;30 minutes. After the survey, health education on diabetic oral health was provided to the participants based on their responses. All questionnaires were distributed and collected on-site. A total of 435 questionnaires were distributed, with four excluded due to a missing data rate exceeding 50%. In total, 431 valid questionnaires were collected, resulting in a valid response rate of 99.1%. The General Information Questionnaire, including age, gender, marital status, and disease-related data, was obtained by the investigator from the hospital\\u0026apos;s electronic medical records system. Additionally, the risk of falls, risk of malnutrition, and activities of daily living were assessed by endocrinology nurses within 24 hours of the patient\\u0026apos;s hospital admission.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003e2.6 Statistical methods\\u003c/h2\\u003e\\n \\u003cp\\u003eThe questionnaire data of this study were entered using EpiData 3.1 software, and the data were organized and analyzed using R 4.3.1 software. The \\u0026ldquo;tableone\\u0026rdquo; program package was used to describe the data. Normally distributed variables were presented using the mean and standard deviation and compared using the t-test. Variables that were not normally distributed were presented using the median and interquartile range, and the Mann-Whitney U-test was used to compare them. Categorical variables were expressed as frequency and percentage, and the chi-square test or Fisher\\u0026rsquo;s test was used to compare them. Correlation analysis and visualization were performed using the \\u0026ldquo;corrplot\\u0026rdquo; package. Logistic regression and stepwise regression analyses were performed using the \\u0026ldquo;glm\\u0026rdquo; package, and the logistic regression model was constructed by screening with backward stepwise culling. The logistic regression model was screened by the backward stepwise elimination method, and the forest plot was drawn using the \\u0026ldquo;forestploter\\u0026rdquo; package. A p-value of \\u0026lt;\\u0026thinsp;0.05 was considered statistically significant, and the significance level was set at \\u0026alpha;\\u0026thinsp;=\\u0026thinsp;0.05.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"3 Results\",\"content\":\"\\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e\\n \\u003ch2\\u003e3.1 General characteristics\\u003c/h2\\u003e\\n \\u003cp\\u003eA total of 431 elderly patients with type 2 diabetes mellitus (T2DM) were included in the study. Oral frailty was identified in 142 patients, representing 32.95% of the cohort. The mean age of participants was 71.44\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;7.47 years. Among them, 197 patients (45.71%) were male, and 234 (54.29%) were female. Most participants were married (n\\u0026thinsp;=\\u0026thinsp;355, 82.37%) and resided in towns or cities (n\\u0026thinsp;=\\u0026thinsp;268, 62.18%). Sixty-two patients (14.39%) lived alone.\\u003c/p\\u003e\\n \\u003cp\\u003eRegarding monthly household income, 207 patients (48.03%) earned less than 3,000 yuan, 112 patients (25.99%) earned between 3,000 and 5,000 yuan, and another 112 patients (25.99%) earned 5,000 yuan or more. Health insurance coverage included residents\\u0026rsquo; health insurance for 231 patients (53.60%), employees\\u0026rsquo; health insurance for 195 patients (45.23%), and self-payment or other types of health financing for 5 patients (1.16%).\\u003c/p\\u003e\\n \\u003cp\\u003eLifestyle factors revealed that 159 patients (36.89%) were current smokers, and 153 patients (35.50%) consumed alcohol. Polypharmacy (use of multiple medications) was observed in 230 patients (53.36%). In terms of xerostomia (dry mouth), 78 patients (18.09%) reported no symptoms, 211 patients (48.96%) had mild symptoms, 137 patients (31.79%) had moderate symptoms, and 5 patients (1.16%) experienced severe symptoms. Additionally, 59 patients (13.69%) had swallowing dysfunction, and 172 patients (39.91%) had fewer than 20 remaining teeth.\\u003c/p\\u003e\\n \\u003cp\\u003eConcerning comorbidities, 25 patients (5.80%) had no other chronic diseases, 90 patients (20.88%) had one chronic disease, 107 patients (24.83%) had two chronic diseases, and 209 patients (48.49%) had three or more chronic diseases.\\u003c/p\\u003e\\n \\u003ch2\\u003e\\u003cstrong\\u003e3.2 Analysis of the correlation between the risk of developing oral frailty and other factors in elderly patients with type 2 diabetes mellitus\\u003c/strong\\u003e\\u003c/h2\\u003e\\n \\u003cp\\u003eWe calculated the correlation coefficient matrix between oral frailty and other factors, along with the matrix of significant \\u003cem\\u003ep\\u003c/em\\u003e-values (Fig. 2). The results indicated that age had the strongest positive correlation with oral frailty (r\\u0026thinsp;=\\u0026thinsp;0.44, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), while the number of remaining teeth showed the strongest negative correlation (r = \\u0026minus;\\u0026thinsp;0.48, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). These findings are illustrated in Fig. 2.\\u003c/p\\u003e\\n \\u003ch2\\u003e\\u003cstrong\\u003e3.3 Univariate analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus\\u003c/strong\\u003e\\u003c/h2\\u003e\\n \\u003cp\\u003eUnivariate analysis indicated that several factors were significantly associated with the occurrence of oral frailty in elderly patients with type 2 diabetes mellitus (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). These factors included age, gender, educational level, marital status, polypharmacy, dysphagia, number of remaining teeth, multiple comorbidities, glycated hemoglobin (HbA1c) levels, risk of falls, activities of daily living (ADL), risk of malnutrition, physical frailty, depression, oral health status, social support, and oral health-related self-efficacy scores. The occurrence of these important factors and the difference were statistically significant (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\n \\u003ctable id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption language=\\\"En\\\"\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eUnivariate analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLevel\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOverall\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;431)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOF group\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;142)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNon-OF group\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;289)\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAge, years (mean [SD])\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e71.44 (7.47)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e66.86 (6.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e73.69 (6.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDuration (mean [SD])\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11.48 (8.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e10.56 (7.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e11.94 (8.67)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSex, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e197 (45.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e76 (53.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e121 (41.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.029\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFemale\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e234 (54.29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e66 (46.48)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e168 (58.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEducation, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLess than lower primary school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e261 (60.56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e70 (49.