The Mechanism of Social Support on Oral Frailty in Older Adults: The Mediating Role of Nutritional Status

The Mechanism of Social Support on Oral Frailty in Older Adults: The Mediating Role of Nutritional Status | 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 The Mechanism of Social Support on Oral Frailty in Older Adults: The Mediating Role of Nutritional Status Qian Wang, Xiu E Li, Chun Li Wang, Qing Qing Pan, Yu Mei Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9219473/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Oral frailty is highly prevalent in older adults and leads to severe adverse health outcomes, posing a major global public health challenge. Nutritional status, a key behavioral and physiological determinant of oral function, is closely associated with social support, yet its mediating role in the relationship between social support and oral frailty remains underexplored. Based on the biopsychosocial theoretical framework, this study aimed to investigate the mediating effect of nutritional status on the link between social support and oral frailty in community-dwelling older adults. Methods A cross-sectional survey was conducted from December 2025 to February 2026 in five communities of Wuxi City, Jiangsu Province, China. A total of 539 older adults aged ≥ 60 years were recruited via convenience sampling. Study instruments included a self-designed general information questionnaire, the Social Support Rating Scale (SSRS), the Mini Nutritional Assessment Short Form (MNA-SF), and the Oral Frailty Index-8 (OFI-8). Data were analyzed using SPSS 21.0 and AMOS 22.0, with descriptive statistics, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling (SEM) applied to verify the mediating effect. Results The prevalence of oral frailty among the participants was 48.05%. Multiple linear regression identified age, number of natural teeth, chronic disease status, subjective chewing difficulty, social support, and nutritional status as independent influencing factors of oral frailty (all P < 0.05), collectively explaining 38.1% of the variance in oral frailty scores. SEM revealed that social support exerted a direct negative effect on oral frailty ( β = -0.280, P < 0.05), and nutritional status also had a direct negative effect on oral frailty ( β = -0.419, P < 0.05). Furthermore, nutritional status played a significant mediating role between social support and oral frailty, with an indirect effect of β = -0.107 ( P < 0.05) that accounted for 27.6% of the total effect of social support on oral frailty. Conclusions Nutritional status serves as an important mediator in the relationship between social support and oral frailty in older adults. These findings highlight the need to integrate the establishment of social support networks with nutritional risk screening and assessment in geriatric health management, and to implement comprehensive strategies combining psychosocial support and nutritional interventions to delay the progression of oral frailty in this population. Oral Frailty Social Support Nutritional Status Older Adults Mediation Effect Biopsychosocial Model Figures Figure 1 Figure 2 1.Introduction Population aging has become an irreversible global trend. According to the United Nations’World Population Prospects 2022 report, the proportion of people aged 65 years and above is projected to reach 16% by 2050, meaning one in six individuals worldwide will be an older adult[1].This demographic shift poses profound challenges to public health systems and socioeconomic sustainable development, making the promotion of healthy aging a global priority[2]. Healthy aging not only focuses on extending lifespan but also emphasizes maintaining physiological function, self-care ability, and social participation to enhance the overall quality of life in older adults. The World Health Organization’s Decade of Healthy Aging 2021-2030 underscores oral health as a cornerstone of healthy aging, as it is critical for nutritional intake, speech function, social interaction, and overall physical and mental well-being[3]. Against this backdrop, oral health issues in older adults have become increasingly prominent, with oral frailty emerging as a key concern. Defined as a multidimensional, progressive syndrome of oral functional decline, oral frailty encompasses impaired chewing efficiency, dysphagia, xerostomia, and oral microbial imbalance[4], Mounting evidence has linked oral frailty to adverse health outcomes including physical frailty, malnutrition, cognitive decline, and all-cause mortality in older adults[5-7].While oral frailty is highly prevalent in community-dwelling older adults and constitutes an urgent public health issue, targeted interventions remain inadequate[8, 9].Without effective prevention and control, oral frailty exacerbates functional disability and social isolation, increases demand for long-term care and medical expenditures, and imposes a heavy burden on families, healthcare systems, and society[10].Thus, exploring the mechanisms underlying oral frailty is essential for developing targeted interventions and alleviating the health burden of aging populations. The biopsychosocial model provides an integrated framework for understanding oral frailty, emphasizing that health outcomes are the result of the interaction among biological foundations, psychological states, and the social environment. However, existing research has predominantly focused on biomedical indicators such as the number of teeth and masticatory function, overlooking the underlying mechanisms through which psychosocial factors influence oral health via behavioral pathways. Recent studies have confirmed that social support, as a crucial external resource, is believed to potentially exert an indirect effect on oral function by influencing an individual's daily behavioral patterns, such as nutritional intake[11].The aforementioned evidence suggests the possible existence of a "social support→ nutritional status→oral frailty" pathway. However, whether nutritional status plays a mediating role in this relationship remains unclear within academic circles, and there is a lack of systematic empirical models to validate it. Based on this, the present study takes the biopsychosocial model as its theoretical foundation to construct and test an integrated mediation model: with social support (a psychosocial factor) as the starting point and oral frailty (a biological functional outcome) as the endpoint, hypothesizing that nutritional status (a behavioral and physiological factor) plays a key mediating role. Through a cross-sectional survey and structural equation modeling analysis, this study not only quantifies the direct effect of social support on oral frailty (the psychosocial pathway) but also systematically validates the existence and effect size of the "social support →nutritional status→oral frailty" behavioral and physiological mediation pathway. This approach aims to provide a more comprehensive explanation of the mechanisms influencing oral health in the older adults.The findings are intended to offer an empirical basis for the development of multidimensional,community-based comprehensive intervention strategies that encompass the enhancement of social support, the management of nutritional risk, and the maintenance of oral function. To verify the existence and effect size of the aforementioned pathways, this study proposes the following core hypotheses (Figure 1): H1: Social support has a significant negative predictive effect on oral frailty in older adults. H2: Nutritional status has a significant negative predictive effect on oral frailty in older adults. H3: Nutritional status plays a mediating role in the relationship between social support and oral frailty. 2. Materials and Methods 2.1. Study Design and Participants A cross-sectional study was conducted from December 2025 to February 2026 in five communities of Wuxi City, Jiangsu Province, China. Convenience sampling was used to recruit community-dwelling older adults aged ≥60 years. Inclusion criteria: (1) aged≥60 years; (2) continuous residence in Wuxi City for ≥6 months; (3) no severe visual, hearing, or cognitive impairment, with the ability to independently understand and complete the questionnaire; (4) provision of written informed consent and voluntary participation. Exclusion criteria: (1) diagnosis of severe cognitive impairment (e.g., dementia) or mental illness; (2) presence of major organ (heart, brain, kidney, etc.) dysfunction or acute illness; (3) other conditions precluding completion of the survey. A total of 539 eligible older adults were included in the final analysis. Paper-based questionnaires were used to facilitate participation, and all investigators received standardized training on study objectives, participant eligibility, and questionnaire administration. During field investigations, investigators provided one-on-one guidance using standardized instructions, and completed questionnaires were checked on-site to supplement missing items promptly. For participants with low educational levels or poor eyesight, investigators read the questions aloud and recorded responses to ensure data completeness. 2.2. Ethical Approval This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Wuxi Stomatological Hospital (Approval No.: 2025120801). All participants were fully informed of the study’s purpose, procedures, potential risks, and benefits prior to enrollment, and written informed consent was obtained from all subjects. Participation was entirely voluntary, and participants had the right to withdraw at any time without penalty or explanation. All questionnaire data were collected anonymously, and electronic data were stored in an encrypted system with access restricted exclusively to the research team for data analysis. 2.3. Measurement Tools 2.3.1 .General Information Questionnaire A self-designed general information questionnaire was developed based on a systematic review of relevant literature and expert consultations, tailored to the characteristics of the older adult population and study objectives. The questionnaire included 12 items covering demographic and clinical characteristics: gender, age, educational level, marital status, monthly household income, smoking history, drinking history, number of natural teeth, number of dentures, subjective chewing difficulty, parental dental status, and chronic disease status (yes/no). 2.3.2. Social Support Rating Scale (SSRS) The SSRS, developed by Xiao[12], is a widely used 10-item scale to assess social support from three dimensions: subjective support (Items 1, 3, 4, 5; 4 items, score range: 8-32), objective support (Items 2, 6, 7; 3 items, score range: 1-22), and support utilization (Items 8-10; 3 items, score range: 3-12). Scoring rules were as follows: Items 1-4 and 8-10 were single-choice questions scored 1-4 based on support level; Item 5 included four sub-items (each scored 1-4), with the total score being the sum of the sub-items; Items 6 and 7 scored 0 for “no source” and 1 per identified support source. The total score (sum of all 10 items) ranges from 12 to 66, with higher scores indicating higher levels of social support. The SSRS has been validated for good reliability and validity in Chinese older adult populations[13, 14]. 2.3.3. Mini Nutritional Assessment Short Form (MNA-SF) This scale was developed by Cohendy in 2001 as a simplified version based on the full-length MNA, specifically designed for rapid nutritional screening in older adults[15].The scale covers six core indicators: decline in food intake, weight loss, mobility, acute stress events, psychological issues, and BMI. It employs a three-level scoring system (e.g., "yes"/"no"/"unsure"), with individual items scored from 0-2 or 0-3 points. The total score ranges from 0 to 14, with higher scores indicating better nutritional status. A score of 7 is used as the cut-off point: scores > 7 indicate normal nutritional status, while scores ≤ 7 suggest malnutrition[15, 16]. This tool is simple and efficient, making it particularly suitable for assessing nutritional risk in community-dwelling older populations, including those with oral frailty[17]. 2.3.4 .Oral Frailty Index-8 (OFI-8) In 2021, Tanaka's team optimized the scale based on the OFI-6, resulting in an 8-item version covering five dimensions: denture use, chewing ability, swallowing function, oral health behaviors, and social participation. The scoring method is as follows: for items 1-3, a "yes" response scores 2 points; for items 4-5, a "yes" response scores 1 point; for items 6-8, a "no" response scores 1 point. The total score ranges from 0 to 11 points. A score of ≥ 4 indicates oral frailty, with higher scores reflecting greater risk[18]. This scale has been validated in studies across multiple countries and is suitable for community-dwelling older adult populations[19, 20]. In 2023, Chen Zongmei et al. [21] adapted the OFI-8 into a Chinese version. Validation results showed excellent reliability and validity for the Chinese version: the Cronbach's α coefficient was 0.949, the test-retest reliability was 0.786, and the content validity index was 0.934, all superior to the original scale. The Chinese version of the OFI-8 is simple to administer, does not rely on specialized equipment, and is suitable for large-scale screening applications among community-dwelling older adults[21]. 2.4. Data Analysis Data were analyzed using the Statistical Package for the Social Sciences (SPSS) 21.0 (IBM Corp., Armonk, NY, USA) and Analysis of Moment Structures (AMOS) 22.0 (IBM Corp., Armonk, NY, USA). Continuous variables were described as mean ±standard deviation (SD), and categorical variables as frequencies and percentages (n, %). Independent samples t-tests and one-way analysis of variance (ANOVA) were used to compare oral frailty scores across groups with different demographic and clinical characteristics (age was dichotomized into ≤ 70 years and > 70 years). Pearson correlation analysis was performed to examine the bivariate correlations among social support, nutritional status, and oral frailty. Variables with significant differences in univariate analysis, along with total scores of social support and nutritional status, were included as independent variables in a multiple linear regression analysis (enter method), with the total oral frailty score as the dependent variable, to identify independent influencing factors of oral frailty. Structural equation modeling (SEM) was constructed in AMOS to test the mediating effect of nutritional status on the relationship between social support and oral frailty (social support: independent variable; oral frailty: dependent variable; nutritional status: mediating variable). The maximum likelihood method was used for parameter estimation and model modification. The Bootstrap method (5000 resamples) was applied to calculate the indirect effect and its 95% confidence interval (CI) to verify the significance of the mediating effect and its proportion of the total effect. All statistical tests were two-tailed, with a significance level set at α = 0.05. 