Clinical Oral Health Status and Its Associations with Functional Dependence, Cognitive Function, and Nutritional Status in Elderly Inpatients with Disabilities in Medical-Care Institutions

Clinical Oral Health Status and Its Associations with Functional Dependence, Cognitive Function, and Nutritional Status in Elderly Inpatients with Disabilities in Medical-Care Institutions | 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 Clinical Oral Health Status and Its Associations with Functional Dependence, Cognitive Function, and Nutritional Status in Elderly Inpatients with Disabilities in Medical-Care Institutions Tiantian Wang, Xin Yang, Xueting Wang, Weijing Chen, Chao Peng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8537876/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study examined the oral health of elderly inpatients with disabilities and its links to functional dependence, cognitive function, and nutritional status in medical-care institutions Methods This study utilized a cross-sectional design between June and December 2025 and recruited a convenience sample of 150 elderly inpatients with disabilities from two medical-care institutions. Data collection involved oral examinations, which included the Decayed, Missing, and Filled Teeth (DMFT) index, Gingival Index (GI), and assessment of prosthetic status. Additionally, evaluations were conducted using the Barthel Index, Mini-Mental State Examination (MMSE) score, Mini Nutritional Assessment Short-Form (MNA-SF) score, Charlson Comorbidity Index (CCI), and medication count. Data analysis was carried out using multiple linear regression and logistic regression techniques. Results The study population demonstrated significant systemic health challenges, with a mean age of 82.79 ± 8.32 years. Severe functional dependence was observed in 72.7% of participants, cognitive impairment in 68.7%, and a risk of malnutrition in 63.3%. The oral health status was notably poor, as indicated by a mean Decayed, Missing, and Filled Teeth (DMFT) index of 25.17 ± 6.55. Additionally, 77.3% of participants exhibited non-ideal prosthetic status, and the mean Gingival Index (GI) was 1.37 ± 0.78. Multiple regression analyses identified distinct association patterns: the DMFT index was independently associated with a lower Barthel Index (B = -0.099, p < 0.001) and a lower MNA-SF score (B = -0.778, p < 0.001). The GI was independently associated with an increased number of medications (B = 0.146, p = 0.004) and a lower MNA-SF score (B = -0.151, p < 0.001). In contrast, non-ideal prosthetic status was independently associated with a higher CCI score (OR = 2.762, p = 0.009), a lower Barthel Index (OR = 0.946, p = 0.010), and a lower MMSE score (OR = 0.803, p = 0.003). Conclusion Elderly inpatients with disabilities in medical-care institutions exhibit significant oral health challenges. Distinct core health dimensions are associated with dental caries, gingival inflammation, and prosthetic status. These findings indicate that promoting oral health within this population necessitates comprehensive and tailored intervention strategies that incorporate nutritional support, functional rehabilitation, medication management, and cognitive care. Medical-care Institutions Elderly inpatients with disabilities Clinical oral health status Functional dependence Cognitive function Nutritional status 1. Introduction The global phenomenon of population aging constitutes a significant public health challenge in the 21st century [ 1 ] . In response to this development, healthcare institutions that integrate medical treatment, rehabilitation, and elder care services have become pivotal environments. Within these institutions, elderly inpatients with disabilities represent a particularly vulnerable and complex demographic requiring comprehensive care [ 2 – 3 ] . Ensuring the overall health and quality of life for this population necessitates an urgent emphasis on health domains that are intricately linked to their multidimensional functional decline. Among the various health concerns, oral health plays a crucial yet often underestimated role [ 4 – 5 ] . It not only directly affects masticatory function and nutritional intake [ 6 ] but is also closely associated with systemic complications such as aspiration pneumonia [ 7 ] and cardiovascular diseases [ 8 ] , as well as the subjective quality of life [ 9 ] . For elderly individuals with disabilities residing in medical-care institutions, maintaining oral health poses particularly formidable challenges. Research indicates that this population is typically characterized by advanced age, multiple comorbidities, a high degree of functional dependence, a high prevalence of cognitive impairment, and a significant risk of malnutrition [ 10 – 12 ] . This constellation of complex health issues interweaves within the institutional setting, creating a unique dilemma for oral health maintenance. Physiologically, functional and cognitive decline severely compromise both the ability and the willingness of patients to perform effective self-administered oral hygiene [ 13 – 14 ] . Furthermore, within the institutional care model, the widespread lack of professional oral care resources and standardized assessment protocols often results in oral health problems being overshadowed by more urgent primary medical and daily care needs, leading to a significant gap in health management [ 15 – 17 ] . Among the numerous determinants impacting oral health, dependence on Activities of Daily Living (ADL), cognitive dysfunction, and the risk of malnutrition may form an interconnected and mutually reinforcing "risk cycle" [ 18 – 20 ] . Dependence on ADL directly impairs the physical ability to perform oral self-care [ 21 ] . Cognitive impairment disrupts adherence to care protocols and the understanding of complex instructions [ 22 ] . Malnutrition, in turn, undermines tissue repair and immune defense capabilities, often serving as a direct consequence of declining oral function [ 23 – 24 ] . Nonetheless, the existing body of research exhibits notable contextual and perspectival deficiencies. Most studies concerning oral health in older adults have concentrated on community-dwelling individuals or acute-care patients in general hospitals, thereby neglecting a systematic exploration within long-term care settings, such as medical-care institutions [ 15 , 25 – 26 ] . To date, no empirical investigation has simultaneously analyzed the associations between the three core dimensions of frailty—functional dependence, cognitive impairment, and nutritional risk—and a comprehensive clinical oral health status, which includes dental caries, periodontal inflammation, and prosthetic function, among elderly inpatients with disabilities in Chinese medical-care institutions. This study sought to utilize a cross-sectional survey to elucidate the effects of functional dependence, cognitive impairment, and malnutrition on the clinical oral health status of elderly inpatients with disabilities in medical-care institutions. The anticipated findings aim to furnish direct and essential evidence to advocate for the development of a comprehensive, routine, and evidence-based protocol for oral health assessment and intervention within these environments. 2 Method 2.1 Study Participants and Sample Size This study utilized a cross-sectional design, recruiting participants from two medical-care institutions in Nanjing, China. Through convenience sampling, inpatients meeting the eligibility criteria were screened between June and December 2025, culminating in a final sample of 150 elderly patients with disabilities. The inclusion criteria were as follows: (1) age of 60 years or older; (2) a Barthel Index score of 60 or less, indicating a disabled or semi-disabled status; (3) an anticipated hospital stay of at least 7 days; and (4) provision of informed consent by the patient or their legal guardian. The exclusion criteria included: (1) being in the terminal stage of a disease or having unstable vital signs; (2) the presence of severe communication barriers that hindered the acquisition of valid information even from primary caregivers (e.g., severe aphasia); (3) a history of severe mental illness; and (4) participation in any other interventional clinical study within the preceding three months. 2.3 Variables and measurements 2.3.1 Clinical oral health status For the assessment of dental caries status, the Decayed, Missing, and Filled Teeth (DMFT) index was employed [ 27 ] . This index quantifies the total number of decayed, missing due to caries, and filled teeth per patient, with each tooth categorized exclusively as decayed (D), missing (M), or filled (F), yielding a total score between 0 and 32. A higher score reflects a more severe cumulative history of dental caries. For periodontal status, the Gingival Index (GI) was utilized [ 28 ] . This index evaluates the gingival condition of each tooth, with scores assigned as follows: 0 denotes healthy gingiva; 1 indicates mild inflammation characterized by color change and slight edema without bleeding on probing; 2 represents moderate inflammation with redness, swelling, and bleeding on probing; and 3 signifies severe inflammation with pronounced redness, swelling, ulceration, and a tendency for spontaneous bleeding. The mean GI score across all teeth was calculated to determine the final GI score for each patient. For prosthetic Status, the utilization of dentures was documented. For individuals with partial or complete edentulism, a thorough evaluation of denture status was performed. This evaluation was classified into two primary categories: (1) Ideal Status: Dentures exhibited optimal retention, stability, comfort, and functionality. (2) Non-ideal Status: This category was further divided into two subcategories: (i) Present but not used: Dentures were available but not worn due to the aforementioned problems; (ii) Not restored: Edentulous spaces were present, but no dentures were worn. 2.3.2 Independent Variables Functional status: The Chinese version of the Barthel Index was used to evaluate functional status [ 29 ] . This scale measures ten basic daily living activities, such as feeding, bathing, dressing, toileting, and walking, with scores ranging from 0 to 100. Higher scores indicate more independence. Disability levels were categorized as severe dependence (≤ 40 points), moderate dependence (41–60 points), mild dependence (61–99 points), and full independence (100 points). The Barthel Index has shown good internal consistency (Cronbach's α > 0.80) in studies [ 29 – 30 ] . Cognitive function: The assessment of cognitive function was conducted utilizing the Chinese version of the Mini-Mental State Examination (MMSE) [ 31 ] , a tool designed to evaluate various cognitive domains, including orientation, memory, attention and calculation, recall, and language abilities. The MMSE yields a total score ranging from 0 to 30. To enhance the precision of cognitive impairment identification, MMSE scores were adjusted for educational attainment in accordance with established Chinese norms [ 32 ] . The following cutoff scores were applied: ≤17 for individuals without formal education, ≤ 20 for those with primary education (up to 6 years of schooling), and ≤ 24 for individuals with secondary education or higher (more than 6 years of schooling). Scores at or below these specified thresholds were indicative of cognitive impairment. The MMSE has demonstrated robust internal consistency, with Cronbach’s alpha values ranging from 0.780 to 0.908, and exhibits satisfactory item discrimination [ 31 , 33 ] . Nutritional status: The nutritional status of participants was evaluated utilizing the Mini Nutritional Assessment Short-Form (MNA-SF) [ 34 ] . This instrument consists of six components, including a decline in body mass index, weight loss, acute disease or psychological stress, mobility, neuropsychological issues, and reduced food intake or anorexia, yielding a total score ranging from 0 to 14. Nutritional status was classified based on the following scoring criteria: malnutrition (≤ 7 points), at risk of malnutrition (8–11 points), and normal nutritional status (12–14 points). The MNA-SF is a widely employed nutritional screening tool, with its validity and reliability extensively established and corroborated in numerous studies involving older adults, effectively differentiating between various nutritional statuses [ 35 – 36 ] . 