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e191 (66.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.005\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMiddle school\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e100 (23.20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e46 (32.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e54 (18.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUpper secondary or vocational training\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e49 (11.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e19 (13.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e30 (10.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCollege degree or above\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e21 (4.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e7 (4.93)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e14 (4.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMarital status, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eCurrently married\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e355 (82.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e126 (88.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e229 (79.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.022\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUnmarried/divorced/widowed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e76 (17.63)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e16 (11.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e60 (20.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResidence, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRural\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e268 (62.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e98 (69.01)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e170 (58.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.052\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUrban\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e163 (37.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e44 (30.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e119 (41.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLiving alone, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e369 (85.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e124 (87.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e245 (84.78)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.574\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e62 (14.39)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e18 (12.68)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e44 (15.22)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMonthly family income (RMB) (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;3000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e207 (48.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e63 (44.37)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e144 (49.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.561\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e3000\\u0026ndash;5000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e112 (25.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e39 (27.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e73 (25.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026gt;\\u0026thinsp;5000\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e112 (25.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e40 (28.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e72 (24.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMedicare, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eResidents\\u0026rsquo; medical insurance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e231 (53.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e69 (48.59)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e162 (56.06)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.181\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eEmployee medical insurance\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e195 (45.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e70 (49.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e125 (43.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePrivate expense and other types\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5 (1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3 (2.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2 (0.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSmoking, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e272 (63.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e84 (59.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e188 (65.05)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.277\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e159 (36.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e58 (40.85)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e101 (34.95)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDrinking, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e278 (64.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e84 (59.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e194 (67.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.129\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e153 (35.50)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e58 (40.85)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e95 (32.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePolypharmacy, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo, \\u0026lt;\\u0026thinsp;4 kinds\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e201 (46.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e82 (57.75)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e119 (41.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.002\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes, \\u0026ge;\\u0026thinsp;5 kinds\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e230 (53.36)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e60 (42.25)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e170 (58.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eXerostomia, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo dry mouth symptoms\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e78 (18.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31 (21.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e47 (16.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.107\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSlight dry feeling in the mouth\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e211 (48.96)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e76 (53.52)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e135 (46.71)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNoticeable dryness and some discomfort\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e137 (31.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e33 (23.24)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e104 (35.99)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIntense dryness, significantly affecting\\u003c/p\\u003e\\n \\u003cp\\u003espeaking and eating\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e5 (1.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e2 (1.41)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3 (1.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDysphagia, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e372 (86.31)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e139 (97.89)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e233 (80.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e59 (13.69)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3 (2.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e56 (19.