3.Results 3.1. Demographic correlates of Oral Frailty Univariate analysis revealed significant differences in oral frailty scores across groups with different age, educational level, marital status, monthly household income, smoking history, number of natural teeth, number of dentures, subjective chewing difficulty, parental dental status, and chronic disease status (all P 0.05). Specifically, participants aged > 70 years, with lower educational levels, non-married status (unmarried/divorced/widowed), lower household income, smoking history, < 20 natural teeth, ≥ 20 dentures, subjective chewing difficulty, poor parental dental status, or chronic diseases had significantly higher oral frailty scores (Table 1). Table 1: Univariate analysis of oral frailty in older adults( n= 539). Variable n （%） Oral Frailty（Mean±SD） Statistic P Gender Male 241（44.71） 3.86±2.373 1.502 0.134 Female 298（55.29） 3.56±2.275 Age ≤70 330（61.22） 3.26±2.308 -5.528 0.000 ＞70 209（38.78） 4.37±2.185 Educational level Junior high school and below 345（64.01） 3.97±2.373 3.765 0.000 High school and above 194（35.99） 3.20±2.146 Marital status Married 460（85.34） 3.59±2.322 -2.548 0.011 Unmarried, divorced or widowed 79（14.66） 4.30±2.238 Monthly household income ≤5000 CNY 316（58.63） 3.98±2.428 3.602 0.000 ＞5000 CNY 223（41.37） 3.28±2.100 Smoking history Yes 164（30.43） 4.15±2.537 2.899 0.004 No 375（69.57） 3.49±2.195 Drinking history Yes 183（33.95） 3.85±2.526 1.102 0.271 No 356（66.05） 3.61±2.209 Number of natural teeth ＜20 teeth 170（31.54） 5.19±2.079 11.338 0.000 ≥20 teeth 369（68.46） 3.00±2.092 Number of dentures ＜20 teeth 470（87.20） 3.44±2.278 -6.713 0.000 ≥20 teeth 69（12.80） 5.38±1.887 Subjective chewing difficulty Yes 141（26.16） 5.50±2.150 12.164 0.000 No 398（73.84） 3.05±2.024 Parental dental status Good 231（42.86） 3.25±2.204 -3.906 0.000 Poor 308（57.14） 4.03±2.356 Presence of chronic diseases No 188（34.88） 2.90±2.143 -5.988 0.000 Yes 351（65.12） 4.12±2.305 3.2. Descriptive statistics and correlation analysis The prevalence of oral frailty among the participants was 48.05%, with a mean oral frailty score of 3.69±2.32. The mean social support score was 32.52±6.244, and the mean nutritional status score was 12.48±1.554. Pearson correlation analysis showed that social support was significantly negatively correlated with oral frailty ( r = -0.224, P < 0.01), and nutritional status was significantly negatively correlated with oral frailty ( r = -0.282, P < 0.01). Additionally, social support was significantly positively correlated with nutritional status ( r = 0.119, P < 0.01) (Table 2). Table 2: Descriptive statistics and correlation analysis of key variables( n= 539). Variable Mean±SD Social support Nutritional status Social support 32.52±6.244 1 - Nutritional status 12.48±1.554 0.119** 1 Oral Frailty 3.69±2.32 -0.224** -0.282** Note: P < 0.01. 3.3. Multiple Linear Regression Analysis of Oral Frailty Influencing Factors Multiple linear regression analysis identified six independent influencing factors of oral frailty (all P < 0.05): age (≥ 70 years), number of natural teeth, chronic disease status, subjective chewing difficulty, social support, and nutritional status. These six variables jointly explained 38.1% of the variance in oral frailty scores (R² = 0.395, adjusted R² = 0.381, F = 28.591, P < 0.001). Specifically, higher age, presence of chronic diseases, and subjective chewing difficulty were associated with higher oral frailty scores, while more natural teeth, higher social support, and better nutritional status were associated with lower oral frailty scores (Table 3). Table 3: Multiple linear regression analysis of factors affecting Oral Frailty( n= 539). Variable B SE β T P (Constant) 12.679 1.245 10.181 0.000 Age≥70years 0.395 0.173 0.083 2.281 0.023 Education -0.351 0.181 -0.073 -1.935 0.053 marital status -0.288 0.245 -0.044 -1.176 0.240 Monthly household income -0.200 0.176 -0.042 -1.134 0.257 Smoking history -0.247 0.175 -0.049 -1.413 0.158 number of natural teeth -1.192 0.221 -0.239 -5.389 0.000 Number of dentures -0.021 0.291 -0.003 -0.073 0.942 Chronic Diseases 0.684 0.170 0.141 4.025 0.000 Parental Dental Status 0.180 0.165 0.038 1.090 0.276 Subjective Chewing Difficulty -1.540 0.205 -0.292 -7.509 0.000 Social support -0.029 0.014 -0.078 -2.100 0.036 Nutritional status -0.303 0.052 -0.203 -5.853 0.000 Note: R² = 0.395, adjusted R² = 0.381, F = 28.591, P < 0.001. 3.4. Mediation Effect of Nutritional Status (SEM Analysis) The final SEM model exhibited good fit with the study data (CMIN/DF = 2.013, RMSEA = 0.043, RMR = 0.062, CFI = 0.912, GFI = 0.963, AGFI = 0.944, IFI = 0.915) (Table 4). SEM results confirmed the three study hypotheses: Social support had a significant direct negative effect on oral frailty ( β = -0.280, P < 0.05); nutritional status also had a significant direct negative effect on oral frailty ( β = -0.419, P < 0.05);Social support had a significant positive direct effect on nutritional status ( β = 0.255, P < 0.05), and nutritional status exerted a significant indirect negative effect on the social support-oral frailty relationship ( β = -0.107, P < 0.05). The mediating effect accounted for 27.6% of the total effect of social support on oral frailty (total effect of social support on oral frailty: β = -0.387) (Table 5, Figure 2). Table 4: Overall Fit of the Structural Equation Model( n= 539). Fit Index Estimate Threshold Interpretation CMIN 140.889 DF 70 CMIN/DF 2.013 1-3 Excellent RMSEA 0.043 <0.06 Acceptable RMR 0.062 0.90 Acceptable GFI 0.963 >0.90 Excellent AGFI 0.944 >0.90 Excellent IFI 0.915 >0.90 Acceptable Note: CMIN = minimum discrepancy; DF = degrees of freedom; RMSEA = root mean square error of approximation; RMR = root mean square residual; CFI = comparative fit index;GFI = goodness-of-fit index; AGFI = adjusted goodness-of-fit index; IFI = incremental fit index. Figure 2: Path diagram of mediation model: social support, nutritional status, oral frailty in older adults. Note: P < 0.05; standardized path coefficients are shown. Table 5: Standardized direct, indirect, and total effects of social support and nutritional status on oral frailty( n= 539). Pathway Direct Effect Indirect Effect Total Effect Social support→Nutritional status 0.255* - 0.255* Social support→Oral frailty -0.280* - - Nutritional status→Oral frailty -0.419* - -0.419* Social support→Nutritional status→Oral frailty - -0.107* - Social support→Oral frailty (total) - - -0.387* Note: P < 0.05. 4.Discussion This study is the first to empirically validate the social support → nutritional status → oral frailty mediation pathway in a community-dwelling Chinese older adult population based on the biopsychosocial model. Transcending the limitations of traditional biomedical research that focuses solely on biological factors, this study integrated psychosocial (social support) and behavioral-physiological (nutritional status) factors into a unified analytical framework. Using SEM, we quantified the direct protective effect of social support on oral frailty and the indirect effect via nutritional status, confirming that nutritional status plays a significant partial mediating role in this relationship. These findings advance the understanding of oral frailty mechanisms from risk factor identification to mechanistic elucidation, and provide empirical evidence for developing a comprehensive social-nutritional-oral trinity strategy for geriatric oral health management. Below, we discuss the key findings and their implications. 4.1. High Prevalence of Oral Frailty in Wuxi Community-Dwelling Older Adults The prevalence of oral frailty in this study was 48.05%, which falls within the medium-to-high range of the global prevalence (42%, 95% CI: 32%-51%) reported in a recent meta-analysis[22].This rate is slightly lower than the pooled estimate for Chinese community-dwelling older adults (53%, 95% CI: 42%-65%) but significantly higher than that for Japanese older adults (22%, 95% CI: 19%-39%)[23].Compared with domestic studies, the result of this study is at a moderately high level. A survey by Jiang Wenyi et al.of 3,063 community-dwelling older adults in Anhui Province showed an oral frailty incidence of 46.82%, slightly lower than that of this study. The similarity between the two results may be related to both regions being in the eastern area, with comparable economic development levels and degrees of population aging[24].However, as a deeply aging city , Wuxi has a higher proportion of older adults[25, 26], which may contribute to its slightly higher prevalence rate.A survey by Lu of 361 community-dwelling older adults in Shijiazhuang City showed an oral frailty prevalence rate of 33.4%. Both Shijiazhuang and Wuxi are urban community samples, but the significant difference in prevalence rates may suggest variations in oral health management and utilization of oral health services for the older adults between North China and East China[27].Tang Ji reported an oral frailty prevalence rate of 44.7% among rural older adults in Guizhou, which is lower than that in the Wuxi community (48.05%)[28].This difference may stem from a deep-seated urban-rural divide in access to oral health services. Although rural older adults experience more tooth loss, the decline in oral function often remains in an "unidentified" state due to inconvenient access to medical care. In contrast, while urban older adults retain more teeth, their diverse dietary structure imposes higher demands on masticatory function, making a comparable degree of functional decline more likely to be detected. In summary, there are significant regional differences in the prevalence of oral frailty among community-dwelling older adults in China. The detection rate of 48.05% in this study is at a relatively high level, indicating that the oral health problems of community-dwelling older adults in Wuxi are quite prominent and require attention. This means that nearly half of the community-dwelling older adults are already in a state of critical or evident impairment in oral function. This figure is not only much higher than previous reports from some regions but also constitutes a public health warning that cannot be ignored-given that oral frailty has been confirmed as an independent risk factor for physical frailty, falls, cognitive decline, and all-cause mortality. The current passive service model centered on clinical restorative treatment is clearly insufficient to curb the trend of declining oral function at the population level. Therefore, it is urgent to incorporate oral frailty screening into the national essential public health services program for older adult health management and to build a comprehensive prevention system covering the entire chain of "functional assessment-nutritional intervention-social support-oral maintenance" based on community platforms. 4.2 . Multiple Independent Influencing Factors of Oral Frailty This study identified six independent influencing factors of oral frailty: age, number of natural teeth, chronic diseases, subjective chewing difficulty, social support, and nutritional status, collectively explaining 38.1% of the variance in oral frailty scores. These factors reflect the multifactorial nature of oral frailty, consistent with the biopsychosocial model. 4.2.1. Advancing age can significantly increase the level of oral frailty Age is one of the most significant biological predictors of oral frailty. This study showed that the oral frailty score of older adults aged >70 years was significantly increased, a finding highly consistent with the conclusions of recent systematic reviews: Meta-analyses have confirmed that age is an independent risk factor for oral frailty, with the risk of disease significantly increased in the elderly population due to the cumulative decline in oral functional reserve[29].The mechanism can be explained from two levels. Firstly, aging is accompanied by a series of degenerative changes in oral tissues, including decreased saliva secretion, atrophy of the oral mucosa, reduced periodontal support, and diminished neuromuscular coordination. These changes collectively lead to decreased masticatory efficiency and swallowing function[30].Secondly, the systemic low-grade inflammatory state-namely, "inflammaging"-plays a key role: the accumulation of senescent cells leads to increased release of pro-inflammatory cytokines (such as IL-6, TNF-α). These inflammatory mediators not only exacerbate periodontal tissue destruction and alveolar bone resorption but also cause dysregulation of local immunity and repair capacity by affecting neutrophil function[31]. Therefore, age is not only a marker of physiological aging but also a key indicator of the decline in oral functional reserve. 4.2.2. Tooth Loss: The Initiating Factor in Oral Function Decline The number of natural teeth is the foundation for maintaining oral function. This study shows that the oral frailty score of older adults with fewer than 20 remaining natural teeth is significantly increased. This finding is consistent with the results of a large-scale meta-analysis covering 441,508 participants, which found that having fewer than 20 teeth is significantly associated with all-cause mortality in older adults (OR = 2.04)[7].The JAGES study based on 21,542 older adults in Japan further revealed that retaining≥20 teeth can significantly reduce the risk of oral frailty and can eliminate nearly 30% of the impact of socioeconomic inequalities on oral health[32].Tooth loss not only directly leads to reduced chewing area and decreased bite force (decreases by 75–85% in edentulous patients)[33], but may also trigger a series of compensatory changes, such as overloading of the remaining teeth[34].More importantly, tooth loss can affect the choice of food texture, prompting older adults to avoid meats, vegetables, and fruits that are difficult to chew, consequently leading to insufficient intake of key nutrients like protein, dietary fiber, and vitamin C, which may result in an imbalanced nutritional structure[35].Over the long term, this can further lead to disuse atrophy of the oral muscles, changes in saliva composition, and may affect the gut microbiota and systemic metabolism, forming a vicious cycle of "tooth loss—malnutrition—deterioration of general health" [36, 37]. 