2.3.3 Covariates Covariate data were obtained through a review of the electronic medical record system and brief interviews with patients or their primary caregivers. Sociodemographic characteristics: age (in years), sex (male or female), and educational level (classified as illiterate, primary school, or junior high school and above). Comorbidity Burden: The Charlson Comorbidity Index (CCI) was used to measure the burden of comorbidities, assigning weighted scores based on the presence and severity of certain diseases such as myocardial infarction and diabetes [ 37 ] . A higher score suggests a greater burden of comorbidities and increased long-term mortality risk. This study utilized the Chinese revised version of the CCI [ 38 ] . Number of Medications: The total count of regularly prescribed medications for each patient, excluding those taken as needed or for short durations, was noted to indicate disease complexity and polypharmacy. 2.4 Statistical Analysis The data analysis was conducted utilizing IBM SPSS Statistics software (version 27.0). Continuous variables were expressed as mean ± standard deviation or median (interquartile range), while categorical variables were presented as frequency (percentage). Initially, univariate analyses were undertaken to investigate preliminary associations between the variables and oral health indicators. Group comparisons were executed using t-tests or analysis of variance (ANOVA), and correlations were evaluated using Pearson or Spearman correlation coefficients, as deemed appropriate. To comprehensively examine the independent effects of the primary independent variables on oral health outcomes, multivariable regression models were developed. These models were adjusted for potential confounding variables, including age, sex, educational attainment, primary disease diagnoses, and the number of medications. The specific model specifications were as follows: For continuous outcome variables, such as the DMFT index and GI, multiple linear regression analysis was utilized. The results are reported as adjusted regression coefficients (β) accompanied by their 95% confidence intervals (CIs). For the binary outcome variable of prosthetic status (ideal = 0, non-ideal = 1), binary logistic regression was employed. The results are expressed as adjusted odds ratios (aORs) with corresponding 95% CIs. All statistical tests were two-sided, with a P-value of less than 0.05 considered indicative of statistical significance. 3 Results 3.1 Descriptive Statistics of the Study Sample The study encompassed 150 elderly inpatients with disabilities from medical-care institutions. As detailed in Table 1 , the participants had a mean age of 82.79 ± 8.32 years, with 82 individuals (54.7%) being female. A significant proportion of participants had attained an educational level of junior high school or higher (n = 73, 48.7%). The participants generally exhibited poor systemic health, as indicated by a mean CCI score of 5.01 ± 0.95 and an average medication usage of 7.02 ± 1.13. Functional dependence was notably severe, with a mean Barthel Index (BI) score of 34.57 ± 16.36. Specifically, 109 participants (72.7%) were categorized as having severe dependence (BI ≤ 40), 41 (27.3%) as having moderate dependence (BI 41–60), and none as having mild dependence. Cognitive impairment was prevalent, with a mean Mini-Mental State Examination (MMSE) score of 17.94 ± 6.45; 103 participants (68.7%) were identified as having cognitive impairment. Nutritional status was also a concern, as reflected by a mean Mini Nutritional Assessment Short-Form (MNA-SF) score of 10.47 ± 2.29, with 14 participants (9.3%) classified as malnourished and 81 (54.0%) at risk of malnutrition. The oral health status of the study population was suboptimal, as evidenced by a mean Decayed, Missing, and Filled Teeth (DMFT) index of 25.17 ± 6.55 and a mean Gingival Index (GI) of 1.37 ± 0.78. Furthermore, the prosthetic status of the participants was predominantly inadequate. A total of 116 patients (77.3%) demonstrated non-ideal prosthetic status. This cohort comprised 71 individuals with entirely unrestored edentulous spaces and 45 individuals who possessed prostheses but were unable to utilize them due to complications such as looseness, damage, or discomfort. Table 1 Baseline Characteristics and Oral Health Status of the Study Participants (N = 150) Characteristic Mean ± SD / n (%) Sociodemographic Age (years) 82.79 ± 8.32 Sex, n (%) Male 68 (45.3%) Female 82 (54.7%) Education Level, n (%) Junior High School or Above 73 (48.7%) Primary School 55 (36.7%) Illiteracy 22 (14.6%) Charlson Comorbidity Index (CCI) Score 5.01 ± 0.95 Number of Medications 7.02 ± 1.13 Core Independent Variables Barthel Index (BI) Score 34.57 ± 16.36 Functional Dependence Grade, n (%) Severe (BI ≤ 40) 109 (72.7%) Moderate (BI 41–60) 41 (27.3%) Mild (BI 61–99) 0 Mini-Mental State Examination (MMSE) Score 17.94 ± 6.45 Presence of Cognitive Impairment, n (%) # 103 (68.7%) Mini Nutritional Assessment-Short Form (MNA-SF) Score 10.47 ± 2.29 Nutritional Status, n (%) Malnourished (MNA-SF ≤ 7) 14 (9.3%) At Risk (MNA-SF 8–11) 81(54.0%) Normal (MNA-SF 12–14) 55 (36.7%) Oral Health Outcomes Decayed, Missing, Filled Teeth (DMFT) Index 25.17 ± 6.55 Gingival Index (GI) 1.37 ± 0.78 Prosthetic Status, n (%) Ideal Condition 34 (22.7%) Non-Ideal Condition 116 (77.3%) # Defined by education-adjusted cut-offs: Illiteracy ≤ 17, Primary ≤ 20, ≥Junior High ≤ 24 3.2 Univariate Analysis of Clinical Oral Health Status 3.2.1 the DMFT index and GI As illustrated in Table 2, educational level, among the categorical variables, exerted a statistically significant influence on the DMFT index (F = 3.455, p = 0.034). The illiterate group exhibited the highest DMFT score (26.50 ± 7.751), whereas individuals with an education level of junior high school or above demonstrated the lowest score (24.08 ± 6.459). Conversely, educational level did not have a statistically significant impact on the GI (p = 0.071). Furthermore, sex did not significantly affect either the DMFT index or the GI, as indicated by p-values exceeding 0.05. Among the continuous variables analyzed, the DMFT index demonstrated a significant negative correlation with the Barthel Index (r = -0.569, p < 0.001), the MMSE score (r = -0.374, p < 0.001), and the MNA-SF nutrition score (r = -0.578, p 0.05). In contrast, the GI score exhibited a significant positive correlation with the CCI (r = 0.186, p = 0.022) and the number of medications (r = 0.204, p = 0.012), while showing a significant negative correlation with the Barthel Index (r = -0.355, p < 0.001) and the MNA-SF score (r = -0.438, p < 0.001). No significant correlations were observed between the GI and either the MMSE score or age. Table 2. Univariate Analysis of Factors Associated with Oral Health Indicators (DMFT Index and GI) Variable DMFT Index Gingival Index (GI) ‾x ± s t / F p ‾x ± s t / F p Gender -0.497 0.62 -0.615 0.54 Male 19.94 ± 4.843 1.32 ± 0.800 Female 20.35 ± 5.224 1.40 ± 0.768 Education Level 3.455 0.034 2.687 0.071 Junior High School or Above 24.08 ± 6.459 1.33 ± 0.647 Primary School 26.07 ± 6.670 1.35 ± 0.886 Illiteracy 26.50 ± 7.751 1.55 ± 0.912 r P r P Age 0.135 0.098 0.026 0.752 CCI Score 0.092 0.263 0.186 0.022 Number of Medications 0.005 0.949 0.204 0.012 Barthel Index -0.569 <0.001 -0.355 <0.001 MMSE Score -0.374 <0.001 -0.068 0.411 MNA-SF Score -0.578 <0.001 -0.438 <0.001 DMFT: Decayed, Missing, Filled Teeth; CCI: Charlson Comorbidity Index; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form. 3.2.2 Prosthetic status As demonstrated in Table 3 , the univariate analysis of binary prosthetic status indicated that patients within the non-ideal prosthetic group exhibited a significantly elevated comorbidity burden, as measured by the Charlson Comorbidity Index (CCI: 5.16 ± 0.966). Additionally, these patients showed significantly poorer outcomes in functional status (Barthel Index: 30.73 ± 6.168), cognitive function (MMSE score: 16.47 ± 3.407), and nutritional status (MNA-SF score: 9.95 ± 2.174), with all intergroup differences achieving high statistical significance (all p < 0.001). Specifically, individuals with non-ideal prostheses were characterized by more severe comorbidities and notably poorer functional, cognitive, and nutritional profiles. Conversely, no statistically significant differences were identified between the two groups concerning sex, educational level, age, or medication count (all p > 0.05). Table 3 Univariate Analysis of Factors Associated with Oral Health Indicators (Prosthetic Status) Variable Prosthetic Status Ideal Non-Ideal χ 2 P n (%) n (%) Gender 0.053 0.818 Male 16(23.5) 18(22.0) Female 52(76.5) 64(78.0) Education Level 1.062 0.588 Junior High School or Above 18(52.9) 55(47.4) Primary School 10(29.4) 45(38.8) Illiteracy 6(17.7) 16(13.8) ‾x ± s ‾x ± s t P Age 82.00 ± 8.478 82.85 ± 8.080 -0.536 0.593 CCI Score 4.50 ± 0.707 5.16 ± 0.966 -3.675 <0.001 Number of Medications 7.00 ± 0.853 7.03 ± 1.205 -0.117 0.907 Barthel Index 47.65 ± 8.370 30.73 ± 6.168 5.864 <0.001 MMSE Score 22.97 ± 4.344 16.47 ± 3.407 5.668 <0.001 MNA-SF Score 12.24 ± 2.724 9.95 ± 2.174 5.631 <0.001 DMFT: Decayed, Missing, Filled Teeth; CCI: Charlson Comorbidity Index; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form. 3.3 Regression Analysis of Clinical Oral Health Status 3.3.1 Factors Associated with the DMFT Index The multiple linear regression analysis identified the Barthel Index and the MNA-SF nutritional score as significant predictors in the final model. The Barthel Index (B = -0.099, 95% CI: -0.154 to -0.044, p < 0.001) and the MNA-SF score (B = -0.778, 95% CI: -1.173 to -0.383, p < 0.001) both demonstrated a statistically significant negative correlation with the DMFT index (see Table 4). 