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRemaining teeth, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e172 (39.91)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e9 (6.34)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e163 (56.40)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;\\u0026thinsp;20\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e259 (60.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e133 (93.66)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e126 (43.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNumber of chronic diseases, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e25 (5.80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13 (9.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12 (4.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.005\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e90 (20.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e40 (28.17)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e50 (17.30)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e107 (24.83)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e30 (21.13)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e77 (26.64)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;\\u0026thinsp;3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e209 (48.49)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e59 (41.55)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e150 (51.90)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHbA1c, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e29 (6.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e15 (10.56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e14 (4.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.043\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;\\u0026thinsp;7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e402 (93.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e127 (89.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e275 (95.16)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFall risk, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLow risk\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e95 (22.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e39 (27.46)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e56 (19.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.031\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eModerate risk\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e259 (60.09)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e86 (60.56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e173 (59.86)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHigh risk\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e77 (17.87)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17 (11.97)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e60 (20.76)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eBarthel index, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo dependency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e91 (21.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e43 (30.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e48 (16.61)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMild dependency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e263 (61.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e83 (58.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e180 (62.28)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eModerate dependency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e60 (13.92)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e13 (9.15)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e47 (16.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSevere dependency\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e17 (3.94)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e3 (2.11)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e14 (4.84)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNutrition, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNormal nutritional status\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e351 (81.44)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e124 (87.32)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e227 (78.55)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e0.038\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAt risk of malnutrition\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e80 (18.56)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e18 (12.68)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e62 (21.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrailty, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eRobust\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e143 (33.18)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e75 (52.82)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e68 (23.53)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003ePre-frailty\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e207 (48.03)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e55 (38.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e152 (52.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eFrailty\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e81 (18.79)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e12 (8.45)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e69 (23.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDepression, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNo\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e271 (62.88)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e119 (83.80)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e152 (52.60)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eYes\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e160 (37.12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e23 (16.20)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e137 (47.40)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOHAT, number (%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;\\u0026thinsp;3 points, healthy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e83 (19.26)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52 (36.62)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e31 (10.73)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003e\\u0026ge;\\u0026thinsp;3 points, unhealthy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e348 (80.74)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e90 (63.38)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e258 (89.27)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSocial support (mean [SD])\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e55.23 (11.02)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e58.18 (10.35)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e53.78 (11.07)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eOHSE (mean [SD])\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e52.91 (9.04)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e58.25 (7.57)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e50.28 (8.54)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"char\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003ctfoot\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd colspan=\\\"6\\\"\\u003eNotes: \\u003cem\\u003eSD\\u003c/em\\u003e, standard deviation;OHAT, Oral Health Assessment Tool ;OHSE, Geriatric Self Efficacy Scale for Oral Health Scale\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tfoot\\u003e\\n \\u003c/table\\u003e\\n \\u003cp\\u003eInsert Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e here\\u003c/p\\u003e\\n \\u003ch2\\u003e\\u003cstrong\\u003e3.4 Multifactorial analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes mellitus\\u003c/strong\\u003e\\u003c/h2\\u003e\\n \\u003cp\\u003eTo further investigate the factors influencing oral frailty, we conducted a logistic regression analysis using oral frailty occurrence (score\\u0026thinsp;\\u0026ge;\\u0026thinsp;4) as the dependent variable. Variables that showed statistical significance in the univariate analysis were included in the regression model, and a backward elimination method was applied for variable selection. The results indicated that age (OR\\u0026thinsp;=\\u0026thinsp;1.098, 95% CI: 1.054\\u0026ndash;1.146, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), presence of dysphagia (OR\\u0026thinsp;=\\u0026thinsp;8.401; 95% CI: 2.276\\u0026ndash;43.846; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.004), glycated hemoglobin (HbA1c)\\u0026thinsp;\\u0026ge;\\u0026thinsp;7% (OR\\u0026thinsp;=\\u0026thinsp;3.745; 95% CI: 1.203\\u0026ndash;12.647; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.027), and poor oral health status (OR\\u0026thinsp;=\\u0026thinsp;2.213; 95% CI: 1.134\\u0026ndash;4.394; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.021) were significant risk factors for oral frailty in elderly patients with type 2 diabetes mellitus. Conversely, having\\u0026thinsp;\\u0026ge;\\u0026thinsp;20 remaining teeth (OR\\u0026thinsp;=\\u0026thinsp;0.105; 95% CI: 0.046\\u0026ndash;0.217; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and higher levels of oral health-related self-efficacy (OR\\u0026thinsp;=\\u0026thinsp;0.934; 95% CI: 0.898\\u0026ndash;0.970; \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.001) were significant protective factors against oral frailty in this population. (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) (Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and Fig. 3).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTable 2.\\u003c/strong\\u003e Multifactorial analysis of the risk of developing oral frailty in elderly patients with type 2 diabetes (n = 431)\\u003c/p\\u003e\\n \\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"100%\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003eBeta\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003eSE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003eOR (95% CI)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eEducation (ref=1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003e(ref=2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.579\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.336\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.085\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e0.56 (0.289\\u0026ndash;1.082)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003e(ref=3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e0.559\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.436\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.200\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e1.749 (0.749\\u0026ndash;4.173)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003e(ref=4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e0.704\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.589\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.232\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e2.022 (0.647\\u0026ndash;6.671)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eAge\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e0.093\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.021\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e1.098 (1.054\\u0026ndash;1.146)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eDysphagia (ref=1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e2.128\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.739\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.004\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e8.401 (2.276\\u0026ndash;43.846)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eHbA1c (ref=1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e1.320\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.597\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.027\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e3.745 (1.203\\u0026ndash;12.647)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eOHAT (ref=1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e0.795\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.344\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.021\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e2.213 (1.134\\u0026ndash;4.394)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eTeeth (ref=1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;2.257\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.394\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026lt;0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e0.105 (0.046\\u0026ndash;0.217)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 22.6804%;\\\"\\u003e\\n \\u003cp\\u003eOHSE\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4703%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026minus;0.068\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e0.020\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 15.4639%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e0.001\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 30.94%;\\\"\\u003e\\n \\u003cp\\u003e0.934 (0.898\\u0026ndash;0.970)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\u003cbr\\u003eNotes: \\u003cem\\u003eSE\\u003c/em\\u003e: standard error; \\u003cem\\u003eOR\\u003c/em\\u003e: odds ratio; \\u003cem\\u003e95% CI\\u003c/em\\u003e: 95% confidence interval; \\u003cem\\u003eref\\u003c/em\\u003e: reference group\\n\\u003c/div\\u003e\"},{\"header\":\"5 Discussion\",\"content\":\"\\u003cp\\u003eIn this study, 142 out of 431 elderly patients with type 2 diabetes mellitus (T2DM) had oral frailty (OFI-8 score\\u0026thinsp;\\u0026ge;\\u0026thinsp;4), representing an incidence of 32.95%. This rate is lower than that reported among diabetic patients in the Japanese study by Ishii et al.(53.2%)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e, and also lower than the incidence observed in hospitalized cancer patients (64.3%)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]\\u003c/sup\\u003e and elderly patients undergoing maintenance hemodialysis (45.2%)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]\\u003c/sup\\u003e. Several factors may contribute to the lower incidence observed in our study:(1) Compared to participants in foreign studies, our study population was younger and excluded patients with complete tooth loss or full dentures. A significant proportion of our participants resided in urban areas (62.18%) and had employee medical insurance (45.23%). The urban environment offers more opportunities to access professional oral health knowledge and advice. Additionally, having employee medical insurance may provide more financial resources to invest in oral health care. (2) Compared with patients suffering from other diseases, individuals with T2DM often consume whole grains rich in dietary fiber, which may help maintain chewing and swallowing functions. Lifestyle interventions involving regular physical activity are fundamental in diabetes management and may help delay the onset of oral frailty. Furthermore, the hypoglycemic medication metformin has been reported to alleviate oral lesions and reduce tooth loss\\u003csup\\u003e[\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]\\u003c/sup\\u003e, potentially contributing to a lower incidence of oral frailty.