4.2.3. Self-perceived chewing difficulty is an important warning sign of oral frailt y Self-perceived chewing difficulty is an important subjective indicator of oral frailty and an early signal of functional decline. This study shows that older adults with self-perceived chewing difficulties have significantly higher oral frailty scores. Research by Japanese scholars further reveals that decreased chewing function is significantly associated with reduced bite force and diminished tongue-lip motor function, representing a key link in the chain of oral functional decline[38].Self-perceived chewing difficulty is not only a manifestation of impaired local oral health but is also significantly associated with systemic pathological processes such as sarcopenia through mediating pathways including systemic inflammation and liver dysfunction[39], forming an interaction between oral and systemic health. Large-scale population studies have confirmed that self-reported chewing difficulty can independently predict a 35% increased risk of hospitalization for aspiration pneumonia and a 28% increased risk of all-cause mortality in older adults, with clinical significance comparable to objective functional tests[40]. Therefore, self-perceived chewing difficulty should be regarded as a critical functional warning sign, indicating the need for systematic oral function assessment and early intervention. Incorporating it into routine health screening programs for older adults has important public health implications. 4.2.4. Chronic Diseases are Significant Drivers of Oral Frailty This study found that older adults with chronic diseases have significantly higher levels of oral frailty, which is consistent with the conclusions of a meta-analysis-a history of chronic disease is an independent risk factor for oral frailty (OR = 1.96)[22].In terms of directionality, systemic diseases can impair oral health through pathways such as microcirculatory disorders, immune dysregulation, and metabolic disturbances[41];Conversely, oral infections, as foci of chronic inflammation, can release inflammatory mediators into the systemic circulation, exacerbating insulin resistance and the progression of atherosclerosis, thus forming a vicious cycle[41, 42].This interaction has been validated in multiple studies: patients with periodontitis have a significantly increased risk of cardiovascular events[42],periodontitis progresses more rapidly in diabetic patients, and a bidirectional relationship exists[41]; and poor oral health is significantly associated with multimorbidity. Recent research further reveals that in older patients with chronic diseases, oral frailty affects cognitive function through the chain mediating effect of nutritional status and the inflammatory marker CRP, suggesting that the inflammatory pathway is a core hub connecting oral and systemic health[43]. These findings indicate that oral health assessment must be integrated into the management of chronic diseases in older adults, and oral interventions should also be incorporated into a comprehensive medical model for managing multiple comorbidities. 4.2.5. Direct Protective Effect of Social Support on Oral Frailty SEM confirmed a significant direct negative effect of social support on oral frailty ( β = -0.280, P < 0.05), indicating that social support exerts a protective effect through a psychosocial pathway independent of nutritional status. This finding is highly consistent with domestic and international studies. Hua Weiyi surveyed 628 rural older adults and showed that perceived social support was significantly negatively correlated with oral frailty ( r = -0.084, P < 0.05), and could indirectly buffer the decline in oral function by improving nutritional status[11]. Qin Meirong confirmed through structural equation modeling that social support partially mediates the relationship between oral frailty and oral health self-efficacy (mediating effect 28.97%)[44] .Collectively, this evidence reinforces the independent protective role of social support. Analyzing the mechanism, the direct protective effect of social support is achieved through multidimensional pathways. The scoping review by Chan et al[45]outlined three core pathways: First, the emotional support and stress buffering pathway, which directly maintains oral tissue homeostasis by regulating neuroendocrine stress responses (e.g., reducing cortisol levels). Second, the behavioral promotion and health literacy pathway, which promotes regular oral hygiene behaviors by transmitting oral health knowledge and enhancing self-efficacy. A longitudinal study published by Zhao et al further confirmed that perceived social support is an independent factor influencing the trajectory of oral frailty in older adults after stroke; those with higher levels of support were more likely to maintain regular oral hygiene behaviors and routine dental visit habits. Third, the social capital and community support environment pathway[46].Another study by Chan et al [47], based on 7,796 older adults from the CLHLS, showed that community-level social capital can buffer the negative impact of tooth loss on cognitive function by promoting social participation. This study explicitly pointed out that the association between oral health and general health exists not only at the biological level but is also profoundly embedded in the psychosocial dimension. In summary, the direct protective effect of social support on oral frailty operates through multiple levels, including neuroendocrine regulation, promotion of health behaviors, enhancement of self-efficacy, and the creation of a supportive community environment. This suggests that intervention strategies must place "strengthening social support networks" on equal footing with "maintaining oral function." By constructing a family-community integrated support system, it is possible to achieve direct empowerment for the oral health of older adults. 4.2.6.Nutritional Status as a Key Mediator Between Social Support and Oral Frailty The core finding of this study is the confirmation of nutritional status as a significant partial mediator between social support and oral frailty (indirect effect β = -0.107, P < 0.05), accounting for 27.6% of the total effect of social support on oral frailty. This validates the hypothesized social support→nutritional status→oral frailtypathway, translating the abstract link between psychosocial resources and health into a clear mechanistic chain. First, social support positively predicts nutritional status ( β = 0.255, P < 0.05), consistent with global evidence. The behavioral mechanisms are primarily manifested in two aspects: firstly, promoting social eating through communal meals, which improves dietary quality and diversity; and secondly, overcoming barriers to food access and preparation for older adults through instrumental support (assisting with shopping and cooking) and informational support (conveying knowledge about healthy diets), thereby preventing malnutrition[48]. Second, nutritional status exerts the strongest direct protective effect on oral frailty ( β = -0.419, P < 0.05) among all predictors in this study, establishing it as a core “physiological hub” for oral health. A review by Martu I et al.systematically elaborated on the mechanisms through which nutrition impacts oral health: adequate protein intake maintains masticatory muscle mass and periodontal tissue integrity, preventing sarcopenia; vitamin D and calcium work synergistically to maintain alveolar bone density and slow periodontitis-induced bone resorption; antioxidant vitamins (such as C and E) protect periodontal tissues from inflammatory damage by reducing oxidative stress; and good overall nutritional status supports normal salivary secretion and mucosal immune function, establishing a stable internal environment for the mouth to resist pathogens and inflammation[49]. This mediating pathway highlights a critical gap in current oral health interventions: oral hygiene education alone is insufficient if it neglects nutritional deterioration caused by social isolation or mobility barriers. Future interventions must integrate social support, nutritional intervention, and oral function maintenance to address the multifactorial nature of oral frailty. 4.2.7. Nutritional status is the direct proximal factor with the greatest contributing degree in the multifactorial model of oral frailty One of the most critical findings of this study is the quantification, through structural equation modeling, of the direct and powerful negative predictive effect of nutritional status on oral frailty. In the final well-fitting model, the standardized direct path coefficient from nutritional status to oral frailty was as high as -0.419, significantly higher than that of other predictors such as social support, ranking it as the most core direct proximal factor with the largest effect size influencing oral frailty. This strong association can be explained through multi-level biological mechanisms and is supported by cutting-edge international research. At the macronutrient level, protein, serving as the "building material" for maintaining oral structure and function, is crucial for sustaining masticatory muscle mass, combating sarcopenia, and ensuring the repair capacity of periodontal tissues. The scoping review by Moynihan et al systematically elaborated on this mechanism, pointing out that adequate dietary protein intake plays an important role in maintaining masticatory muscle function and preventing sarcopenia in older adults[50]. At the micronutrient level, vitamins act as "precision regulators" controlling homeostasis and defense through multiple roles. Wang et al[51], through pharmacological analysis, systematically revealed the multiple molecular mechanisms by which vitamins affect periodontal health: vitamins C and E exert antioxidant and anti-inflammatory effects by scavenging reactive oxygen species and inhibiting the release of inflammatory factors; vitamin D modulates immune cell function and reduces the production of pro-inflammatory mediators; vitamins D, K, and A ameliorate alveolar bone resorption by promoting osteoblast differentiation and inhibiting osteoclast activity. The review by Curca further systematically elaborated on the mechanisms of nutrition's impact on oral health: high-sugar and ultra-processed diets can trigger inflammatory responses and oral microbiota dysbiosis, increasing susceptibility to dental caries and periodontitis; whereas nutrient-rich, anti-inflammatory diets can improve immune regulation, maintain microbial balance, and are associated with better periodontal status[49]. At the level of systemic nutritional status, good overall nutritional status shapes an "internal environment" conducive to the maintenance of oral health. Curca[49]points out that nutritional status has a decisive impact on oral and periodontal health by influencing inflammatory responses, oxidative stress, saliva composition, and the oral microbiome. Good overall nutrition supports normal salivary secretion and mucosal immune barrier function, establishing a stable internal environment for the mouth to resist pathogens and inflammation. Conversely, malnutrition simultaneously compromises oral functional reserve across multiple dimensions, including reduced saliva, mucosal atrophy, and lowered immunity. In summary, nutritional status, acting as a "physiological shield" independent of psychosocial and other biomedical pathways, has a protective effect with a solid biological foundation: from proteins supplying the basic structure for muscles and connective tissues, to vitamins precisely regulating inflammation, oxidative stress, and bone metabolism, and further to systemic nutrition shaping an overall internal environment conducive to oral health. The "rehabilitation-nutrition-oral management" ternary strategy proposed by Yoshimura et al. [52]confirms that multidisciplinary interventions integrating nutritional support, rehabilitation training, and oral care are superior to single interventions in improving muscle mass, swallowing function, activities of daily living, and nutritional status. This suggests that clinical interventions for oral frailty must place nutritional assessment and support at the core, promote community-based intervention models that integrate nutritional screening and support, oral function training, and social support networks, and drive a fundamental shift in elderly health management from "disease-centered treatment" to "health promotion and function-centered maintenance". 5.Conclusion This study, grounded in the context of the increasingly severe public health issue of aging and oral health globally, is based on the biopsychosocial theoretical framework. It is the first study to systematically construct and empirically test an integrated mediation model of "Social Support-Nutritional Status-Oral Frailty" within a community-dwelling Chinese older adult population. The significance of this exploration lies in its approach: it no longer views oral frailty merely as a natural consequence of tooth loss or functional decline, but rather understands it within a dynamic system composed of psychosocial resources, behavioral and physiological states, and biological foundations. The research results showed that age, number of natural teeth, chronic diseases, subjective chewing difficulty, social support, and nutritional status were all independently significant predictors of oral frailty, with the six variables jointly explaining 38.1% of the variance in the oral frailty score. The value of this finding lies not only in confirming which factors are important, but also in revealing the structural relationships among them-notably, nutritional status had the most prominent direct effect on oral frailty( β = -0.419), establishing it as the core "physiological hub" connecting social support and oral health. This study demonstrates significant innovative value at the theoretical, methodological, and practical levels. Theoretically, it breaks through the limitation of previous oral health research that focused solely on biological factors, integrating demographic characteristics (age), oral structural foundation (number of natural teeth), disease burden (chronic diseases), functional perception (subjective chewing difficulty), psychosocial resources (social support), and behavioral/physiological status (nutritional status) into a unified analytical framework, systematically clarifying the hierarchical roles of each factor. The research empirically reveals a clear mechanistic pathway—social support not only directly maintains oral health (the psychosocial pathway) but also exerts an indirect protective effect by improving nutritional status (the behavioral-physiological pathway). This marks an important evolution in the research paradigm of this field from single attribution towards systematic and mechanistic explanations. Methodologically, this study employed structural equation modeling for quantitative testing, which not only confirmed the good fit of the model but also precisely calculated the significant partial mediating effect of nutritional status. Furthermore, the direct effect of nutritional status on oral frailty ( β = -0.419) had the largest effect size among all predictors, highlighting its core position as a "physiological shield." This provides measurable and verifiable mechanistic evidence for how social determinants influence health outcomes through behavioral-physiological pathways, enhancing the scientific rigor and explanatory power of the research. At the practical level, the research findings have clear translational significance for guiding interventions: uncontrollable factors such as age and chronic diseases suggest the need for focused monitoring of the oldest-old and those with multimorbidity; the number of natural teeth and subjective chewing difficulty, as perceptible indicators of oral function, should be incorporated into routine community screening; and social support and nutritional status, as core modifiable targets, constitute the focal points for intervention strategies. This study powerfully demonstrates that addressing oral frailty in older adults necessitates a multidimensional, cross-system synergistic strategy—simultaneously advancing the construction of social support networks, the management of nutritional risk screening, and the early maintenance of oral function. This provides crucial scientific evidence and actionable pathways for transitioning from a passive, disease-centered treatment model to a comprehensive intervention model centered on active health promotion, integrating the "social-nutritional-oral" triad. 