3.3.2 Factors Associated with the GI The regression analysis revealed that both the number of medications and the MNA-SF score were significant predictors of the GI. Specifically, a positive correlation was identified between the number of medications and the GI (B = 0.146, 95% CI: 0.048 to 0.244, p = 0.004). Conversely, the MNA-SF score demonstrated a negative correlation with the GI (B = -0.151, 95% CI: -0.200 to -0.102, p < 0.001) (see Table 4). 3.3.3 Factors Associated with the Prosthetic status The binary logistic regression analysis identified the CCI, Barthel Index, and MMSE score as significant determinants of prosthetic status. Specifically, an elevated CCI score emerged as a risk factor (Odds Ratio [OR] = 2.762, 95% Confidence Interval [CI]: 1.287 to 5.927, p = 0.009), whereas higher scores on the Barthel Index (OR = 0.946, 95% CI: 0.908 to 0.987, p = 0.010) and MMSE (OR = 0.803, 95% CI: 0.696 to 0.928, p = 0.003) were identified as protective factors (see Table 4). Table 4. Multivariable Analysis of the Independent Effects of Functional Dependence, Cognition, and Nutrition on Oral Health Independent Variable DMFT Index B (95% CI) p Barthel Index -0.099(-0.154, -0.044) <0.001 MNA-SF Score -0.778(-1.173, -0.383) <0.001 Gingival Index (GI) B (95% CI) p Number of Medications 0.146(0.048, 0.244) 0.004 MNA-SF Score -0.151(-0.200, -0.102) <0.001 Prosthetic Status OR (95% CI) P CCI Score 2.762(1.287, 5.927) 0.009 Barthel Index 0.946(0.908, 0.987) 0.01 MMSE Score 0.803(0.696, 0.928) 0.003 DMFT: Decayed, Missing, Filled Teeth; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form. B: Unstandardized regression coefficient from multiple linear regression. OR: Adjusted Odds Ratio from multiple logistic regression. All models were adjusted for age, sex, education level, Charlson Comorbidity Index (CCI), and number of medications. 4 Discussions This study represents the inaugural cross-sectional analysis aimed at systematically evaluating the comprehensive clinical oral health status of elderly inpatients with disabilities residing in medical-care institutions. It concurrently investigates the associations of oral health with three fundamental dimensions of frailty: functional dependence, nutritional status, and cognitive function. The findings indicate a significant and overlapping burden of systemic frailty and oral health issues among the institutionalized elderly inpatients with disabilities surveyed. In terms of systemic health, the study population exhibited a critical convergence of four primary frailty indicators: advanced age, severe functional dependence, a high prevalence of cognitive impairment, and a significant risk of malnutrition. Specifically, 72.7% of participants were severely functionally dependent, and 68.7% exhibited cognitive impairment, indicating a dual deficit in both self-care capacity and executive function. Notably, 63.3% were at risk of malnutrition, a rate considerably higher than that observed in the general elderly population within similar care settings [ 39 – 40 ] . This finding suggests that the combination of disability and inpatient status significantly exacerbates nutritional vulnerability. The pronounced co-occurrence of these four conditions—referred to here as a frailty tetrad—highlights that the participants represent a particularly vulnerable subgroup, with more severely depleted physiological reserves and self-management capacity compared to community-dwelling elders or less impaired institutionalized peers [ 41 – 42 ] . The oral health status of this population reflects a systemic crisis. In terms of cumulative disease burden, the DMFT index was recorded at 25.17, which is significantly higher than the national average for adults aged 65–74, as reported in the Forth National Oral Health Survey [ 43 – 44 ] . This finding underscores an exceptionally severe lifetime caries burden. The current state of oral treatment and maintenance is particularly concerning, with 77.3% of patients having prostheses in a suboptimal condition, and 71 individuals (47.3% of the total sample) lacking any prosthesis. This proportion substantially exceeds the rates observed among community-dwelling older adults with better functional status [ 45 – 46 ] , indicating that the long-term success of dental interventions is highly jeopardized in the presence of severe disability and cognitive impairment. Additionally, the mean GI was 1.37, indicating mild inflammation. The management of gingival inflammation in this cohort is further complicated by the combined effects of institutionalization, prevalent polypharmacy, and a high risk of malnutrition, presenting persistent and complex challenges [ 47 ] . Utilizing multivariable regression analysis, this study elucidates the distinct and differentiated patterns of influence exerted by three core dimensions—functional capacity, nutritional status, and cognitive function—on three categories of oral health outcomes: dental caries, periodontal inflammation, and prosthetic status. The findings suggest that, within the complex population of institutionalized elderly individuals with disabilities, various oral health issues are associated with specific dimensions of functional decline. This insight offers critical clues for investigating underlying mechanisms and developing targeted intervention strategies in future research. The following sections interpret these differentiated patterns in the context of existing literature and clinical logic. The analysis of the data indicated a significant association between a higher DMFT index and both diminished functional status and poorer nutritional status. Specifically, the study identified that elevated scores on the Barthel Index and the MNA-SF were independently correlated with a lower DMFT index. This observation is consistent with existing literature [ 48 – 49 ] . Functional dependence often results in substantial limitations in oral self-care abilities, thereby considerably increasing the risk of plaque accumulation and dental caries, a relationship extensively documented in numerous studies concerning frail older adults [ 50 – 51 ] . Additionally, malnutrition or elevated nutritional risk is frequently associated with altered dietary habits, such as a reliance on high-carbohydrate liquid or soft diets, which are well-established as cariogenic risk factors [ 52 ] . Regression analysis indicated that both an increased number of medications and a decreased MNA-SF nutrition score were independently correlated with more severe gingival inflammation. This pattern implies that gingival health is significantly influenced by immediate, modifiable physiological and metabolic factors. On one hand, polypharmacy, especially involving medications known to induce xerostomia (such as anticholinergics, diuretics, and antidepressants), can directly disrupt oral homeostasis [ 53 ] . Reduced salivary flow compromises its mechanical cleansing, acid-buffering, and antimicrobial functions, while also altering the oral microbial ecology [ 54 ] . This environment promotes the colonization and biofilm formation of cariogenic and periodontal pathogens, thereby increasing susceptibility to gingival inflammation [ 55 ] . On the other hand, malnutrition or nutritional risk frequently manifests as insufficient consumption of protein, vitamins (such as vitamin C), and trace elements (such as zinc), which systematically undermines host immune defenses and the capacity for connective tissue repair [ 56 – 57 ] . Under such conditions, the integrity of the gingival epithelial barrier and the effectiveness of local immune cells are compromised, resulting in an exaggerated inflammatory response to a given amount of plaque and a delayed healing process [ 58 – 59 ] . Additionally, some older adults may refrain from consuming hard foods due to dental pain, leading to inadequate intake of dietary fiber, protein, and other essential nutrients, thereby further impairing oral tissue repair [ 60 ] . Finally, non-ideal prosthetic status was strongly linked to greater overall illness burden (higher CCI score), worse physical function, and more severe cognitive decline. This reflects the high overall health demands that successful prosthetic care—from planning to long-term home maintenance—places on these patients. A high comorbidity burden harms prosthetic outcomes in several ways, acting as a key risk factor for non-ideal status. Systemically, serious chronic diseases (e.g., uncontrolled diabetes) can shift healthcare priorities away from complex dental care [ 61 ] . Locally, poor overall health slows tissue healing and adaptation, weakening prosthesis fit [ 62 ] . Additionally, multiple diseases and their treatments can disrupt the oral environment (e.g., saliva, microbes), upsetting the balance between the prosthesis and oral tissues [ 63 ] . This can lead to problems like new cavities, gum disease, or sore spots, raising the risk that patients stop using the prosthesis due to discomfort. Finally, frequent medical visits or hospitalizations interrupt regular dental check-ups, allowing minor issues to go unchecked and worsen into an unusable state. The Barthel Index, serving as a protective factor, highlights that basic activities of daily living constitute the essential physical foundation for the long-term success of a prosthesis. It is imperative for patients to have adequate manual dexterity, coordination, and physical strength to effectively utilize tools such as interdental brushes, dental floss, or specialized toothbrushes for cleaning the prosthesis neck, proximal surfaces, and abutment teeth. This capability is vital for preventing plaque accumulation around the prosthesis, as well as secondary caries and periodontal inflammation. In the current study, the prevalent functional dependence, indicated by low Barthel scores among participants, compromised this critical physical foundation necessary for daily maintenance [ 64 ] . Similarly, the MMSE score, as an additional protective factor, underscores the pivotal cognitive and behavioral importance of intact cognitive function in the long-term maintenance of prostheses [ 65 ] . Patients with preserved cognitive abilities are capable of comprehending and recalling instructions for prosthesis use and specialized cleaning techniques. They can actively identify and report issues such as prosthesis looseness, damage, or discomfort, and adhere to recommended professional follow-up and maintenance schedules. Conversely, patients with cognitive impairments demonstrate substantial deficiencies in these areas, significantly elevating the risk of minor issues escalating into major complications, which may ultimately result in complete prosthetic failure. The results of this study have significant implications for clinical practice and future research trajectories. The distinct correlations identified between dental caries, gingival inflammation, and prosthetic status with functional-nutritional, pharmacological-metabolic, and systemic-functional-cognitive