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e5.1 Oral Frailty in Elderly Patients with Type 2 Diabetes Is Influenced by Multiple Factors\\u003c/h2\\u003e \\u003cp\\u003eAdvanced age was a risk factor for the development of oral frailty in elderly patients with T2DM, the older the age, the higher the risk of developing oral frailty (OR\\u0026thinsp;=\\u0026thinsp;1.098, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). This finding aligns with the predictions of the integrated frailty model, which suggests that life-course influencing factors impact the occurrence of oral frailty. It is also consistent with the results of a previous study by Ishii et al, which noted that the oral frailty questionnaire scores of patients with T2DM\\u0026thinsp;\\u0026ge;\\u0026thinsp;75 years of age were positively correlated with age, and the prevalence of oral frailty increased with age\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e. Several reasons may explain this association. As age increases, there is a progressive decline in both the structure and function of the oral cavity among the elderly. Common issues include tooth wear, enamel thinning or demineralization, degenerative changes in periodontal tissues, and a weakened oral immune system. These problems lead to decreased masticatory efficiency and reduced saliva synthesis and secretion, resulting in conditions like periodontitis and oral mucositis, which in turn induce oral frailty\\u003csup\\u003e[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, oral health literacy in elderly T2DM patients gradually decreases with age\\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e, Low health literacy is closely associated with more severe periodontitis, higher plaque indices, and increased tooth loss\\u003csup\\u003e[\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]\\u003c/sup\\u003e. Furthermore, as the duration of diabetes extends, glycemic control becomes more challenging, and the incidence of diabetes-related complications rises. These complications are risk factors for oral diseases, which may also contribute to the higher susceptibility to oral frailty in older T2DM patients. Therefore, healthcare professionals should emphasize the assessment and screening of oral frailty in elderly T2DM patients. By providing health education to improve oral health literacy and highlighting the importance of oral health, the progression of oral frailty can be delayed.\\u003c/p\\u003e \\u003cp\\u003eSubjective dysphagia was also a risk factor for oral frailty in elderly patients with T2DM(OR\\u0026thinsp;=\\u0026thinsp;8.401, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). This finding is consistent with the results of Nishida et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]\\u003c/sup\\u003e and aligns with the predictions of the frailty integration model, which suggests that dysphagia exacerbates the occurrence of oral frailty. The possible reasons for this include: (1) The prevalence of sarcopenia in patients with T2DM can be as high as 29.3%\\u003csup\\u003e[\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003c/sup\\u003e, When sarcopenia affects the swallowing muscle groups, it manifests as reduced pharyngeal contraction and upper esophageal sphincter dysfunction, leading to difficulty in swallowing. Additionally, the reduction of pharyngeal muscle mass decreases pharyngeal pressure, increasing the risk of choking when drinking water\\u003csup\\u003e[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]\\u003c/sup\\u003e. (2) Patients with T2DM often have a narrower choice of foods and less dietary diversity due to necessary dietary restrictions. Patients with dysphagia may also suffer from malnutrition because they have difficulty meeting their nutritional requirements with a conventional diet. Ultimately, poorer nutritional status elevates the risk of developing oral frailty\\u003csup\\u003e[\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]\\u003c/sup\\u003e. Therefore, it is recommended that healthcare professionals assess the eating habits and chewing and swallowing functions of patients with T2DM. Developing targeted dietary plans and providing instruction on oral and swallowing function training for patients with subjective dysphagia can improve swallowing ability, increase the likelihood of oral intake, and prevent malnutrition.\\u003c/p\\u003e \\u003cp\\u003eIn this study, A HbA1c of \\u0026ge;\\u0026thinsp;7.0% was identified as a risk factor for the development of oral frailty in elderly patients with type 2 diabetes mellitus (OR\\u0026thinsp;=\\u0026thinsp;3.745, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.027), which is consistent with the findings of Demmer et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]\\u003c/sup\\u003e, This aligns with the prediction of the frailty integration model that oral health status is compromised in patients with chronic diseases. Specifically, patients with HbA1c levels\\u0026thinsp;\\u0026ge;\\u0026thinsp;7.0% exhibited poorer oral health compared to those with adequate glycemic control. HbA1c, as the gold standard for reflecting glycemic control levels, is an important factor affecting the oral health of diabetic patients\\u003csup\\u003e[\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]\\u003c/sup\\u003e. The underlying reason may be that long-term poor glycemic control alters the oral microenvironment due to hyperglycemia, significantly increasing the risk of dental caries and periodontitis.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]\\u003c/sup\\u003e Furthermore, the development of periodontitis promotes the release of inflammatory mediators, which may enhance insulin resistance and elevate blood glucose levels. Particularly, the elevation of blood glucose may delay the timing of periodontal treatment in patients with T2DM who require it, affecting the effectiveness of periodontal treatment and in turn affecting oral health. Therefore, it is recommended that healthcare professionals assist patients in setting individualized glycemic control goals, emphasizing the significant impact of blood glucose levels on oral health to ensure it receives adequate attention.\\u003c/p\\u003e \\u003cp\\u003ePoor oral health was identified as a risk factor for developing oral frailty (OR\\u0026thinsp;=\\u0026thinsp;2.213, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001),, aligning with the findings of Hanako et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e]\\u003c/sup\\u003e, who suggested that elderly individuals with poor oral health are more likely to develop oral frailty. These results are consistent with the hypothesized model predicting an association between oral health status and oral frailty. Poor oral health is characterized by reduced saliva production (dry mouth), worn or missing teeth, inadequate oral cleanliness, and oral pain. Firstly, reduced saliva production increases the risk of oral fungal infections, and diabetes mellitus heightens susceptibility to opportunistic oral infections. Secondly, a decreased number of teeth leads to reduced tongue pressure and impaired oral motor function Additionally, microbial dysbiosis in dental plaque resulting from insufficient oral hygiene can induce oral frailty\\u003csup\\u003e[\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]\\u003c/sup\\u003e, and dental pain can further exacerbate this condition. Therefore, it is recommended that nursing staff assess and care for the patients' oral cavity according to the Oral Health Management Program, develop good oral hygiene habits, and ensure adequate oral cleaning and health care to improve the oral status.