6.Limitations Although this study has yielded meaningful findings in exploring mechanisms, several limitations exist, which point the way for future research: First, the cross-sectional design limits causal inference. Although this study proposed the pathway hypothesis of "social support→nutritional status→oral frailty" based on the biopsychosocial theory and validated the structural relationships among variables through structural equation modeling, cross-sectional data cannot establish causality temporally. Reverse pathways (e.g., oral frailty leading to reduced social interaction and decreased perception of social support) or bidirectional effects are equally logical possibilities. Future research needs to conduct causal validation of the mediating pathway revealed in this study through prospective cohort studies or interventional trials. Second, the limitation of the sample source affects the generalizability of the results. The study sample was derived from older adults in a single urban community in Eastern China. Although efforts were made to ensure representativeness during the sampling process, caution is still needed when generalizing the findings to older adult populations in rural areas, different cultural backgrounds, or those with significantly different socioeconomic statuses. Large-sample, cross-regional, multi-center studies will be helpful in testing the stability and generalizability of this model. Third, there may be bias in the measurement methods of core variables. Key variables such as social support and subjective chewing difficulty relied on self-reports from the study participants, which could be influenced by factors like recall bias and social desirability. Future research should consider incorporating objective assessment tools, such as using social network mapping to measure actual social connections and employing standardized chewing function testing equipment to assess masticatory efficiency, in order to enhance the precision and reliability of measurements. Fourth, the completeness of the mediation model needs further expansion. This study focused on the mediating role of nutritional status between social support and oral frailty, but did not include other psychological or behavioral variables that might also play a role, such as depressive symptoms, health literacy, oral health self-efficacy, and specific oral hygiene behaviors. These factors may interact with social support and nutritional status to jointly influence the occurrence and development of oral frailty. Future research could build upon this model by incorporating more potential variables to construct a more comprehensive explanatory framework. Fifth, there is room to expand the dimensions of oral frailty assessment. The Chinese version of the OFI-8 scale used in this study demonstrated good reliability and validity among the community-dwelling older adult population. However, as a screening tool, it does not cover all potential dimensions of oral frailty, such as objectively measured salivary flow rate, oral microbiome composition, and oral-related fine motor skills. Adopting a multi-modal, interdisciplinary assessment system in the future will contribute to a more comprehensive and accurate delineation of the nature of this complex syndrome of oral frailty. Overall, the limitations mentioned above do not diminish the main findings of this study, but rather provide clear directions for improvement in subsequent research. The mediation model constructed in this study needs to be further tested using more rigorous research designs, more diverse study populations, more precise measurement tools, and a more comprehensive system of variables. Abbreviations OFI-8 Oral frailty index‐8 MNA-SF Mini Nutritional Assessment Short Form SSRS Social Support Rating Scale SEM Structural Equation Modeling Declarations Author Contributions: Q.W. conceptualized and designed the study, coordinated data collection, performed statistical analyses, drafted the initial manuscript, and revised all subsequent versions.X.E.L. and C.L.W. were verified the accuracy of all data, figures and their presentation, and participated actively in the revision of the manuscript.Q.Q.P. and Y.M.C. assisted with community liaison and coordination, participated in data collection, and offered critical comments during the manuscript review process.All authors read and approved the final version of the manuscript for submission. Funding : This work was supported by the Geriatric Health Research Project of Jiangsu Provincial Health Commission (Grant No. LKZ2025008); and the Wuxi Research Center on Aging (Grant No. WXLN25-A-22). Institutional Review Board Statement : The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Wuxi Stomatological Hospital (Approval No.: 2025120801; date of approval: 8 December 2025). Informed Consent Statement : Informed written consent was obtained from all participants involved in the study. Data Availability Statement : The dataset(s) supporting the conclusions of this article is(are) not publicly available due to participant privacy protection but may be available from the corresponding author upon reasonable request and with institutional approval. Acknowledgments : The authors would like to thank the staff of the five communities in Wuxi City for their assistance with participant recruitment and survey implementation, and all the older adults who volunteered to participate in this study. Conflicts of Interest: The authors declare no conflict of interest. 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According to the United Nations’World Population Prospects 2022 report, the proportion of people aged 65 years and above is projected to reach 16% by 2050, meaning one in six individuals worldwide will be an older adult[1].This demographic shift poses profound challenges to public health systems and socioeconomic sustainable development, making the promotion of healthy aging a global priority[2]. Healthy aging not only focuses on extending lifespan but also emphasizes maintaining physiological function, self-care ability, and social participation to enhance the overall quality of life in older adults. The World Health Organization’s Decade of Healthy Aging 2021-2030 underscores oral health as a cornerstone of healthy aging, as it is critical for nutritional intake, speech function, social interaction, and overall physical and mental well-being[3].\u003c/p\u003e\n\u003cp\u003eAgainst this backdrop, oral health issues in older adults have become increasingly prominent, with oral frailty emerging as a key concern. Defined as a multidimensional, progressive syndrome of oral functional decline, oral frailty encompasses impaired chewing efficiency, dysphagia, xerostomia, and oral microbial imbalance[4],\u0026nbsp;Mounting evidence has linked oral frailty to adverse health outcomes including physical frailty, malnutrition, cognitive decline, and all-cause mortality in older adults[5-7].While oral frailty is highly prevalent in community-dwelling older adults and constitutes an urgent public health issue, targeted interventions remain inadequate[8, 9].Without effective prevention and control, oral frailty exacerbates functional disability and social isolation, increases demand for long-term care and medical expenditures, and imposes a heavy burden on families, healthcare systems, and society[10].Thus, exploring the mechanisms underlying oral frailty is essential for developing targeted interventions and alleviating the health burden of aging populations.\u003c/p\u003e\n\u003cp\u003eThe biopsychosocial model provides an integrated framework for understanding oral frailty, emphasizing that health outcomes are the result of the interaction among biological foundations, psychological states, and the social environment. However, existing research has predominantly focused on biomedical indicators such as the number of teeth and masticatory function, overlooking the underlying mechanisms through which psychosocial factors influence oral health via behavioral pathways. Recent studies have confirmed that social support, as a crucial external resource, is believed to potentially exert an indirect effect on oral function by influencing an individual's daily behavioral patterns, such as nutritional intake[11].The aforementioned evidence suggests the possible existence of a \"social support→ nutritional status→oral frailty\" pathway. However, whether nutritional status plays a mediating role in this relationship remains unclear within academic circles, and there is a lack of systematic empirical models to validate it.\u003c/p\u003e\n\u003cp\u003eBased on this, the present study takes the biopsychosocial model as its theoretical foundation to construct and test an integrated mediation model: with social support (a psychosocial factor) as the starting point and oral frailty (a biological functional outcome) as the endpoint, hypothesizing that nutritional status (a behavioral and physiological factor) plays a key mediating role. Through a cross-sectional survey and structural equation modeling analysis, this study not only quantifies the direct effect of social support on oral frailty (the psychosocial pathway) but also systematically validates the existence and effect size of the \"social support\u0026nbsp;→nutritional status→oral frailty\" behavioral and physiological mediation pathway. This approach aims to provide a more comprehensive explanation of the mechanisms influencing oral health in the older adults.The findings are intended to offer an empirical basis for the development of multidimensional,community-based comprehensive intervention strategies that encompass the enhancement of social support, the management of nutritional risk, and the maintenance of oral function.\u003c/p\u003e\n\u003cp\u003eTo verify the existence and effect size of the aforementioned pathways, this study proposes the following core hypotheses (Figure 1):\u003c/p\u003e\n\u003cp\u003eH1: Social support has a significant negative predictive effect on oral frailty in older adults.\u003c/p\u003e\n\u003cp\u003eH2: Nutritional status has a significant negative predictive effect on oral frailty in older adults.\u003c/p\u003e\n\u003cp\u003eH3: Nutritional status plays a mediating role in the relationship between social support and oral frailty.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study Design and Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional study was conducted from December 2025 to February 2026 in five communities of Wuxi City, Jiangsu Province, China. Convenience sampling was used to recruit community-dwelling older adults aged ≥60 years.\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) aged≥60 years; (2) continuous residence in Wuxi City for ≥6 months; (3) no severe visual, hearing, or cognitive impairment, with the ability to independently understand and complete the questionnaire; (4) provision of written informed consent and voluntary participation.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) diagnosis of severe cognitive impairment (e.g., dementia) or mental illness; (2) presence of major organ (heart, brain, kidney, etc.) dysfunction or acute illness; (3) other conditions precluding completion of the survey.\u003c/p\u003e\n\u003cp\u003eA total of 539 eligible older adults were included in the final analysis. Paper-based questionnaires were used to facilitate participation, and all investigators received standardized training on study objectives, participant eligibility, and questionnaire administration. During field investigations, investigators provided one-on-one guidance using standardized instructions, and completed questionnaires were checked on-site to supplement missing items promptly. For participants with low educational levels or poor eyesight, investigators read the questions aloud and recorded responses to ensure data completeness.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Ethical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Wuxi Stomatological Hospital (Approval No.: 2025120801). All participants were fully informed of the study’s purpose, procedures, potential risks, and benefits prior to enrollment, and written informed consent was obtained from all subjects. Participation was entirely voluntary, and participants had the right to withdraw at any time without penalty or explanation. All questionnaire data were collected anonymously, and electronic data were stored in an encrypted system with access restricted exclusively to the research team for data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Measurement Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.1 .General Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA self-designed general information questionnaire was developed based on a systematic review of relevant literature and expert consultations, tailored to the characteristics of the older adult population and study objectives. The questionnaire included 12 items covering demographic and clinical characteristics: gender, age, educational level, marital status, monthly household income, smoking history, drinking history, number of natural teeth, number of dentures, subjective chewing difficulty, parental dental status, and chronic disease status (yes/no).