dimensions, respectively, indicate a need for a paradigm shift in oral health management within medical care institutions [ 66 – 67 ] . This shift should move away from universal care towards precise, integrated interventions. Specifically, systemic nutritional support should be established as a foundational measure. In parallel, targeted strategies should be applied synergistically: addressing barriers to oral hygiene arising from functional dependence, incorporating the long-term oral health impacts of medications into comprehensive medical decision-making, and performing thorough pre-prosthetic evaluations of patients' systemic health and self-maintenance capabilities [ 68 ] . Additionally, the professional maintenance requirements for prostheses should be incorporated into routine nursing protocols. This study is subject to several limitations. Firstly, its cross-sectional design limits the ability to draw causal inferences from the observed associations. Secondly, the study did not evaluate specific daily oral hygiene behaviors, such as the frequency, technique, and duration of caregiver-assisted brushing, nor did it assess detailed dietary composition. These behavioral factors are likely significant mediators through which intrinsic capacity factors, such as functional dependence and cognitive impairment, affect oral health outcomes. It is important to highlight that oral hygiene care for the elderly inpatients with disabilities in this study is predominantly reliant on caregivers. Consequently, self-reported measures, such as "brushing frequency," may lack reliability in this population [ 69 – 71 ] . Future research should focus on developing more objective indicators to accurately assess oral hygiene behaviors in disabled older adults. Moreover, given that the sample was obtained from only two healthcare institutions, the generalizability of the findings necessitates validation across a broader spectrum of settings. Nonetheless, by concentrating on fundamental intrinsic-capacity dimensions, this study has distinctly outlined stable and differentiated patterns of association with comprehensive clinical oral health outcomes. This approach thereby offers effective assessment targets for the identification of individuals at high risk. Future research endeavors should focus on addressing the existing limitations in the field. A primary objective is to undertake longitudinal studies to elucidate causal pathways. Building upon this foundation, a central task is the development of a rapid and comprehensive oral health risk assessment tool tailored for institutional environments. Utilizing such a tool, integrated intervention protocols should be formulated to seamlessly align with routine institutional workflows, thereby enhancing the effective translation of scientific evidence into standard care practices. Declarations Ethics approval and consent to participate This study was approved by the ethics committee of Nanjing Stomatological Hospital (NJSH-2023NL-015), and conducted in accordance with the ethical principles of Declaration of Helsinki. Informed consent was obtained in written form from all individual participants or their legally authorized representatives (e.g., next of kin) prior to their inclusion in the study. Consent for publication Not applicable. Declaration of Competing Interest The authors declare that they have no conflicts of interest. Funding Information This study was funded by the Nanjing Health Education Association Research Project (NHEAsfp-2024-008), Nanjing Preventive Medicine Research Project (NJYFKT202406), Nanjing Municipal Association for Science and Technology Soft Science Research Project. The funder had no role in the study design, data collection and analysis, interpretation of data and writing the manuscript. Author Contribution Tiantian Wang: Conceptualization, Methodology, Data curation, Writing – original draft, Software, Validation, Writing – review & editing. Xin Yang: Conceptualization, Methodology, Data curation, Writing – original draft, Validation. Xueting Wang : Data curation, Writing – original draft, Validation. Weijing Chen: Data curation, Writing – original draft, Validation. Chao Peng: Data curation, Writing – original draft, Validation. Yuxin Tian: Data curation, Writing – original draft. Hongyuan Dai: Data curation, Conceptualization, Methodology, Writing – review & editing, Supervision. Acknowledgements The authors would like to express their sincere gratitude to the staff of all participating medical-care institutions for their invaluable assistance and cooperation throughout this study. We are also deeply thankful to the families and caregivers of the participants for their support and dedication, without which this research would not have been possible Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to institutional policies and patient confidentiality but may be available from the corresponding author upon reasonable request and subject to approval by the institutional ethics committee. References Hong C, Sun L, Liu G, Guan B, Li C, Luo Y. Response of global health towards the challenges presented by population aging[J]. China CDC Wkly. 2023;5(39):884–7. 10.46234/ccdcw2023.168 . Yang G, Wan L, Dong H, Liang X, He Y. Utilisation willingness for institutional care by the disabled elderly and its influencing factors based on andersen's model: A cross-sectional survey of henan, china[J]. BMJ open. 2022;12(12):e064949. 10.1136/bmjopen-2022-064949 . 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Long-term success of oral health intervention among care-dependent institutionalized seniors: Findings from a controlled clinical trial[J]. Commun Dent Oral Epidemiol. 2018;46(2):109–17. 10.1111/cdoe.12335 . Yang Y, Liang L, Cai J, You J, Liao X. Improving oral hygiene for better cognitive health: Interrelationships of oral hygiene habits, oral health status, and cognitive function in older adults[J]. J Adv Nurs. 2024;80(1):275–86. 10.1111/jan.15769 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. 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11:12:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1126876,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8537876/v1/de21ed6b-63bf-492b-bd92-586917cae5b8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Oral Health Status and Its Associations with Functional Dependence, Cognitive Function, and Nutritional Status in Elderly Inpatients with Disabilities in Medical-Care Institutions","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe global phenomenon of population aging constitutes a significant public health challenge in the 21st century\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In response to this development, healthcare institutions that integrate medical treatment, rehabilitation, and elder care services have become pivotal environments. Within these institutions, elderly inpatients with disabilities represent a particularly vulnerable and complex demographic requiring comprehensive care\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Ensuring the overall health and quality of life for this population necessitates an urgent emphasis on health domains that are intricately linked to their multidimensional functional decline. Among the various health concerns, oral health plays a crucial yet often underestimated role\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. It not only directly affects masticatory function and nutritional intake\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e but is also closely associated with systemic complications such as aspiration pneumonia\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e and cardiovascular diseases\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e, as well as the subjective quality of life\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFor elderly individuals with disabilities residing in medical-care institutions, maintaining oral health poses particularly formidable challenges. Research indicates that this population is typically characterized by advanced age, multiple comorbidities, a high degree of functional dependence, a high prevalence of cognitive impairment, and a significant risk of malnutrition\u003csup\u003e[\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. This constellation of complex health issues interweaves within the institutional setting, creating a unique dilemma for oral health maintenance. Physiologically, functional and cognitive decline severely compromise both the ability and the willingness of patients to perform effective self-administered oral hygiene\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Furthermore, within the institutional care model, the widespread lack of professional oral care resources and standardized assessment protocols often results in oral health problems being overshadowed by more urgent primary medical and daily care needs, leading to a significant gap in health management\u003csup\u003e[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Among the numerous determinants impacting oral health, dependence on Activities of Daily Living (ADL), cognitive dysfunction, and the risk of malnutrition may form an interconnected and mutually reinforcing \"risk cycle\"\u003csup\u003e[\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Dependence on ADL directly impairs the physical ability to perform oral self-care\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Cognitive impairment disrupts adherence to care protocols and the understanding of complex instructions\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. Malnutrition, in turn, undermines tissue repair and immune defense capabilities, often serving as a direct consequence of declining oral function\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNonetheless, the existing body of research exhibits notable contextual and perspectival deficiencies. Most studies concerning oral health in older adults have concentrated on community-dwelling individuals or acute-care patients in general hospitals, thereby neglecting a systematic exploration within long-term care settings, such as medical-care institutions\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. To date, no empirical investigation has simultaneously analyzed the associations between the three core dimensions of frailty\u0026mdash;functional dependence, cognitive impairment, and nutritional risk\u0026mdash;and a comprehensive clinical oral health status, which includes dental caries, periodontal inflammation, and prosthetic function, among elderly inpatients with disabilities in Chinese medical-care institutions.\u003c/p\u003e \u003cp\u003eThis study sought to utilize a cross-sectional survey to elucidate the effects of functional dependence, cognitive impairment, and malnutrition on the clinical oral health status of elderly inpatients with disabilities in medical-care institutions. The anticipated findings aim to furnish direct and essential evidence to advocate for the development of a comprehensive, routine, and evidence-based protocol for oral health assessment and intervention within these environments.