\\u003c/p\\u003e \\u003cp\\u003eThe number of retained teeth\\u0026thinsp;\\u0026ge;\\u0026thinsp;20 was a protective factor against oral frailty in elderly patients with T2DM (OR\\u0026thinsp;=\\u0026thinsp;0.105, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001),, consistent with the findings of Kurinami et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]\\u003c/sup\\u003e, This study proposed that the number of remaining or healthy teeth in patients with T2DM was significantly lower than in patients without T2DM and that the number of remaining teeth\\u0026thinsp;\\u0026ge;\\u0026thinsp;20 was an important indicator of a favorable prognosis in patients with T2DM. Zhang et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e]\\u003c/sup\\u003e also observed a significant correlation between the number of remaining teeth and the degree of periodontal inflammation in patients with periodontitis and type 2 diabetes. Those with \\u0026ge;\\u0026thinsp;20 remaining teeth exhibited significantly lower levels of periodontal inflammation and HbA1c compared to those with fewer than 20 teeth. The reduction in the number of remaining teeth not only exacerbates periodontal inflammation but also impairs normal chewing and occlusal functions, potentially leading to masticatory dysfunction\\u003csup\\u003e[\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e]\\u003c/sup\\u003e,defined in the study as having fewer than 20 teeth .Therefore, it is recommended that elderly patients with T2DM undergo regular dental examinations, periodontitis treatment should be standardized. One of the treatment goals should be to maintain at least 20 teeth and ensure adequate masticatory function, which can contribute to better overall management of their condition.\\u003c/p\\u003e \\u003cp\\u003eA high level of oral health-related self-efficacy was a protective factor for the occurrence of oral frailty in elderly patients with T2DM (OR\\u0026thinsp;=\\u0026thinsp;0.934, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001), consistent with the findings of Wen et al.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e. This observation aligns with the predictions of the frailty integrative model, which suggests that psychological factors influence the onset of oral frailty. Oral health-related self-efficacy refers to an individual's subjective perception or judgment of their ability to effectively maintain oral health\\u003csup\\u003e[\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]\\u003c/sup\\u003e, It is a critical factor in personal oral health maintenance and plays a decisive role in oral health behaviors. Research has demonstrated that high levels of oral health-related self-efficacy enhance self-care capabilities in patients with type 2 diabetes\\u003csup\\u003e[\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e]\\u003c/sup\\u003e. Additionally, it triggers greater demands for oral hygiene and motivates positive health behaviors\\u003csup\\u003e[\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]\\u003c/sup\\u003e, encouraging these patients to prioritize oral hygiene. This focus effectively improves oral diseases and glycated hemoglobin levels, thereby reducing the risk of oral frailty. Conversely, patients with low self-efficacy are more prone to oral health-related problems\\u003csup\\u003e[\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e]\\u003c/sup\\u003e, increasing their risk of developing oral frailty. Therefore, it is recommended that healthcare providers enhance communication with elderly patients with type 2 diabetes to better understand their oral care needs, correct any misconceptions, and establish accurate beliefs regarding oral health management. By improving oral health-related self-efficacy and self-care abilities in these patients, the prevention of oral frailty can be effectively achieved.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003e5.2 Limitations\\u003c/h2\\u003e \\u003cp\\u003eFirstly, the cross-sectional design of this observational study limits the ability to infer causal relationships from the findings. Future research should employ multicenter longitudinal or qualitative studies with larger sample sizes and extended follow-up periods to thoroughly investigate the relevant influencing factors in greater depth. Secondly, the study aggregated the number of chronic diseases, which precluded the assessment of how the severity of these conditions influences oral frailty. Lastly, the present study relied on subjective scales to evaluate the degree of oral debilitation and oral health status among patients. Objective indicators, such as the looseness of remaining teeth, the number of caries, and the presence of dentures, were not assessed; these factors may also influence the study's outcomes. Therefore, future research is recommended to incorporate these objective measures to more comprehensively address the aforementioned issues.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"6 Conclusion\",\"content\":\"\\u003cp\\u003eOral frailty is more prevalent among elderly patients with type 2 diabetes mellitus (T2DM). Advanced age, dysphagia, HbA1c levels\\u0026thinsp;\\u0026ge;\\u0026thinsp;7%, and poor oral health status are identified as risk factors for oral frailty, whereas having 20 or more remaining teeth and high oral health-related self-efficacy serve as protective factors. However, the specific impact and mechanisms by which these four risk factors and two protective factors influence oral frailty require further investigation. The findings of this study provide valuable insights for developing preventive and management strategies for oral health in elderly T2DM patients. Additionally, the results emphasize the need for clinical healthcare professionals to prioritize oral frailty in elderly T2DM patients by conducting early assessments and interventions targeting these risk factors. Providing personalized, long-term oral health management services is essential to prevent and reduce the occurrence of oral frailty in this population.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eGSEOH Geriatric Self Efficacy Scale for Oral Health\\u003c/p\\u003e\\n\\u003cp\\u003eIDF International Diabetes Federation\\u003c/p\\u003e\\n\\u003cp\\u003eNCD Non-communicable diseases\\u003c/p\\u003e\\n\\u003cp\\u003eOHAT Oral Health Assessment Tool\\u003c/p\\u003e\\n\\u003cp\\u003ePSSS Perceived Social Support Scale\\u003c/p\\u003e\\n\\u003cp\\u003eSHIP Study of Health in Pomerania\\u003c/p\\u003e\\n\\u003cp\\u003eVAS Visual analog scale\\u003c/p\\u003e\\n\\u003cp\\u003eWHO World Health Organization\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was approved by the Affiliated Hospital of North Sichuan Medical College (Approval No. 2024ER132-1). All participants provided informed consent by signing the consent form prior to participation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to patient privacy concerns but are available from the corresponding author upon reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWY Land and LZ contributed to the study concept and design. WY L, JF Z, and LY Q were responsible for data acquisition. WY L conducted the analysis and interpretation of data. WY L and LZ drafted the manuscript. LZ critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors thank all the participants for their valuable contributions to this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; information\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eWorld HO. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization. 2013.\\u003c/li\\u003e\\n\\u003cli\\u003eFederation ID. IDF diabetes atlas, tenth. Int Diabetes. 2021.\\u003c/li\\u003e\\n\\u003cli\\u003eSun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119, PMID 34879977.\\u003c/li\\u003e\\n\\u003cli\\u003eZhao W. Interpretation on clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in china; 2022 Edition. Med J Peking Union Med College Hospital 2022;13:574-80.\\u003c/li\\u003e\\n\\u003cli\\u003ePayne M, Morley JE. Editorial: Dysphagia, dementia and frailty. J Nutr Health Aging. 2018;22:562-5. doi: 10.1007/s12603-018-1033-5, PMID 29717753.\\u003c/li\\u003e\\n\\u003cli\\u003eWatanabe Y, Okada K, Kondo M, Matsushita T, Nakazawa S, Yamazaki Y. Oral Health for achieving longevity. Geriatr Gerontol Int. 2020;20:526-38. doi: 10.1111/ggi.13921, PMID 32307825.