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.2. Social Support Rating Scale (SSRS)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SSRS, developed by Xiao[12], is a widely used 10-item scale to assess social support from three dimensions: subjective support (Items 1, 3, 4, 5; 4 items, score range: 8-32), objective support (Items 2, 6, 7; 3 items, score range: 1-22), and support utilization (Items 8-10; 3 items, score range: 3-12). Scoring rules were as follows: Items 1-4 and 8-10 were single-choice questions scored 1-4 based on support level; Item 5 included four sub-items (each scored 1-4), with the total score being the sum of the sub-items; Items 6 and 7 scored 0 for\u0026nbsp;“no source”\u0026nbsp;and 1 per identified support source. The total score (sum of all 10 items) ranges from 12 to 66, with higher scores indicating higher levels of social support. The SSRS has been validated for good reliability and validity in Chinese older adult populations[13, 14].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.3. Mini Nutritional Assessment Short Form (MNA-SF)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis scale was developed by Cohendy in 2001 as a simplified version based on the full-length MNA, specifically designed for rapid nutritional screening in older adults[15].The scale covers six core indicators: decline in food intake, weight loss, mobility, acute stress events, psychological issues, and BMI. It employs a three-level scoring system (e.g., \"yes\"/\"no\"/\"unsure\"), with individual items scored from 0-2 or 0-3 points. The total score ranges from 0 to 14, with higher scores indicating better nutritional status. A score of 7 is used as the cut-off point: scores \u0026gt; 7 indicate normal nutritional status, while scores ≤ 7 suggest malnutrition[15, 16]. This tool is simple and efficient, making it particularly suitable for assessing nutritional risk in community-dwelling older populations, including those with oral frailty[17].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3.4 .Oral Frailty Index-8 (OFI-8)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn 2021, Tanaka's team optimized the scale based on the OFI-6, resulting in an 8-item version covering five dimensions: denture use, chewing ability, swallowing function, oral health behaviors, and social participation. The scoring method is as follows: for items 1-3, a \"yes\" response scores 2 points; for items 4-5, a \"yes\" response scores 1 point; for items 6-8, a \"no\" response scores 1 point. The total score ranges from 0 to 11 points. A score of ≥ 4 indicates oral frailty, with higher scores reflecting greater risk[18].\u0026nbsp;This scale has been validated in studies across multiple countries and is suitable for community-dwelling older adult populations[19, 20]. In 2023, Chen Zongmei et al.\u0026nbsp;[21]\u0026nbsp;adapted the OFI-8 into a Chinese version. Validation results showed excellent reliability and validity for the Chinese version: the Cronbach's α coefficient was 0.949, the test-retest reliability was 0.786, and the content validity index was 0.934, all superior to the original scale. The Chinese version of the OFI-8 is simple to administer, does not rely on specialized equipment, and is suitable for large-scale screening applications among community-dwelling older adults[21].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using the Statistical Package for the Social Sciences (SPSS) 21.0 (IBM Corp., Armonk, NY, USA) and Analysis of Moment Structures (AMOS) 22.0 (IBM Corp., Armonk, NY, USA). Continuous variables were described as mean ±standard deviation (SD), and categorical variables as frequencies and percentages (n, %). Independent samples t-tests and one-way analysis of variance (ANOVA) were used to compare oral frailty scores across groups with different demographic and clinical characteristics (age was dichotomized into ≤ 70 years and \u0026gt; 70 years).\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis was performed to examine the bivariate correlations among social support, nutritional status, and oral frailty. Variables with significant differences in univariate analysis, along with total scores of social support and nutritional status, were included as independent variables in a multiple linear regression analysis (enter method), with the total oral frailty score as the dependent variable, to identify independent influencing factors of oral frailty.\u003c/p\u003e\n\u003cp\u003eStructural equation modeling (SEM) was constructed in AMOS to test the mediating effect of nutritional status on the relationship between social support and oral frailty (social support: independent variable; oral frailty: dependent variable; nutritional status: mediating variable). The maximum likelihood method was used for parameter estimation and model modification. The Bootstrap method (5000 resamples) was applied to calculate the indirect effect and its 95% confidence interval (CI) to verify the significance of the mediating effect and its proportion of the total effect. All statistical tests were two-tailed, with a significance level set at α = 0.05.\u003c/p\u003e"},{"header":"3.Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Demographic correlates of Oral Frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis revealed significant differences in oral frailty scores across groups with different age, educational level, marital status, monthly household income, smoking history, number of natural teeth, number of dentures, subjective chewing difficulty, parental dental status, and chronic disease status (all \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). No significant differences were found by gender or drinking history (all \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026gt; 0.05). Specifically, participants aged \u0026gt; 70 years, with lower educational levels, non-married status (unmarried/divorced/widowed), lower household income, smoking history, \u0026lt; 20 natural teeth, \u0026ge; 20 dentures, subjective chewing difficulty, poor parental dental status, or chronic diseases had significantly higher oral frailty scores (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: Univariate analysis of oral frailty in older adults(\u003cem\u003en=\u003c/em\u003e539).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003eOral Frailty（Mean\u0026plusmn;SD）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eStatistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e241（44.71）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.86\u0026plusmn;2.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1.502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e298（55.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.56\u0026plusmn;2.275\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026le;70\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e330（61.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.26\u0026plusmn;2.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-5.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e＞70\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e209（38.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e4.37\u0026plusmn;2.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Junior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e345（64.01）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.97\u0026plusmn;2.373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e3.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;High school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e194（35.99）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.20\u0026plusmn;2.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e460（85.34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.59\u0026plusmn;2.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-2.548\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Unmarried, divorced or widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e79（14.66）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e4.30\u0026plusmn;2.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eMonthly household income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026le;5000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e316（58.63）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.98\u0026plusmn;2.428\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e3.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;＞5000 CNY\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e223（41.37）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.28\u0026plusmn;2.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSmoking history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e164（30.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e4.15\u0026plusmn;2.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e2.899\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e375（69.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.49\u0026plusmn;2.195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eDrinking history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e183（33.95）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.85\u0026plusmn;2.526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e356（66.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.61\u0026plusmn;2.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNumber of natural teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; ＜20 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e170（31.54）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e5.19\u0026plusmn;2.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e11.338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026ge;20 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e369（68.46）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.00\u0026plusmn;2.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eNumber of dentures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;＜20 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e470（87.20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.44\u0026plusmn;2.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-6.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026ge;20 teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e69（12.80）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e5.38\u0026plusmn;1.887\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eSubjective chewing difficulty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e141（26.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e5.50\u0026plusmn;2.150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e12.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e398（73.84）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.05\u0026plusmn;2.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eParental dental status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e231（42.86）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e3.25\u0026plusmn;2.204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-3.906\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Poor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e308（57.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e4.03\u0026plusmn;2.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003ePresence of chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e188（34.88）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e2.90\u0026plusmn;2.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e-5.988\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e351（65.12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e4.12\u0026plusmn;2.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Descriptive statistics and correlation analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of oral frailty among the participants was 48.05%, with a mean oral frailty score of 3.69\u0026plusmn;2.32. The mean social support score was 32.52\u0026plusmn;6.244, and the mean nutritional status score was 12.48\u0026plusmn;1.554.\u003c/p\u003e\n\u003cp\u003ePearson correlation analysis showed that social support was significantly negatively correlated with oral frailty (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= -0.224, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01), and nutritional status was significantly negatively correlated with oral frailty (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= -0.282, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01). Additionally, social support was significantly positively correlated with nutritional status (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= 0.119, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2:\u0026nbsp;Descriptive statistics and correlation analysis of key variables(\u003cem\u003en=\u003c/em\u003e539).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eNutritional status\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e32.52\u0026plusmn;6.244\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eNutritional status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e12.48\u0026plusmn;1.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.119**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eOral Frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e3.69\u0026plusmn;2.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e-0.224**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e-0.282**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Multiple Linear Regression Analysis of Oral Frailty Influencing Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultiple linear regression analysis identified six independent influencing factors of oral frailty (all \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05): age (\u0026ge; 70 years), number of natural teeth, chronic disease status, subjective chewing difficulty, social support, and nutritional status. These six variables jointly explained 38.1% of the variance in oral frailty scores (R\u0026sup2; = 0.395, adjusted R\u0026sup2; = 0.381, F = 28.591, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001). Specifically, higher age, presence of chronic diseases, and subjective chewing difficulty were associated with higher oral frailty scores, while more natural teeth, higher social support, and better nutritional status were associated with lower oral frailty scores (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3: Multiple linear regression analysis of factors affecting Oral Frailty(\u003cem\u003en=\u003c/em\u003e539).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003eT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003e(Constant)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e12.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e10.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eAge\u0026ge;70years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e2.281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003emarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.245\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eMonthly household income\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eSmoking history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-1.413\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003enumber of natural teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-1.