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Participants and Sample Size\u003c/h2\u003e \u003cp\u003eThis study utilized a cross-sectional design, recruiting participants from two medical-care institutions in Nanjing, China. Through convenience sampling, inpatients meeting the eligibility criteria were screened between June and December 2025, culminating in a final sample of 150 elderly patients with disabilities. The inclusion criteria were as follows: (1) age of 60 years or older; (2) a Barthel Index score of 60 or less, indicating a disabled or semi-disabled status; (3) an anticipated hospital stay of at least 7 days; and (4) provision of informed consent by the patient or their legal guardian. The exclusion criteria included: (1) being in the terminal stage of a disease or having unstable vital signs; (2) the presence of severe communication barriers that hindered the acquisition of valid information even from primary caregivers (e.g., severe aphasia); (3) a history of severe mental illness; and (4) participation in any other interventional clinical study within the preceding three months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Variables and measurements\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.3.1 Clinical oral health status\u003c/h2\u003e \u003cp\u003eFor the assessment of dental caries status, the Decayed, Missing, and Filled Teeth (DMFT) index was employed\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. This index quantifies the total number of decayed, missing due to caries, and filled teeth per patient, with each tooth categorized exclusively as decayed (D), missing (M), or filled (F), yielding a total score between 0 and 32. A higher score reflects a more severe cumulative history of dental caries.\u003c/p\u003e \u003cp\u003eFor periodontal status, the Gingival Index (GI) was utilized\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. This index evaluates the gingival condition of each tooth, with scores assigned as follows: 0 denotes healthy gingiva; 1 indicates mild inflammation characterized by color change and slight edema without bleeding on probing; 2 represents moderate inflammation with redness, swelling, and bleeding on probing; and 3 signifies severe inflammation with pronounced redness, swelling, ulceration, and a tendency for spontaneous bleeding. The mean GI score across all teeth was calculated to determine the final GI score for each patient.\u003c/p\u003e \u003cp\u003eFor prosthetic Status, the utilization of dentures was documented. For individuals with partial or complete edentulism, a thorough evaluation of denture status was performed. This evaluation was classified into two primary categories: (1) Ideal Status: Dentures exhibited optimal retention, stability, comfort, and functionality. (2) Non-ideal Status: This category was further divided into two subcategories: (i) Present but not used: Dentures were available but not worn due to the aforementioned problems; (ii) Not restored: Edentulous spaces were present, but no dentures were worn.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.3.2 Independent Variables\u003c/h2\u003e \u003cp\u003eFunctional status: The Chinese version of the Barthel Index was used to evaluate functional status\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. This scale measures ten basic daily living activities, such as feeding, bathing, dressing, toileting, and walking, with scores ranging from 0 to 100. Higher scores indicate more independence. Disability levels were categorized as severe dependence (\u0026le;\u0026thinsp;40 points), moderate dependence (41\u0026ndash;60 points), mild dependence (61\u0026ndash;99 points), and full independence (100 points). The Barthel Index has shown good internal consistency (Cronbach's α\u0026thinsp;\u0026gt;\u0026thinsp;0.80) in studies\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCognitive function: The assessment of cognitive function was conducted utilizing the Chinese version of the Mini-Mental State Examination (MMSE)\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e, a tool designed to evaluate various cognitive domains, including orientation, memory, attention and calculation, recall, and language abilities. The MMSE yields a total score ranging from 0 to 30. To enhance the precision of cognitive impairment identification, MMSE scores were adjusted for educational attainment in accordance with established Chinese norms\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. The following cutoff scores were applied: \u0026le;17 for individuals without formal education, \u0026le;\u0026thinsp;20 for those with primary education (up to 6 years of schooling), and \u0026le;\u0026thinsp;24 for individuals with secondary education or higher (more than 6 years of schooling). Scores at or below these specified thresholds were indicative of cognitive impairment. The MMSE has demonstrated robust internal consistency, with Cronbach\u0026rsquo;s alpha values ranging from 0.780 to 0.908, and exhibits satisfactory item discrimination\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNutritional status: The nutritional status of participants was evaluated utilizing the Mini Nutritional Assessment Short-Form (MNA-SF)\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. This instrument consists of six components, including a decline in body mass index, weight loss, acute disease or psychological stress, mobility, neuropsychological issues, and reduced food intake or anorexia, yielding a total score ranging from 0 to 14. Nutritional status was classified based on the following scoring criteria: malnutrition (\u0026le;\u0026thinsp;7 points), at risk of malnutrition (8\u0026ndash;11 points), and normal nutritional status (12\u0026ndash;14 points). The MNA-SF is a widely employed nutritional screening tool, with its validity and reliability extensively established and corroborated in numerous studies involving older adults, effectively differentiating between various nutritional statuses\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.3.3 Covariates\u003c/h2\u003e \u003cp\u003eCovariate data were obtained through a review of the electronic medical record system and brief interviews with patients or their primary caregivers.\u003c/p\u003e \u003cp\u003eSociodemographic characteristics: age (in years), sex (male or female), and educational level (classified as illiterate, primary school, or junior high school and above).\u003c/p\u003e \u003cp\u003eComorbidity Burden: The Charlson Comorbidity Index (CCI) was used to measure the burden of comorbidities, assigning weighted scores based on the presence and severity of certain diseases such as myocardial infarction and diabetes\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. A higher score suggests a greater burden of comorbidities and increased long-term mortality risk. This study utilized the Chinese revised version of the CCI\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNumber of Medications: The total count of regularly prescribed medications for each patient, excluding those taken as needed or for short durations, was noted to indicate disease complexity and polypharmacy.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e \u003cp\u003eThe data analysis was conducted utilizing IBM SPSS Statistics software (version 27.0). Continuous variables were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation or median (interquartile range), while categorical variables were presented as frequency (percentage). Initially, univariate analyses were undertaken to investigate preliminary associations between the variables and oral health indicators. Group comparisons were executed using t-tests or analysis of variance (ANOVA), and correlations were evaluated using Pearson or Spearman correlation coefficients, as deemed appropriate.\u003c/p\u003e \u003cp\u003eTo comprehensively examine the independent effects of the primary independent variables on oral health outcomes, multivariable regression models were developed. These models were adjusted for potential confounding variables, including age, sex, educational attainment, primary disease diagnoses, and the number of medications. The specific model specifications were as follows: For continuous outcome variables, such as the DMFT index and GI, multiple linear regression analysis was utilized. The results are reported as adjusted regression coefficients (β) accompanied by their 95% confidence intervals (CIs). For the binary outcome variable of prosthetic status (ideal\u0026thinsp;=\u0026thinsp;0, non-ideal\u0026thinsp;=\u0026thinsp;1), binary logistic regression was employed. The results are expressed as adjusted odds ratios (aORs) with corresponding 95% CIs. All statistical tests were two-sided, with a P-value of less than 0.05 considered indicative of statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Descriptive Statistics of the Study Sample\u003c/h2\u003e \u003cp\u003eThe study encompassed 150 elderly inpatients with disabilities from medical-care institutions. As detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the participants had a mean age of 82.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32 years, with 82 individuals (54.7%) being female. A significant proportion of participants had attained an educational level of junior high school or higher (n\u0026thinsp;=\u0026thinsp;73, 48.7%). The participants generally exhibited poor systemic health, as indicated by a mean CCI score of 5.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95 and an average medication usage of 7.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13. Functional dependence was notably severe, with a mean Barthel Index (BI) score of 34.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.36. Specifically, 109 participants (72.7%) were categorized as having severe dependence (BI\u0026thinsp;\u0026le;\u0026thinsp;40), 41 (27.3%) as having moderate dependence (BI 41\u0026ndash;60), and none as having mild dependence. Cognitive impairment was prevalent, with a mean Mini-Mental State Examination (MMSE) score of 17.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45; 103 participants (68.7%) were identified as having cognitive impairment. Nutritional status was also a concern, as reflected by a mean Mini Nutritional Assessment Short-Form (MNA-SF) score of 10.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29, with 14 participants (9.3%) classified as malnourished and 81 (54.0%) at risk of malnutrition.\u003c/p\u003e \u003cp\u003eThe oral health status of the study population was suboptimal, as evidenced by a mean Decayed, Missing, and Filled Teeth (DMFT) index of 25.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55 and a mean Gingival Index (GI) of 1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78. Furthermore, the prosthetic status of the participants was predominantly inadequate. A total of 116 patients (77.3%) demonstrated non-ideal prosthetic status. This cohort comprised 71 individuals with entirely unrestored edentulous spaces and 45 individuals who possessed prostheses but were unable to utilize them due to complications such as looseness, damage, or discomfort.