\\u003c/li\\u003e\\n\\u003cli\\u003eYokoyama H, Kitano Y. Oral frailty as a risk factor for fall incidents among community-dwelling people. Geriatrics (Basel). 2024;9. doi: 10.3390/geriatrics9020054, PMID 38667521.\\u003c/li\\u003e\\n\\u003cli\\u003eIzutsu M, Hirayama K, Su Y, et al. Risk factors for oral frailty among community-dwelling pre-frail older adults in Japan: A cross-sectional analysis. Community Dent Hlth. 2023;40:221-6.\\u003c/li\\u003e\\n\\u003cli\\u003eKugimiya Y, Motokawa K, Yamamoto K, Hayakawa M, Mikami Y, Iwasaki M, et al. Relationship between the rate of a decreased oral function and the nutrient intake in community-dwelling older persons: an examination using oral function-related items in a questionnaire for latter-stage elderly people. Nihon Ronen Igakkai Zasshi. 2021;58:91-100. doi: 10.3143/geriatrics.58.91, PMID 33627567.\\u003c/li\\u003e\\n\\u003cli\\u003eIshii M, Yamaguchi Y, Hamaya H, Iwata Y, Takada K, Ogawa S, et al. Influence of oral health on frailty in patients with type 2 diabetes aged 75 years or older. BMC Geriatr. 2022;22:145. doi: 10.1186/s12877-022-02841-x, PMID 35183107.\\u003c/li\\u003e\\n\\u003cli\\u003eRohani B. Oral manifestations in patients with diabetes mellitus. World J Diabetes. 2019;10:485-9. doi: 10.4239/wjd.v10.i9.485, PMID 31558983.\\u003c/li\\u003e\\n\\u003cli\\u003eChen MQ, Zhou ZQ, Liu H, et al. The status quo of oral health literacy among elderly patients with type 2 diabetes and analysis of influencing factors. J Qiqihar Med Coll. 2024;45(17):1688\\u0026ndash;1692.\\u003c/li\\u003e\\n\\u003cli\\u003eParisius KG, Wartewig E, Schoonmade LJ, Aarab G, Gobbens R, Lobbezoo F. Oral frailty dissected and conceptualized: A scoping review. Arch Gerontol GERIATr. 2022;100:104653. doi: 10.1016/j.archger.2022.104653, PMID 35176531..\\u003c/li\\u003e\\n\\u003cli\\u003eGobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: opinions of experts. J Am Med Dir Assoc. 2010;11:338-43. doi: 10.1016/j.jamda.2009.09.015, PMID 20511101.\\u003c/li\\u003e\\n\\u003cli\\u003eGlasgow RE, Toobert DJ, Barrera MJ, Strycker LA. The Chronic Illness Resources Survey: cross-validation and sensitivity to intervention. Health Educ Res. 2005;20:402-9. doi: 10.1093/her/cyg140.\\u003c/li\\u003e\\n\\u003cli\\u003eMasnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17:230. doi: 10.1186/s12877-017-0621-2, PMID 29017448.\\u003c/li\\u003e\\n\\u003cli\\u003eTanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol A Biol Sci Med Sci. 2018;73:1661-7. doi: 10.1093/gerona/glx225, PMID 29161342.\\u003c/li\\u003e\\n\\u003cli\\u003eChen ZM, Tan Y, Liang YJ, et al. Shi GF. Chinesization of the Oral Frailty Index-8 and its reliability and validity test. Chin Nur Res. 2023;37:3808-12.\\u003c/li\\u003e\\n\\u003cli\\u003eChalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The oral health assessment tool--validity and reliability. Aust Dent J. 2005;50:191-9. doi: 10.1111/j.1834-7819.2005.tb00360.x, PMID 16238218.\\u003c/li\\u003e\\n\\u003cli\\u003eWang JQ, Zhu SZ, Zhan Y, et al. Reliability and validity test of Chinese version of the oral Health Assessment Tool. Chin J Mod Nurs. 2019;25:3607-10.\\u003c/li\\u003e\\n\\u003cli\\u003eBelafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117:919-24. doi: 10.1177/000348940811701210, PMID 19140539.\\u003c/li\\u003e\\n\\u003cli\\u003eColquhoun AN, Ferguson MM. An association between oral lichen planus and a persistently dry mouth. \\u003cem\\u003eOral Surg Oral Med Oral Pathol Oral Radiol Endod\\u003c/em\\u003e. 2004;98(1):60\\u0026ndash;68.doi: \\u003cu\\u003e10.1016\\u003c/u\\u003e/j.tripleo.\\u003cem\\u003e\\u003cu\\u003e2003.11.003\\u003c/u\\u003e\\u003c/em\\u003e.\\u003c/li\\u003e\\n\\u003cli\\u003evan Kan GA, Rolland YM, Morley JE, Vellas B. Frailty: Toward a clinical definition. J Am Med Dir Assoc. 2008;9:71-2. doi: 10.1016/j.jamda.2007.11.005.\\u003c/li\\u003e\\n\\u003cli\\u003eWei Y, Cao YP, Yang XL, et al. Frailty syndrome in hospitalized geriatric patients and its risk factors. Fudan Univ J Med Sci. 2018;45:496-502.\\u003c/li\\u003e\\n\\u003cli\\u003eHoyl MT, Alessi CA, Harker JO, Josephson KR, Pietruszka FM, Koelfgen M, et al. Development and testing of a five‐item version of the Geriatric Depression Scale. J Am Geriatr Soc. 1999;47:873-8. doi: 10.1111/j.1532-5415.1999.tb03848.x, PMID 10404935.\\u003c/li\\u003e\\n\\u003cli\\u003eRinaldi P, Mecocci P, Benedetti C, Ercolani S, Bregnocchi M, Menculini G, et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc. 2003;51:694-8. doi: 10.1034/j.1600-0579.2003.00216.x, PMID 12752847.\\u003c/li\\u003e\\n\\u003cli\\u003eOhara Y, Yoshida N, Kawai H, Obuchi S, Yoshida H, Mataki S, et al. Development of an oral health‐related self‐efficacy scale for use with older adults. Geriatr Gerontol Int. 2017;17:1406-11. doi: 10.1111/ggi.12873, PMID 27531046.\\u003c/li\\u003e\\n\\u003cli\\u003eYuxin X, Hongmei W, Junchi M, et al. Sinicization and reliability and validity test of the Geriatric self-efficacy Scale for Oral Health. Chin Nurs Res. 2021;35:2858-63.\\u003c/li\\u003e\\n\\u003cli\\u003eBlumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G. Social support, type A behavior, and coronary artery disease. Psychosom Med. 1987;49:331-40. doi: 10.1097/00006842-198707000-00002, PMID 3615762.\\u003c/li\\u003e\\n\\u003cli\\u003eYi L, Ziyan Z, Yanling Z, et al. Oral frailty and its influencing factors among hospitalized cancer patients. J Nurs Sci. 2024;39:49-52.\\u003c/li\\u003e\\n\\u003cli\\u003eChen M, He M, Gu Q, Gao X, Lu G. The current status and influencing factors of oral frailty in elderly maintenance hemodialysis patients based on the Andersen Oral Health Outcome Model. BMC Oral Health. 2024;24:1085. doi: 10.1186/s12903-024-04872-9, PMID 39272094.\\u003c/li\\u003e\\n\\u003cli\\u003eNajeeb S, Zafar MS, Khurshid Z, Zohaib S, Madathil SA, Mali M, et al. Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis. Saudi Pharm J. 2018;26:634-42. doi: 10.1016/j.jsps.2018.02.029, PMID 29991907.\\u003c/li\\u003e\\n\\u003cli\\u003eDibello V, Zupo R, Sardone R, Lozupone M, Castellana F, Dibello A, et al. Oral frailty and its determinants in older age: a systematic review. Lancet Healthy Longev. 2021;2:e507-20. doi: 10.1016/S2666-7568(21)00143-4, PMID 36098000.\\u003c/li\\u003e\\n\\u003cli\\u003eJingjing Y, Shengkai L. Investigation on the current state of oral health literacy and the influencing factors among residents in Fuyang city. Chin J Gen Pract. 2024;22:97-100.\\u003c/li\\u003e\\n\\u003cli\\u003eNishida T, Yamabe K, Honda S. Dysphagia is associated with oral, physical, cognitive and psychological frailty in Japanese community-dwelling elderly persons. Gerodontology. 2020;37:185-90. doi: 10.1111/ger.12455, PMID 31874118.\\u003c/li\\u003e\\n\\u003cli\\u003eFeng L, Gao Q, Hu K, Wu M, Wang Z, Chen F, et al. Prevalence and risk factors of sarcopenia in patients with diabetes: A meta-analysis. J Clin Endocrinol Metab. 2022;107:1470-83. doi: 10.1210/clinem/dgab884, PMID 34904651.\\u003c/li\\u003e\\n\\u003cli\\u003eButler SG, Stuart A, Wilhelm E, Rees C, Williamson J, Kritchevsky S. The effects of aspiration status, liquid type, and bolus volume on pharyngeal peak pressure in healthy older adults. Dysphagia. 2011;26:225-31. doi: 10.1007/s00455-010-9290-4, PMID 20623303.\\u003c/li\\u003e\\n\\u003cli\\u003eNomura Y, Ishii Y, Suzuki S, Morita K, Suzuki A, Suzuki S, et al. nutritional status and oral frailty: A community based study. Nutrients. 2020j;12. doi: 10.3390/nu12092886, PMID 32967313.\\u003c/li\\u003e\\n\\u003cli\\u003eDemmer RT, Holtfreter B, Desvarieux M, Jacobs DR, Kerner W, Nauck M, et al. The influence of type 1 and type 2 diabetes on periodontal disease progression: Prospective results from the Study of Health in Pomerania (SHIP). Diabetes Care. 2012;35:2036-42. doi: 10.2337/dc11-2453, PMID 22855731.