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-5.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eNumber of dentures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.942\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eChronic Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e4.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eParental Dental Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e1.090\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eSubjective Chewing Difficulty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-1.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-7.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-2.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 220px;\"\u003e\n \u003cp\u003eNutritional status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e-0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e-0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e-5.853\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: R\u0026sup2; = 0.395, adjusted R\u0026sup2; = 0.381, F = 28.591, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.001.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4. Mediation Effect of Nutritional Status (SEM Analysis)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe final SEM model exhibited good fit with the study data (CMIN/DF = 2.013, RMSEA = 0.043, RMR = 0.062, CFI = 0.912, GFI = 0.963, AGFI = 0.944, IFI = 0.915) (Table 4). SEM results confirmed the three study hypotheses:\u003c/p\u003e\n\u003cp\u003eSocial support had a significant direct negative effect on oral frailty (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.280, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05); nutritional status also had a significant direct negative effect on oral frailty (\u003cem\u003e\u0026beta;\u003c/em\u003e = -0.419, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05);Social support had a significant positive direct effect on nutritional status (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= 0.255, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), and nutritional status exerted a significant indirect negative effect on the social support-oral frailty relationship (\u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= -0.107, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). The mediating effect accounted for 27.6% of the total effect of social support on oral frailty (total effect of social support on oral frailty: \u003cem\u003e\u0026beta;\u0026nbsp;\u003c/em\u003e= -0.387) (Table 5, Figure 2).\u003c/p\u003e\n\u003cp\u003eTable 4: Overall Fit of the Structural Equation Model(\u003cem\u003en=\u003c/em\u003e539).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eFit Index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eEstimate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eThreshold\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eInterpretation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eCMIN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e140.889\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eDF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eCMIN/DF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eRMSEA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026lt;0.06\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eRMR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026lt;0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eCFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.963\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eAGFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eExcellent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eIFI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003e\u0026gt;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAcceptable\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eNote: CMIN = minimum discrepancy; DF = degrees of freedom; RMSEA = root mean square error of approximation; RMR = root mean square residual; CFI = comparative fit index;GFI = goodness-of-fit index; AGFI = adjusted goodness-of-fit index;\u0026nbsp;IFI = incremental fit index.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigure 2: Path diagram of mediation model: social support, nutritional status, oral frailty in older adults.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNote: \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05; standardized path coefficients are shown.\u003c/p\u003e\n\u003cp\u003eTable 5: Standardized direct, indirect, and total effects of social support and nutritional status on oral frailty(\u003cem\u003en=\u003c/em\u003e539).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"336\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePathway\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003eDirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003eIndirect Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 72px;\"\u003e\n \u003cp\u003eTotal Effect\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eSocial support\u0026rarr;Nutritional status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.255*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e0.255*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eSocial support\u0026rarr;Oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.280*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eNutritional status\u0026rarr;Oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.419*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.419*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eSocial support\u0026rarr;Nutritional status\u0026rarr;Oral frailty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.107*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eSocial support\u0026rarr;Oral frailty (total)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e-0.387*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003eNote: \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4.Discussion","content":"\u003cp\u003eThis study is the first to empirically validate the social support → nutritional status → oral frailty mediation pathway in a community-dwelling Chinese older adult population based on the biopsychosocial model. Transcending the limitations of traditional biomedical research that focuses solely on biological factors, this study integrated psychosocial (social support) and behavioral-physiological (nutritional status) factors into a unified analytical framework. Using SEM, we quantified the direct protective effect of social support on oral frailty and the indirect effect via nutritional status, confirming that nutritional status plays a significant partial mediating role in this relationship. These findings advance the understanding of oral frailty mechanisms from risk factor identification to mechanistic elucidation, and provide empirical evidence for developing a comprehensive social-nutritional-oral trinity strategy for geriatric oral health management. Below, we discuss the key findings and their implications.\u003c/p\u003e\n\u003ch3\u003e4.1. High Prevalence of Oral Frailty in Wuxi Community-Dwelling Older Adults\u003c/h3\u003e\n\u003cp\u003eThe prevalence of oral frailty in this study was 48.05%, which falls within the medium-to-high range of the global prevalence (42%, 95% CI: 32%-51%) reported in a recent meta-analysis[22].This rate is slightly lower than the pooled estimate for Chinese community-dwelling older adults (53%, 95% CI: 42%-65%) but significantly higher than that for Japanese older adults (22%, 95% CI: 19%-39%)[23].Compared with domestic studies, the result of this study is at a moderately high level. A survey by Jiang Wenyi et al.of 3,063 community-dwelling older adults in Anhui Province showed an oral frailty incidence of 46.82%, slightly lower than that of this study. The similarity between the two results may be related to both regions being in the eastern area, with comparable economic development levels and degrees of population aging[24].However, as a deeply aging city , Wuxi has a higher proportion of older adults[25, 26], which may contribute to its slightly higher prevalence rate.A survey by Lu of 361 community-dwelling older adults in Shijiazhuang City showed an oral frailty prevalence rate of 33.4%. Both Shijiazhuang and Wuxi are urban community samples, but the significant difference in prevalence rates may suggest variations in oral health management and utilization of oral health services for the older adults between North China and East China[27].Tang Ji reported an oral frailty prevalence rate of 44.7% among rural older adults in Guizhou, which is lower than that in the Wuxi community (48.05%)[28].This difference may stem from a deep-seated urban-rural divide in access to oral health services. Although rural older adults experience more tooth loss, the decline in oral function often remains in an \"unidentified\" state due to inconvenient access to medical care. In contrast, while urban older adults retain more teeth, their diverse dietary structure imposes higher demands on masticatory function, making a comparable degree of functional decline more likely to be detected.\u003c/p\u003e\n\u003cp\u003eIn summary, there are significant regional differences in the prevalence of oral frailty among community-dwelling older adults in China. The detection rate of 48.05% in this study is at a relatively high level, indicating that the oral health problems of community-dwelling older adults in Wuxi are quite prominent and require attention.\u003c/p\u003e\n\u003cp\u003eThis means that nearly half of the community-dwelling older adults are already in a state of critical or evident impairment in oral function. This figure is not only much higher than previous reports from some regions but also constitutes a public health warning that cannot be ignored-given that oral frailty has been confirmed as an independent risk factor for physical frailty, falls, cognitive decline, and all-cause mortality. The current passive service model centered on clinical restorative treatment is clearly insufficient to curb the trend of declining oral function at the population level. Therefore, it is urgent to incorporate oral frailty screening into the national essential public health services program for older adult health management and to build a comprehensive prevention system covering the entire chain of \"functional assessment-nutritional intervention-social support-oral maintenance\" based on community platforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Multiple Independent Influencing Factors of Oral Frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study identified six independent influencing factors of oral frailty: age, number of natural teeth, chronic diseases, subjective chewing difficulty, social support, and nutritional status, collectively explaining 38.1% of the variance in oral frailty scores. These factors reflect the multifactorial nature of oral frailty, consistent with the biopsychosocial model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.1. Advancing age can significantly increase the level of oral frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge is one of the most significant biological predictors of oral frailty. This study showed that the oral frailty score of older adults aged \u0026gt;70 years was significantly increased, a finding highly consistent with the conclusions of recent systematic reviews: Meta-analyses have confirmed that age is an independent risk factor for oral frailty, with the risk of disease significantly increased in the elderly population due to the cumulative decline in oral functional reserve[29].The mechanism can be explained from two levels. Firstly, aging is accompanied by a series of degenerative changes in oral tissues, including decreased saliva secretion, atrophy of the oral mucosa, reduced periodontal support, and diminished neuromuscular coordination. These changes collectively lead to decreased masticatory efficiency and swallowing function[30].Secondly, the systemic low-grade inflammatory state-namely, \"inflammaging\"-plays a key role: the accumulation of senescent cells leads to increased release of pro-inflammatory cytokines (such as IL-6, TNF-α). These inflammatory mediators not only exacerbate periodontal tissue destruction and alveolar bone resorption but also cause dysregulation of local immunity and repair capacity by affecting neutrophil function[31]. Therefore, age is not only a marker of physiological aging but also a key indicator of the decline in oral functional reserve.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.2. Tooth Loss: The Initiating Factor in Oral Function Decline\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe number of natural teeth is the foundation for maintaining oral function. This study shows that the oral frailty score of older adults with fewer than 20 remaining natural teeth is significantly increased. This finding is consistent with the results of a large-scale meta-analysis covering 441,508 participants, which found that having fewer than 20 teeth is significantly associated with all-cause mortality in older adults (OR = 2.04)[7].The JAGES study based on 21,542 older adults in Japan further revealed that retaining≥20 teeth can significantly reduce the risk of oral frailty and can eliminate nearly 30% of the impact of socioeconomic inequalities on oral health[32].Tooth loss not only directly leads to reduced chewing area and decreased bite force (decreases by 75–85% in edentulous patients)[33], but may also trigger a series of compensatory changes, such as overloading of the remaining teeth[34].More importantly, tooth loss can affect the choice of food texture, prompting older adults to avoid meats, vegetables, and fruits that are difficult to chew, consequently leading to insufficient intake of key nutrients like protein, dietary fiber, and vitamin C, which may result in an imbalanced nutritional structure[35].Over the long term, this can further lead to disuse atrophy of the oral muscles, changes in saliva composition, and may affect the gut microbiota and systemic metabolism, forming a vicious cycle of \"tooth loss—malnutrition—deterioration of general health\"\u0026nbsp;[36, 37].