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics and Oral Health Status of the Study Participants (N\u0026thinsp;=\u0026thinsp;150)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSociodemographic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (45.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (54.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJunior High School or Above\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (48.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePrimary School\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIlliteracy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (14.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharlson Comorbidity Index (CCI) Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCore Independent Variables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index (BI) Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.57\u0026thinsp;\u0026plusmn;\u0026thinsp;16.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFunctional Dependence Grade, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSevere (BI\u0026thinsp;\u0026le;\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eModerate (BI 41\u0026ndash;60)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMild (BI 61\u0026ndash;99)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini-Mental State Examination (MMSE) Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of Cognitive Impairment, n (%)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e103 (68.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMini Nutritional Assessment-Short Form (MNA-SF) Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional Status, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMalnourished (MNA-SF\u0026thinsp;\u0026le;\u0026thinsp;7)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAt Risk (MNA-SF 8\u0026ndash;11)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81(54.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNormal (MNA-SF 12\u0026ndash;14)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral Health Outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecayed, Missing, Filled Teeth (DMFT) Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGingival Index (GI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProsthetic Status, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIdeal Condition\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNon-Ideal Condition\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e\u003csup\u003e#\u003c/sup\u003eDefined by education-adjusted cut-offs: Illiteracy\u0026thinsp;\u0026le;\u0026thinsp;17, Primary\u0026thinsp;\u0026le;\u0026thinsp;20, \u0026ge;Junior High\u0026thinsp;\u0026le;\u0026thinsp;24\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Univariate Analysis of Clinical Oral Health Status\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 the DMFT index and GI\u003c/h2\u003e \u003cp\u003eAs illustrated in Table\u0026nbsp;2, educational level, among the categorical variables, exerted a statistically significant influence on the DMFT index (F\u0026thinsp;=\u0026thinsp;3.455, p\u0026thinsp;=\u0026thinsp;0.034). The illiterate group exhibited the highest DMFT score (26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.751), whereas individuals with an education level of junior high school or above demonstrated the lowest score (24.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.459). Conversely, educational level did not have a statistically significant impact on the GI (p\u0026thinsp;=\u0026thinsp;0.071). Furthermore, sex did not significantly affect either the DMFT index or the GI, as indicated by p-values exceeding 0.05.\u003c/p\u003e \u003cp\u003eAmong the continuous variables analyzed, the DMFT index demonstrated a significant negative correlation with the Barthel Index (r = -0.569, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the MMSE score (r = -0.374, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the MNA-SF nutrition score (r = -0.578, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Conversely, no significant correlations were identified between the DMFT index and age, the CCI, or the number of medications (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In contrast, the GI score exhibited a significant positive correlation with the CCI (r\u0026thinsp;=\u0026thinsp;0.186, p\u0026thinsp;=\u0026thinsp;0.022) and the number of medications (r\u0026thinsp;=\u0026thinsp;0.204, p\u0026thinsp;=\u0026thinsp;0.012), while showing a significant negative correlation with the Barthel Index (r = -0.355, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the MNA-SF score (r = -0.438, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant correlations were observed between the GI and either the MMSE score or age.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;2. Univariate Analysis of Factors Associated with Oral Health Indicators (DMFT Index and GI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eDMFT Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eGingival Index (GI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.497\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.615\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.94\u0026thinsp;\u0026plusmn;\u0026thinsp;4.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.768\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.455\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJunior High School or Above\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.459\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePrimary School\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.670\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.886\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIlliteracy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003er\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.569\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.411\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDMFT: Decayed, Missing, Filled Teeth; CCI: Charlson Comorbidity Index; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Prosthetic status\u003c/h2\u003e \u003cp\u003eAs demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the univariate analysis of binary prosthetic status indicated that patients within the non-ideal prosthetic group exhibited a significantly elevated comorbidity burden, as measured by the Charlson Comorbidity Index (CCI: 5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.966). Additionally, these patients showed significantly poorer outcomes in functional status (Barthel Index: 30.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.168), cognitive function (MMSE score: 16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.407), and nutritional status (MNA-SF score: 9.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.174), with all intergroup differences achieving high statistical significance (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Specifically, individuals with non-ideal prostheses were characterized by more severe comorbidities and notably poorer functional, cognitive, and nutritional profiles. Conversely, no statistically significant differences were identified between the two groups concerning sex, educational level, age, or medication count (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate Analysis of Factors Associated with Oral Health Indicators (Prosthetic Status)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eProsthetic Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdeal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Ideal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.818\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16(23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFemale\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(76.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64(78.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJunior High School or Above\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePrimary School\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(38.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eIlliteracy\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.00\u0026thinsp;\u0026plusmn;\u0026thinsp;8.478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-3.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.65\u0026thinsp;\u0026plusmn;\u0026thinsp;8.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.724\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.95\u0026thinsp;\u0026plusmn;\u0026thinsp;2.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.631\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDMFT: Decayed, Missing, Filled Teeth; CCI: Charlson Comorbidity Index; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Regression Analysis of Clinical Oral Health Status\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Factors Associated with the DMFT Index\u003c/h2\u003e \u003cp\u003eThe multiple linear regression analysis identified the Barthel Index and the MNA-SF nutritional score as significant predictors in the final model. The Barthel Index (B = -0.099, 95% CI: -0.154 to -0.044, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the MNA-SF score (B = -0.778, 95% CI: -1.173 to -0.383, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) both demonstrated a statistically significant negative correlation with the DMFT index (see Table\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 Factors Associated with the GI\u003c/h2\u003e \u003cp\u003eThe regression analysis revealed that both the number of medications and the MNA-SF score were significant predictors of the GI. Specifically, a positive correlation was identified between the number of medications and the GI (B\u0026thinsp;=\u0026thinsp;0.146, 95% CI: 0.048 to 0.244, p\u0026thinsp;=\u0026thinsp;0.004). Conversely, the MNA-SF score demonstrated a negative correlation with the GI (B = -0.151, 95% CI: -0.200 to -0.102, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (see Table\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003e3.3.3 Factors Associated with the Prosthetic status\u003c/h2\u003e \u003cp\u003eThe binary logistic regression analysis identified the CCI, Barthel Index, and MMSE score as significant determinants of prosthetic status. Specifically, an elevated CCI score emerged as a risk factor (Odds Ratio [OR]\u0026thinsp;=\u0026thinsp;2.762, 95% Confidence Interval [CI]: 1.287 to 5.927, p\u0026thinsp;=\u0026thinsp;0.009), whereas higher scores on the Barthel Index (OR\u0026thinsp;=\u0026thinsp;0.946, 95% CI: 0.908 to 0.987, p\u0026thinsp;=\u0026thinsp;0.010) and MMSE (OR\u0026thinsp;=\u0026thinsp;0.803, 95% CI: 0.696 to 0.928, p\u0026thinsp;=\u0026thinsp;0.003) were identified as protective factors (see Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTable\u0026nbsp;4. Multivariable Analysis of the Independent Effects of Functional Dependence, Cognition, and Nutrition on Oral Health\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent Variable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDMFT Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.099(-0.154, -0.044)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.778(-1.173, -0.383)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGingival Index (GI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.146(0.048, 0.244)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMNA-SF Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.151(-0.200, -0.102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProsthetic Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.762(1.287, 5.927)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarthel Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.946(0.908, 0.987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.803(0.696, 0.928)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eDMFT: Decayed, Missing, Filled Teeth; MMSE: Mini-Mental State Examination; MNA-SF: Mini Nutritional Assessment-Short Form.