\\u003c/li\\u003e\\n\\u003cli\\u003eYu SY, Lee SK, Yang B, Lee H, Jeon HJ, Lee DH. Glycemic control and oral health outcomes in patients with diabetes: insights from a nationwide Korean survey. J Korean Med Sci. 2024;39:e209. doi: 10.3346/jkms.2024.39.e209, PMID 38915285.\\u003c/li\\u003e\\n\\u003cli\\u003eYuan CX, Chen X, Yan J. Research progress of oral health quality and influencing factors in elderly patients with diabetes. J Nurs Sci. 2018;33:20-2.\\u003c/li\\u003e\\n\\u003cli\\u003eSato H, Yano A, Shimoyama Y, Sato T, Sugiyama Y, Kishi M. Associations of streptococci and fungi amounts in the oral cavity with nutritional and oral health status in institutionalized elders: A cross sectional study. BMC Oral Health. 2021;21:590. doi: 10.1186/s12903-021-01926-0, PMID 34798863.\\u003c/li\\u003e\\n\\u003cli\\u003eKimura C, Miura K, Watanabe Y, Baba H, Ozaki K, Hasebe A, et al. Association between oral frailty and Prevotella percentage in the oral microbiota of community-dwelling older adults who participated in the CHEER Iwamizawa project, Japan. J Oral Rehabil. 2024;51:1721-9. doi: 10.1111/joor.13767, PMID 38850071.\\u003c/li\\u003e\\n\\u003cli\\u003eKurinami N, Ashida K, Sugiyama S, Morito Y, Hasuzawa N, Yoshida A, et al. Reduced number of remaining or healthy teeth in patients with type 2 diabetes mellitus: A cross-sectional study assessed by dentists or dental hygienists in Japan. Intern Med. 2023;62:987-93. doi: 10.2169/internalmedicine.9773-22, PMID 37005297.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang DX, Xu S, Li WY, et al. Systemic influencing factors of dentition defect in type 2 diabetes mellitus patients with periodontitis. Sichuan Da Xue Xue Bao Yi Xue Ban. 2023;54:97-101.\\u003c/li\\u003e\\n\\u003cli\\u003eAlvarenga MO, Ferreira RO, Magno MB, Fagundes NC, Maia LC, Lima RR. Masticatory dysfunction by extensive tooth loss as a risk factor for cognitive deficit: A systematic review and meta-analysis. Front Physiol. 2019;10:832. doi: 10.3389/fphys.2019.00832, PMID 31333490.\\u003c/li\\u003e\\n\\u003cli\\u003eZhifei W, Xiangeng Z, Hongyan W, et al. Investigation of the oral health-related quality of life in elderly patients with Type ２ diabetes in community based on Andersen. Mil Nurs. 2022;39:1-4.\\u003c/li\\u003e\\n\\u003cli\\u003eZhang XY, Lin YX, Jiang Y, Zhang LC, Dong MY, Chi HY, et al. [Mediating effect of self-efficacy on self-management ability and self-management behavior in patients with type 2 diabetes mellitus]. Beijing Da Xue Xue Bao Yi Xue Ban. 2023;55:450-5. doi: 10.19723/j.issn.1671-167X.2023.03.010, PMID 37291920.\\u003c/li\\u003e\\n\\u003cli\\u003eAllen F, Fan SY, Loke WM, Na TM, Keng Yan GL, Mittal R. The relationship between self-efficacy and oral health status of older adults. J Dent. 2022;122:104085. doi: 10.1016/j.jdent.2022.104085, PMID 35248673.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"type 2 diabetes mellitus, older adults, oral frailty, influencing factors\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5303792/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5303792/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjectives\\u003c/h2\\u003e \\u003cp\\u003eThis study aimed to investigate the current status and influencing factors of oral frailty in elderly patients with type 2 diabetes mellitus to inform the development of oral management programs in this population.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA total of 431 elderly patients with type 2 diabetes mellitus who visited two tertiary public hospitals in Nanchong City from March 2024 to October 2024 were enrolled in this study. The General Information Questionnaire, Oral Frailty Index-8 (OFI-8), Oral Health Assessment Tool (OHAT), Eating Assessment Questionnaire Tool-10 (EAT-10), Perceived Social Support Scale (PSSS), Geriatric Depression Scale (GDS-5), and Geriatric Self Efficacy Scale for Oral Health Scale (GSEOH) were used to investigate and assess the factors related to oral frailty.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe prevalence of oral frailty in elderly patients with type 2 diabetes was 32.95% (142/431). Multivariate logistic regression analysis revealed that advanced age(OR\\u0026thinsp;=\\u0026thinsp;1.098, 95% CI: 1.054\\u0026thinsp;~\\u0026thinsp;1.146), HbA1c\\u0026thinsp;\\u0026ge;\\u0026thinsp;7%(OR\\u0026thinsp;=\\u0026thinsp;3.745, 95% CI: 1.203\\u0026ndash;12.647), dysphagia(OR\\u0026thinsp;=\\u0026thinsp;8.401, 95% CI: 2.276\\u0026ndash;43.846), and poor oral health status (OR\\u0026thinsp;=\\u0026thinsp;2.213, 95% CI: 1.134\\u0026ndash;4.394 ) were risk factors of oral frailty, and the number of remaining teeth\\u0026thinsp;\\u0026ge;\\u0026thinsp;20(OR\\u0026thinsp;=\\u0026thinsp;0.105, 95% CI: 0.046\\u0026ndash;0.217) and high oral health-related self-efficacy(OR\\u0026thinsp;=\\u0026thinsp;0.934, 95% CI: 0.898\\u0026ndash;0.970) were protective factors against oral frailty (\\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eThe main factors affecting oral frailty in elderly patients with type 2 diabetes mellitus include age, HbA1c, dysphagia, poor oral health status, number of remaining teeth, and oral health-related self-efficacy. Healthcare professionals need to formulate targeted oral health management strategies based on relevant influencing factors and implement early interventions to help prevent and delay the onset and development of oral frailty.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Influencing factors of oral frailty in elderly patients with type 2 diabetes in China: A cross- sectional study based on the integral model of frailty\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-10-28 12:59:22\",\"doi\":\"10.21203/rs.3.rs-5303792/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-02-05T06:55:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-01-23T13:07:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"234292855234196614660115093971357306674\",\"date\":\"2025-01-18T22:08:42+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-12-09T18:00:36+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"194705266204113782002062047855610421092\",\"date\":\"2024-12-03T18:21:50+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-11-26T15:52:34+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"169069132684334085301888020669427586316\",\"date\":\"2024-11-12T17:44:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"24885885859571225080178070327325049899\",\"date\":\"2024-11-12T03:11:00+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-11-07T03:09:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2024-10-29T05:24:07+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-10-29T05:18:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-10-24T10:43:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Oral Health\",\"date\":\"2024-10-21T11:01:51+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-oral-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"ohea\",\"sideBox\":\"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/ohea/default.aspx\",\"title\":\"BMC Oral Health\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2e0734ba-bdef-43a1-a284-05386616388f\",\"owner\":[],\"postedDate\":\"October 28th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-04-14T16:09:10+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-5303792\",\"link\":\"https://doi.org/10.1186/s12903-025-05815-8\",\"journal\":{\"identity\":\"bmc-oral-health\",\"isVorOnly\":false,\"title\":\"BMC Oral Health\"},\"publishedOn\":\"2025-04-11 16:05:18\",\"publishedOnDateReadable\":\"April 11th, 2025\"},\"versionCreatedAt\":\"2024-10-28 12:59:22\",\"video\":\"\",\"vorDoi\":\"10.1186/s12903-025-05815-8\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12903-025-05815-8\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5303792\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5303792\",\"identity\":\"rs-5303792\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}