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.3. Self-perceived chewing difficulty is an important warning sign of oral frailt\u003c/strong\u003ey\u003c/p\u003e\n\u003cp\u003eSelf-perceived chewing difficulty is an important subjective indicator of oral frailty and an early signal of functional decline. This study shows that older adults with self-perceived chewing difficulties have significantly higher oral frailty scores. Research by Japanese scholars further reveals that decreased chewing function is significantly associated with reduced bite force and diminished tongue-lip motor function, representing a key link in the chain of oral functional decline[38].Self-perceived chewing difficulty is not only a manifestation of impaired local oral health but is also significantly associated with systemic pathological processes such as sarcopenia through mediating pathways including systemic inflammation and liver dysfunction[39], forming an interaction between oral and systemic health. Large-scale population studies have confirmed that self-reported chewing difficulty can independently predict a 35% increased risk of hospitalization for aspiration pneumonia and a 28% increased risk of all-cause mortality in older adults, with clinical significance comparable to objective functional tests[40]. Therefore, self-perceived chewing difficulty should be regarded as a critical functional warning sign, indicating the need for systematic oral function assessment and early intervention. Incorporating it into routine health screening programs for older adults has important public health implications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.4. Chronic Diseases are Significant Drivers of Oral Frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study found that older adults with chronic diseases have significantly higher levels of oral frailty, which is consistent with the conclusions of a meta-analysis-a history of chronic disease is an independent risk factor for oral frailty (OR = 1.96)[22].In terms of directionality, systemic diseases can impair oral health through pathways such as microcirculatory disorders, immune dysregulation, and metabolic disturbances[41];Conversely, oral infections, as foci of chronic inflammation, can release inflammatory mediators into the systemic circulation, exacerbating insulin resistance and the progression of atherosclerosis, thus forming a vicious cycle[41, 42].This interaction has been validated in multiple studies: patients with periodontitis have a significantly increased risk of cardiovascular events[42],periodontitis progresses more rapidly in diabetic patients, and a bidirectional relationship exists[41]; and poor oral health is significantly associated with multimorbidity. Recent research further reveals that in older patients with chronic diseases, oral frailty affects cognitive function through the chain mediating effect of nutritional status and the inflammatory marker CRP, suggesting that the inflammatory pathway is a core hub connecting oral and systemic health[43].\u0026nbsp;These findings indicate that oral health assessment must be integrated into the management of chronic diseases in older adults, and oral interventions should also be incorporated into a comprehensive medical model for managing multiple comorbidities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.5. Direct Protective Effect of Social Support on Oral Frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSEM confirmed a significant direct negative effect of social support on oral frailty (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= -0.280, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), indicating that social support exerts a protective effect through a psychosocial pathway independent of nutritional status.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis finding is highly consistent with domestic and international studies. Hua Weiyi surveyed 628 rural older adults and showed that perceived social support was significantly negatively correlated with oral frailty (\u003cem\u003er\u0026nbsp;\u003c/em\u003e= -0.084, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), and could indirectly buffer the decline in oral function by improving nutritional status[11].\u0026nbsp;Qin Meirong confirmed through structural equation modeling that social support partially mediates the relationship between oral frailty and oral health self-efficacy (mediating effect 28.97%)[44]\u0026nbsp;.Collectively, this evidence reinforces the independent protective role of social support.\u003c/p\u003e\n\u003cp\u003eAnalyzing the mechanism, the direct protective effect of social support is achieved through multidimensional pathways. The scoping review by Chan et al[45]outlined three core pathways: First, the emotional support and stress buffering pathway, which directly maintains oral tissue homeostasis by regulating neuroendocrine stress responses (e.g., reducing cortisol levels). Second, the behavioral promotion and health literacy pathway, which promotes regular oral hygiene behaviors by transmitting oral health knowledge and enhancing self-efficacy. A longitudinal study published by Zhao et al further confirmed that perceived social support is an independent factor influencing the trajectory of oral frailty in older adults after stroke; those with higher levels of support were more likely to maintain regular oral hygiene behaviors and routine dental visit habits. Third, the social capital and community support environment pathway[46].Another study by Chan et al\u0026nbsp;[47], based on 7,796 older adults from the CLHLS, showed that community-level social capital can buffer the negative impact of tooth loss on cognitive function by promoting social participation. This study explicitly pointed out that the association between oral health and general health exists not only at the biological level but is also profoundly embedded in the psychosocial dimension.\u003c/p\u003e\n\u003cp\u003eIn summary, the direct protective effect of social support on oral frailty operates through multiple levels, including neuroendocrine regulation, promotion of health behaviors, enhancement of self-efficacy, and the creation of a supportive community environment. This suggests that intervention strategies must place \"strengthening social support networks\" on equal footing with \"maintaining oral function.\" By constructing a family-community integrated support system, it is possible to achieve direct empowerment for the oral health of older adults.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.6.Nutritional Status as a Key Mediator Between Social Support and Oral Frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe core finding of this study is the confirmation of nutritional status as a significant partial mediator between social support and oral frailty (indirect effect \u003cem\u003eβ\u003c/em\u003e = -0.107, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), accounting for 27.6% of the total effect of social support on oral frailty. This validates the hypothesized social support→nutritional status→oral frailtypathway, translating the abstract link between psychosocial resources and health into a clear mechanistic chain.\u003c/p\u003e\n\u003cp\u003eFirst, social support positively predicts nutritional status (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= 0.255, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05), consistent with global evidence. The behavioral mechanisms are primarily manifested in two aspects: firstly, promoting social eating through communal meals, which improves dietary quality and diversity; and secondly, overcoming barriers to food access and preparation for older adults through instrumental support (assisting with shopping and cooking) and informational support (conveying knowledge about healthy diets), thereby preventing malnutrition[48].\u003c/p\u003e\n\u003cp\u003eSecond, nutritional status exerts the strongest direct protective effect on oral frailty (\u003cem\u003eβ\u0026nbsp;\u003c/em\u003e= -0.419, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05) among all predictors in this study, establishing it as a core\u0026nbsp;“physiological hub”\u0026nbsp;for oral health. A review by Martu I et al.systematically elaborated on the mechanisms through which nutrition impacts oral health: adequate protein intake maintains masticatory muscle mass and periodontal tissue integrity, preventing sarcopenia; vitamin D and calcium work synergistically to maintain alveolar bone density and slow periodontitis-induced bone resorption; antioxidant vitamins (such as C and E) protect periodontal tissues from inflammatory damage by reducing oxidative stress; and good overall nutritional status supports normal salivary secretion and mucosal immune function, establishing a stable internal environment for the mouth to resist pathogens and inflammation[49].\u003c/p\u003e\n\u003cp\u003eThis mediating pathway highlights a critical gap in current oral health interventions: oral hygiene education alone is insufficient if it neglects nutritional deterioration caused by social isolation or mobility barriers. Future interventions must integrate social support, nutritional intervention, and oral function maintenance to address the multifactorial nature of oral frailty.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.7.\u003c/strong\u003e\u003cstrong\u003eNutritional status is the direct proximal factor with the greatest\u003c/strong\u003e\u003cstrong\u003econtributing degree in the multifactorial model of oral frailty\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOne of the most critical findings of this study is the quantification, through structural equation modeling, of the direct and powerful negative predictive effect of nutritional status on oral frailty. In the final well-fitting model, the standardized direct path coefficient from nutritional status to oral frailty was as high as -0.419, significantly higher than that of other predictors such as social support, ranking it as the most core direct proximal factor with the largest effect size influencing oral frailty. This strong association can be explained through multi-level biological mechanisms and is supported by cutting-edge international research.\u003c/p\u003e\n\u003cp\u003eAt the macronutrient level, protein, serving as the \"building material\" for maintaining oral structure and function, is crucial for sustaining masticatory muscle mass, combating sarcopenia, and ensuring the repair capacity of periodontal tissues. The scoping review by Moynihan et al systematically elaborated on this mechanism, pointing out that adequate dietary protein intake plays an important role in maintaining masticatory muscle function and preventing sarcopenia in older adults[50].\u003c/p\u003e\n\u003cp\u003eAt the micronutrient level, vitamins act as \"precision regulators\" controlling homeostasis and defense through multiple roles. Wang et al[51], through pharmacological analysis, systematically revealed the multiple molecular mechanisms by which vitamins affect periodontal health: vitamins C and E exert antioxidant and anti-inflammatory effects by scavenging reactive oxygen species and inhibiting the release of inflammatory factors; vitamin D modulates immune cell function and reduces the production of pro-inflammatory mediators; vitamins D, K, and A ameliorate alveolar bone resorption by promoting osteoblast differentiation and inhibiting osteoclast activity. The review by Curca further systematically elaborated on the mechanisms of nutrition's impact on oral health: high-sugar and ultra-processed diets can trigger inflammatory responses and oral microbiota dysbiosis, increasing susceptibility to dental caries and periodontitis; whereas nutrient-rich, anti-inflammatory diets can improve immune regulation, maintain microbial balance, and are associated with better periodontal status[49].\u003c/p\u003e\n\u003cp\u003eAt the level of systemic nutritional status, good overall nutritional status shapes an \"internal environment\" conducive to the maintenance of oral health. Curca[49]points out that nutritional status has a decisive impact on oral and periodontal health by influencing inflammatory responses, oxidative stress, saliva composition, and the oral microbiome. Good overall nutrition supports normal salivary secretion and mucosal immune barrier function, establishing a stable internal environment for the mouth to resist pathogens and inflammation. Conversely, malnutrition simultaneously compromises oral functional reserve across multiple dimensions, including reduced saliva, mucosal atrophy, and lowered immunity.\u003c/p\u003e\n\u003cp\u003eIn summary, nutritional status, acting as a \"physiological shield\" independent of psychosocial and other biomedical pathways, has a protective effect with a solid biological foundation: from proteins supplying the basic structure for muscles and connective tissues, to vitamins precisely regulating inflammation, oxidative stress, and bone metabolism, and further to systemic nutrition shaping an overall internal environment conducive to oral health. The \"rehabilitation-nutrition-oral management\" ternary strategy proposed by Yoshimura et al. [52]confirms that multidisciplinary interventions integrating nutritional support, rehabilitation training, and oral care are superior to single interventions in improving muscle mass, swallowing function, activities of daily living, and nutritional status. This suggests that clinical interventions for oral frailty must place nutritional assessment and support at the core, promote community-based intervention models that integrate nutritional screening and support, oral function training, and social support networks, and drive a fundamental shift in elderly health management from \"disease-centered treatment\" to \"health promotion and function-centered maintenance\".\u003c/p\u003e"},{"header":"5.Conclusion","content":"\u003cp\u003eThis study, grounded in the context of the increasingly severe public health issue of aging and oral health globally, is based on the biopsychosocial theoretical framework. It is the first study to systematically construct and empirically test an integrated mediation model of \"Social Support-Nutritional Status-Oral Frailty\" within a community-dwelling Chinese older adult population. The significance of this exploration lies in its approach: it no longer views oral frailty merely as a natural consequence of tooth loss or functional decline, but rather understands it within a dynamic system composed of psychosocial resources, behavioral and physiological states, and biological foundations.\u003c/p\u003e\n\u003cp\u003eThe research results showed that age, number of natural teeth, chronic diseases, subjective chewing difficulty, social support, and nutritional status were all independently significant predictors of oral frailty, with the six variables jointly explaining 38.1% of the variance in the oral frailty score. The value of this finding lies not only in confirming which factors are important, but also in revealing the structural relationships among them-notably, nutritional status had the most prominent direct effect on oral frailty(\u003cem\u003eβ\u003c/em\u003e=\u0026nbsp;-0.419), establishing it as the core \"physiological hub\" connecting social support and oral health.