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eB: Unstandardized regression coefficient from multiple linear regression.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eOR: Adjusted Odds Ratio from multiple logistic regression.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAll models were adjusted for age, sex, education level, Charlson Comorbidity Index (CCI), and number of medications.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4 Discussions","content":"\u003cp\u003e This study represents the inaugural cross-sectional analysis aimed at systematically evaluating the comprehensive clinical oral health status of elderly inpatients with disabilities residing in medical-care institutions. It concurrently investigates the associations of oral health with three fundamental dimensions of frailty: functional dependence, nutritional status, and cognitive function. The findings indicate a significant and overlapping burden of systemic frailty and oral health issues among the institutionalized elderly inpatients with disabilities surveyed. In terms of systemic health, the study population exhibited a critical convergence of four primary frailty indicators: advanced age, severe functional dependence, a high prevalence of cognitive impairment, and a significant risk of malnutrition. Specifically, 72.7% of participants were severely functionally dependent, and 68.7% exhibited cognitive impairment, indicating a dual deficit in both self-care capacity and executive function. Notably, 63.3% were at risk of malnutrition, a rate considerably higher than that observed in the general elderly population within similar care settings\u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e. This finding suggests that the combination of disability and inpatient status significantly exacerbates nutritional vulnerability. The pronounced co-occurrence of these four conditions\u0026mdash;referred to here as a frailty tetrad\u0026mdash;highlights that the participants represent a particularly vulnerable subgroup, with more severely depleted physiological reserves and self-management capacity compared to community-dwelling elders or less impaired institutionalized peers\u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe oral health status of this population reflects a systemic crisis. In terms of cumulative disease burden, the DMFT index was recorded at 25.17, which is significantly higher than the national average for adults aged 65\u0026ndash;74, as reported in the Forth National Oral Health Survey\u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. This finding underscores an exceptionally severe lifetime caries burden. The current state of oral treatment and maintenance is particularly concerning, with 77.3% of patients having prostheses in a suboptimal condition, and 71 individuals (47.3% of the total sample) lacking any prosthesis. This proportion substantially exceeds the rates observed among community-dwelling older adults with better functional status\u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e, indicating that the long-term success of dental interventions is highly jeopardized in the presence of severe disability and cognitive impairment. Additionally, the mean GI was 1.37, indicating mild inflammation. The management of gingival inflammation in this cohort is further complicated by the combined effects of institutionalization, prevalent polypharmacy, and a high risk of malnutrition, presenting persistent and complex challenges\u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eUtilizing multivariable regression analysis, this study elucidates the distinct and differentiated patterns of influence exerted by three core dimensions\u0026mdash;functional capacity, nutritional status, and cognitive function\u0026mdash;on three categories of oral health outcomes: dental caries, periodontal inflammation, and prosthetic status. The findings suggest that, within the complex population of institutionalized elderly individuals with disabilities, various oral health issues are associated with specific dimensions of functional decline. This insight offers critical clues for investigating underlying mechanisms and developing targeted intervention strategies in future research. The following sections interpret these differentiated patterns in the context of existing literature and clinical logic.\u003c/p\u003e \u003cp\u003eThe analysis of the data indicated a significant association between a higher DMFT index and both diminished functional status and poorer nutritional status. Specifically, the study identified that elevated scores on the Barthel Index and the MNA-SF were independently correlated with a lower DMFT index. This observation is consistent with existing literature\u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e. Functional dependence often results in substantial limitations in oral self-care abilities, thereby considerably increasing the risk of plaque accumulation and dental caries, a relationship extensively documented in numerous studies concerning frail older adults\u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e. Additionally, malnutrition or elevated nutritional risk is frequently associated with altered dietary habits, such as a reliance on high-carbohydrate liquid or soft diets, which are well-established as cariogenic risk factors\u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegression analysis indicated that both an increased number of medications and a decreased MNA-SF nutrition score were independently correlated with more severe gingival inflammation. This pattern implies that gingival health is significantly influenced by immediate, modifiable physiological and metabolic factors. On one hand, polypharmacy, especially involving medications known to induce xerostomia (such as anticholinergics, diuretics, and antidepressants), can directly disrupt oral homeostasis\u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e. Reduced salivary flow compromises its mechanical cleansing, acid-buffering, and antimicrobial functions, while also altering the oral microbial ecology\u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e. This environment promotes the colonization and biofilm formation of cariogenic and periodontal pathogens, thereby increasing susceptibility to gingival inflammation\u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e. On the other hand, malnutrition or nutritional risk frequently manifests as insufficient consumption of protein, vitamins (such as vitamin C), and trace elements (such as zinc), which systematically undermines host immune defenses and the capacity for connective tissue repair\u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]\u003c/sup\u003e. Under such conditions, the integrity of the gingival epithelial barrier and the effectiveness of local immune cells are compromised, resulting in an exaggerated inflammatory response to a given amount of plaque and a delayed healing process\u003csup\u003e[\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]\u003c/sup\u003e. Additionally, some older adults may refrain from consuming hard foods due to dental pain, leading to inadequate intake of dietary fiber, protein, and other essential nutrients, thereby further impairing oral tissue repair\u003csup\u003e[\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFinally, non-ideal prosthetic status was strongly linked to greater overall illness burden (higher CCI score), worse physical function, and more severe cognitive decline. This reflects the high overall health demands that successful prosthetic care\u0026mdash;from planning to long-term home maintenance\u0026mdash;places on these patients. A high comorbidity burden harms prosthetic outcomes in several ways, acting as a key risk factor for non-ideal status. Systemically, serious chronic diseases (e.g., uncontrolled diabetes) can shift healthcare priorities away from complex dental care\u003csup\u003e[\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]\u003c/sup\u003e. Locally, poor overall health slows tissue healing and adaptation, weakening prosthesis fit\u003csup\u003e[\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]\u003c/sup\u003e. Additionally, multiple diseases and their treatments can disrupt the oral environment (e.g., saliva, microbes), upsetting the balance between the prosthesis and oral tissues\u003csup\u003e[\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]\u003c/sup\u003e. This can lead to problems like new cavities, gum disease, or sore spots, raising the risk that patients stop using the prosthesis due to discomfort. Finally, frequent medical visits or hospitalizations interrupt regular dental check-ups, allowing minor issues to go unchecked and worsen into an unusable state.\u003c/p\u003e \u003cp\u003eThe Barthel Index, serving as a protective factor, highlights that basic activities of daily living constitute the essential physical foundation for the long-term success of a prosthesis. It is imperative for patients to have adequate manual dexterity, coordination, and physical strength to effectively utilize tools such as interdental brushes, dental floss, or specialized toothbrushes for cleaning the prosthesis neck, proximal surfaces, and abutment teeth. This capability is vital for preventing plaque accumulation around the prosthesis, as well as secondary caries and periodontal inflammation. In the current study, the prevalent functional dependence, indicated by low Barthel scores among participants, compromised this critical physical foundation necessary for daily maintenance\u003csup\u003e[\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]\u003c/sup\u003e. Similarly, the MMSE score, as an additional protective factor, underscores the pivotal cognitive and behavioral importance of intact cognitive function in the long-term maintenance of prostheses\u003csup\u003e[\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]\u003c/sup\u003e. Patients with preserved cognitive abilities are capable of comprehending and recalling instructions for prosthesis use and specialized cleaning techniques. They can actively identify and report issues such as prosthesis looseness, damage, or discomfort, and adhere to recommended professional follow-up and maintenance schedules. Conversely, patients with cognitive impairments demonstrate substantial deficiencies in these areas, significantly elevating the risk of minor issues escalating into major complications, which may ultimately result in complete prosthetic failure.