\u003c/p\u003e\n\u003cp\u003eThis study demonstrates significant innovative value at the theoretical, methodological, and practical levels. Theoretically, it breaks through the limitation of previous oral health research that focused solely on biological factors, integrating demographic characteristics (age), oral structural foundation (number of natural teeth), disease burden (chronic diseases), functional perception (subjective chewing difficulty), psychosocial resources (social support), and behavioral/physiological status (nutritional status) into a unified analytical framework, systematically clarifying the hierarchical roles of each factor. The research empirically reveals a clear mechanistic pathway—social support not only directly maintains oral health (the psychosocial pathway) but also exerts an indirect protective effect by improving nutritional status (the behavioral-physiological pathway). This marks an important evolution in the research paradigm of this field from single attribution towards systematic and mechanistic explanations.\u003c/p\u003e\n\u003cp\u003eMethodologically, this study employed structural equation modeling for quantitative testing, which not only confirmed the good fit of the model but also precisely calculated the significant partial mediating effect of nutritional status. Furthermore, the direct effect of nutritional status on oral frailty (\u003cem\u003eβ\u003c/em\u003e= -0.419) had the largest effect size among all predictors, highlighting its core position as a \"physiological shield.\" This provides measurable and verifiable mechanistic evidence for how social determinants influence health outcomes through behavioral-physiological pathways, enhancing the scientific rigor and explanatory power of the research.\u003c/p\u003e\n\u003cp\u003eAt the practical level, the research findings have clear translational significance for guiding interventions: uncontrollable factors such as age and chronic diseases suggest the need for focused monitoring of the oldest-old and those with multimorbidity; the number of natural teeth and subjective chewing difficulty, as perceptible indicators of oral function, should be incorporated into routine community screening; and social support and nutritional status, as core modifiable targets, constitute the focal points for intervention strategies. This study powerfully demonstrates that addressing oral frailty in older adults necessitates a multidimensional, cross-system synergistic strategy—simultaneously advancing the construction of social support networks, the management of nutritional risk screening, and the early maintenance of oral function. This provides crucial scientific evidence and actionable pathways for transitioning from a passive, disease-centered treatment model to a comprehensive intervention model centered on active health promotion, integrating the \"social-nutritional-oral\" triad.\u003c/p\u003e\n\u003ch2\u003e6.Limitations\u003c/h2\u003e\n\u003cp\u003eAlthough this study has yielded meaningful findings in exploring mechanisms, several limitations exist, which point the way for future research:\u003c/p\u003e\n\u003cp\u003eFirst, the cross-sectional design limits causal inference. Although this study proposed the pathway hypothesis of \"social support→nutritional status→oral frailty\" based on the biopsychosocial theory and validated the structural relationships among variables through structural equation modeling, cross-sectional data cannot establish causality temporally. Reverse pathways (e.g., oral frailty leading to reduced social interaction and decreased perception of social support) or bidirectional effects are equally logical possibilities. Future research needs to conduct causal validation of the mediating pathway revealed in this study through prospective cohort studies or interventional trials.\u003c/p\u003e\n\u003cp\u003eSecond, the limitation of the sample source affects the generalizability of the results. The study sample was derived from older adults in a single urban community in Eastern China. Although efforts were made to ensure representativeness during the sampling process, caution is still needed when generalizing the findings to older adult populations in rural areas, different cultural backgrounds, or those with significantly different socioeconomic statuses. Large-sample, cross-regional, multi-center studies will be helpful in testing the stability and generalizability of this model.\u003c/p\u003e\n\u003cp\u003eThird, there may be bias in the measurement methods of core variables. Key variables such as social support and subjective chewing difficulty relied on self-reports from the study participants, which could be influenced by factors like recall bias and social desirability. Future research should consider incorporating objective assessment tools, such as using social network mapping to measure actual social connections and employing standardized chewing function testing equipment to assess masticatory efficiency, in order to enhance the precision and reliability of measurements. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFourth, the completeness of the mediation model needs further expansion. This study focused on the mediating role of nutritional status between social support and oral frailty, but did not include other psychological or behavioral variables that might also play a role, such as depressive symptoms, health literacy, oral health self-efficacy, and specific oral hygiene behaviors. These factors may interact with social support and nutritional status to jointly influence the occurrence and development of oral frailty. Future research could build upon this model by incorporating more potential variables to construct a more comprehensive explanatory framework.\u003c/p\u003e\n\u003cp\u003eFifth, there is room to expand the dimensions of oral frailty assessment. The Chinese version of the OFI-8 scale used in this study demonstrated good reliability and validity among the community-dwelling older adult population. However, as a screening tool, it does not cover all potential dimensions of oral frailty, such as objectively measured salivary flow rate, oral microbiome composition, and oral-related fine motor skills. Adopting a multi-modal, interdisciplinary assessment system in the future will contribute to a more comprehensive and accurate delineation of the nature of this complex syndrome of oral frailty.\u003c/p\u003e\n\u003cp\u003eOverall, the limitations mentioned above do not diminish the main findings of this study, but rather provide clear directions for improvement in subsequent research. The mediation model constructed in this study needs to be further tested using more rigorous research designs, more diverse study populations, more precise measurement tools, and a more comprehensive system of variables.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOFI-8 \u0026nbsp; \u0026nbsp; Oral frailty index‐8\u003c/p\u003e\n\u003cp\u003eMNA-SF \u0026nbsp;Mini Nutritional Assessment Short Form\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSSRS \u0026nbsp; \u0026nbsp; Social Support Rating Scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSEM \u0026nbsp; \u0026nbsp; Structural Equation Modeling\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQ.W. conceptualized and designed the study, coordinated data collection, performed statistical analyses, drafted the initial manuscript, and revised all subsequent versions.X.E.L. and C.L.W. were verified the accuracy of all data, figures and their presentation, and participated actively in the revision of the manuscript.Q.Q.P. and Y.M.C. assisted with community liaison and coordination, participated in data collection, and offered critical comments during the manuscript review process.All authors read and approved the final version of the manuscript for submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis work was supported by the Geriatric Health Research Project of Jiangsu Provincial Health Commission (Grant No. LKZ2025008); and the Wuxi Research Center on Aging (Grant No. WXLN25-A-22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eThe study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of Wuxi Stomatological Hospital (Approval No.: 2025120801; date of approval: 8 December 2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eInformed written consent was obtained from all participants involved in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eThe dataset(s) supporting the conclusions of this article is(are) not publicly available due to participant privacy protection but may be available from the corresponding author upon reasonable request and with institutional approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003eThe authors would like to thank the staff of the five communities in Wuxi City for their assistance with participant recruitment and survey implementation, and all the older adults who volunteered to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited Nations Department of Economic and Social Affairs. 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A Triad Strategy of Rehabilitation, Nutrition, and Oral Management for Malnutrition, Sarcopenia, and Frailty in Super-Aged Societies. Nutrition. 2025;138:112959. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.nut.2025.112959\u003c/span\u003e\u003cspan address=\"10.1016/j.nut.2025.112959\" 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":false,"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":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oral Frailty, Social Support, Nutritional Status, Older Adults, Mediation Effect, Biopsychosocial Model","lastPublishedDoi":"10.21203/rs.3.rs-9219473/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9219473/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOral frailty is highly prevalent in older adults and leads to severe adverse health outcomes, posing a major global public health challenge. Nutritional status, a key behavioral and physiological determinant of oral function, is closely associated with social support, yet its mediating role in the relationship between social support and oral frailty remains underexplored. Based on the biopsychosocial theoretical framework, this study aimed to investigate the mediating effect of nutritional status on the link between social support and oral frailty in community-dwelling older adults.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted from December 2025 to February 2026 in five communities of Wuxi City, Jiangsu Province, China. A total of 539 older adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years were recruited via convenience sampling. Study instruments included a self-designed general information questionnaire, the Social Support Rating Scale (SSRS), the Mini Nutritional Assessment Short Form (MNA-SF), and the Oral Frailty Index-8 (OFI-8). Data were analyzed using SPSS 21.0 and AMOS 22.0, with descriptive statistics, Pearson correlation analysis, multiple linear regression analysis, and structural equation modeling (SEM) applied to verify the mediating effect.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e The prevalence of oral frailty among the participants was 48.05%. Multiple linear regression identified age, number of natural teeth, chronic disease status, subjective chewing difficulty, social support, and nutritional status as independent influencing factors of oral frailty (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), collectively explaining 38.1% of the variance in oral frailty scores. SEM revealed that social support exerted a direct negative effect on oral frailty (\u003cem\u003eβ =\u003c/em\u003e -0.280, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and nutritional status also had a direct negative effect on oral frailty (\u003cem\u003eβ\u003c/em\u003e = -0.419, \u003cem\u003eP\u0026thinsp;\u0026lt;\u003c/em\u003e\u0026thinsp;0.05). Furthermore, nutritional status played a significant mediating role between social support and oral frailty, with an indirect effect of \u003cem\u003eβ\u003c/em\u003e = -0.107 (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) that accounted for 27.6% of the total effect of social support on oral frailty.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eNutritional status serves as an important mediator in the relationship between social support and oral frailty in older adults. These findings highlight the need to integrate the establishment of social support networks with nutritional risk screening and assessment in geriatric health management, and to implement comprehensive strategies combining psychosocial support and nutritional interventions to delay the progression of oral frailty in this population.\u003c/p\u003e","manuscriptTitle":"The Mechanism of Social Support on Oral Frailty in Older Adults: The Mediating Role of Nutritional Status","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 09:59:08","doi":"10.21203/rs.3.rs-9219473/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-11T11:05:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T16:56:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T23:35:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337932602457870201586469289219185096908","date":"2026-05-02T05:49:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102866985429792335675702314326811125502","date":"2026-05-01T16:55:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T10:10:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"39693842099295129230345003219492512241","date":"2026-04-30T08:50:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146057100071446829901779476616479293679","date":"2026-04-25T09:30:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T19:23:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T07:54:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T04:24:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T04:24:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-03-25T07:06:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d966fc9-460d-403d-a7e9-2a2686196bd4","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T11:05:08+00:00","index":65,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T16:56:37+00:00","index":64,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T23:35:58+00:00","index":63,"fulltext":""},{"type":"reviewerAgreed","content":"337932602457870201586469289219185096908","date":"2026-05-02T05:49:56+00:00","index":60,"fulltext":""},{"type":"reviewerAgreed","content":"102866985429792335675702314326811125502","date":"2026-05-01T16:55:18+00:00","index":59,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T10:10:04+00:00","index":58,"fulltext":""},{"type":"reviewerAgreed","content":"39693842099295129230345003219492512241","date":"2026-04-30T08:50:01+00:00","index":57,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T09:59:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 09:59:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9219473","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9219473","identity":"rs-9219473","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}