\u003c/p\u003e \u003cp\u003eThe results of this study have significant implications for clinical practice and future research trajectories. The distinct correlations identified between dental caries, gingival inflammation, and prosthetic status with functional-nutritional, pharmacological-metabolic, and systemic-functional-cognitive dimensions, respectively, indicate a need for a paradigm shift in oral health management within medical care institutions\u003csup\u003e[\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]\u003c/sup\u003e. This shift should move away from universal care towards precise, integrated interventions. Specifically, systemic nutritional support should be established as a foundational measure. In parallel, targeted strategies should be applied synergistically: addressing barriers to oral hygiene arising from functional dependence, incorporating the long-term oral health impacts of medications into comprehensive medical decision-making, and performing thorough pre-prosthetic evaluations of patients' systemic health and self-maintenance capabilities\u003csup\u003e[\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e]\u003c/sup\u003e. Additionally, the professional maintenance requirements for prostheses should be incorporated into routine nursing protocols.\u003c/p\u003e \u003cp\u003eThis study is subject to several limitations. Firstly, its cross-sectional design limits the ability to draw causal inferences from the observed associations. Secondly, the study did not evaluate specific daily oral hygiene behaviors, such as the frequency, technique, and duration of caregiver-assisted brushing, nor did it assess detailed dietary composition. These behavioral factors are likely significant mediators through which intrinsic capacity factors, such as functional dependence and cognitive impairment, affect oral health outcomes. It is important to highlight that oral hygiene care for the elderly inpatients with disabilities in this study is predominantly reliant on caregivers. Consequently, self-reported measures, such as \"brushing frequency,\" may lack reliability in this population\u003csup\u003e[\u003cspan additionalcitationids=\"CR70\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e]\u003c/sup\u003e. Future research should focus on developing more objective indicators to accurately assess oral hygiene behaviors in disabled older adults. Moreover, given that the sample was obtained from only two healthcare institutions, the generalizability of the findings necessitates validation across a broader spectrum of settings. Nonetheless, by concentrating on fundamental intrinsic-capacity dimensions, this study has distinctly outlined stable and differentiated patterns of association with comprehensive clinical oral health outcomes. This approach thereby offers effective assessment targets for the identification of individuals at high risk.\u003c/p\u003e \u003cp\u003eFuture research endeavors should focus on addressing the existing limitations in the field. A primary objective is to undertake longitudinal studies to elucidate causal pathways. Building upon this foundation, a central task is the development of a rapid and comprehensive oral health risk assessment tool tailored for institutional environments. Utilizing such a tool, integrated intervention protocols should be formulated to seamlessly align with routine institutional workflows, thereby enhancing the effective translation of scientific evidence into standard care practices.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was approved by the ethics committee of Nanjing Stomatological Hospital (NJSH-2023NL-015), and conducted in accordance with the ethical principles of Declaration of Helsinki. Informed consent was obtained in written form from all individual participants or their legally authorized representatives (e.g., next of kin) prior to their inclusion in the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDeclaration of Competing Interest\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Information\u003c/h2\u003e \u003cp\u003eThis study was funded by the Nanjing Health Education Association Research Project (NHEAsfp-2024-008), Nanjing Preventive Medicine Research Project (NJYFKT202406), Nanjing Municipal Association for Science and Technology Soft Science Research Project.\u003c/p\u003e \u003cp\u003eThe funder had no role in the study design, data collection and analysis, interpretation of data and writing the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eTiantian Wang: Conceptualization, Methodology, Data curation, Writing \u0026ndash; original draft, Software, Validation, Writing \u0026ndash; review \u0026amp; editing. Xin Yang: Conceptualization, Methodology, Data curation, Writing \u0026ndash; original draft, Validation. Xueting Wang : Data curation, Writing \u0026ndash; original draft, Validation. Weijing Chen: Data curation, Writing \u0026ndash; original draft, Validation. Chao Peng: Data curation, Writing \u0026ndash; original draft, Validation. Yuxin Tian: Data curation, Writing \u0026ndash; original draft. Hongyuan Dai: Data curation, Conceptualization, Methodology, Writing \u0026ndash; review \u0026amp; editing, Supervision.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to express their sincere gratitude to the staff of all participating medical-care institutions for their invaluable assistance and cooperation throughout this study. We are also deeply thankful to the families and caregivers of the participants for their support and dedication, without which this research would not have been possible\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional policies and patient confidentiality but may be available from the corresponding author upon reasonable request and subject to approval by the institutional ethics committee.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHong C, Sun L, Liu G, Guan B, Li C, Luo Y. Response of global health towards the challenges presented by population aging[J]. 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Improving oral hygiene for better cognitive health: Interrelationships of oral hygiene habits, oral health status, and cognitive function in older adults[J]. J Adv Nurs. 2024;80(1):275\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jan.15769\u003c/span\u003e\u003cspan address=\"10.1111/jan.15769\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medical-care Institutions, Elderly inpatients with disabilities, Clinical oral health status, Functional dependence, Cognitive function, Nutritional status","lastPublishedDoi":"10.21203/rs.3.rs-8537876/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8537876/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study examined the oral health of elderly inpatients with disabilities and its links to functional dependence, cognitive function, and nutritional status in medical-care institutions\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003e This study utilized a cross-sectional design between June and December 2025 and recruited a convenience sample of 150 elderly inpatients with disabilities from two medical-care institutions. Data collection involved oral examinations, which included the Decayed, Missing, and Filled Teeth (DMFT) index, Gingival Index (GI), and assessment of prosthetic status. Additionally, evaluations were conducted using the Barthel Index, Mini-Mental State Examination (MMSE) score, Mini Nutritional Assessment Short-Form (MNA-SF) score, Charlson Comorbidity Index (CCI), and medication count. Data analysis was carried out using multiple linear regression and logistic regression techniques.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe study population demonstrated significant systemic health challenges, with a mean age of 82.79\u0026thinsp;\u0026plusmn;\u0026thinsp;8.32 years. Severe functional dependence was observed in 72.7% of participants, cognitive impairment in 68.7%, and a risk of malnutrition in 63.3%. The oral health status was notably poor, as indicated by a mean Decayed, Missing, and Filled Teeth (DMFT) index of 25.17\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55. Additionally, 77.3% of participants exhibited non-ideal prosthetic status, and the mean Gingival Index (GI) was 1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78. Multiple regression analyses identified distinct association patterns: the DMFT index was independently associated with a lower Barthel Index (B = -0.099, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a lower MNA-SF score (B = -0.778, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The GI was independently associated with an increased number of medications (B\u0026thinsp;=\u0026thinsp;0.146, p\u0026thinsp;=\u0026thinsp;0.004) and a lower MNA-SF score (B = -0.151, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In contrast, non-ideal prosthetic status was independently associated with a higher CCI score (OR\u0026thinsp;=\u0026thinsp;2.762, p\u0026thinsp;=\u0026thinsp;0.009), a lower Barthel Index (OR\u0026thinsp;=\u0026thinsp;0.946, p\u0026thinsp;=\u0026thinsp;0.010), and a lower MMSE score (OR\u0026thinsp;=\u0026thinsp;0.803, p\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eElderly inpatients with disabilities in medical-care institutions exhibit significant oral health challenges. Distinct core health dimensions are associated with dental caries, gingival inflammation, and prosthetic status. These findings indicate that promoting oral health within this population necessitates comprehensive and tailored intervention strategies that incorporate nutritional support, functional rehabilitation, medication management, and cognitive care.\u003c/p\u003e","manuscriptTitle":"Clinical Oral Health Status and Its Associations with Functional Dependence, Cognitive Function, and Nutritional Status in Elderly Inpatients with Disabilities in Medical-Care Institutions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 18:40:53","doi":"10.21203/rs.3.rs-8537876/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b0a45dad-fb1a-4697-a9d6-7fa096cd9bc6","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T11:11:36+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 18:40:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8537876","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8537876","identity":"rs-8537876","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}