Oral Hypofunction in Long term care facilities’ older adults in Bangkok, Under- Recognized Geriatric Condition: A Cross-Sectional Study

Oral Hypofunction in Long term care facilities’ older adults in Bangkok, Under- Recognized Geriatric Condition: A Cross-Sectional Study | 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 Oral Hypofunction in Long term care facilities’ older adults in Bangkok, Under- Recognized Geriatric Condition: A Cross-Sectional Study Kritsada Intaraprajak, Pagaporn Pantuwadee Pisarnturakit, Orapin Komin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8046380/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Thailand’s aging population is rapidly increasing, yet oral hypofunction remains an under-recognized condition among older adults, particularly those in long-term care facilities. This cross-sectional study aimed to identify the prevalence of oral hypofunction (oral hygiene, oral dryness, occlusal force, tongue lip motor function, tongue pressure, masticatory function and swallowing function) and the association with sarcopenia and malnutrition in older adults in long term care facilities in Bangkok. Methods A cross-sectional study was conducted from October 2024 to June 2025 at Baan Bang Khae, a government long-term care facility in Bangkok. A total of 105 participants aged ≥ 60 years were assessed for seven oral function items: oral hygiene, oral moisture, occlusal force, tongue lip motor function, tongue pressure, masticatory function, and swallowing function. Sarcopenia was evaluated using calf circumference, handgrip strength and gait speed. Malnutrition was assessed using the Mini Nutritional Assessment–Short Form (MNA-SF). Bivariate analysis and logistic regression were used to analyze associations. Results The prevalence of oral hypofunction was 70.5%. The most common impairments were decreased tongue-lip motor function (88.6%), reduced occlusal force (69.5%), and decreased tongue pressure (60.9%). Sarcopenia and malnutrition were present in 57.1% and 41.9% of participants, respectively. Tongue pressure, tongue-lip motor function, and swallowing function were significantly associated with sarcopenia, while swallowing function was associated with malnutrition. On the other hand, sarcopenia and MNA-SF scores were significant predictors of oral hypofunction. Conclusions Oral hypofunction is highly prevalent among older adults in long-term care facilities in Bangkok and is significantly associated with sarcopenia and malnutrition. These findings highlight the need for early screening and integrative interventions targeting oral function, physical function and nutritional status to prevent progression toward dysfunction and dependent stage and enhance quality of life of older adults. Oral function Tongue pressure Oral diadochokinesis Sarcopenia Malnutrition Long term care Figures Figure 1 Figure 2 Figure 3 Introduction The global population is aging rapidly, with individuals aged ≥ 60 years comprising 21.5% of the world’s population in 2023 [ 1 ]. In Thailand, older adults account for 20.08% of the population, marking its transition into a super-aged society [ 2 ]. This demographic shift presents significant challenges for healthcare systems, particularly in managing age-related conditions such as oral hypofunction. Oral hypofunction is a clinical condition characterized by the decline of multiple oral functions, including oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. A diagnosis is made when three or more of these functions are impaired [ 3 ]. Unlike structural dental diseases, oral hypofunction reflects systemic vulnerability [ 4 , 5 ]. Emerging evidence suggests that oral hypofunction is closely linked to geriatric syndromes, particularly physical frailty, sarcopenia, and malnutrition. Impaired masticatory and swallowing functions can lead to reduced dietary intake, contributing to muscle loss and nutritional deficits [ 6 ]. Additionally, oral hypofunction has also been associated with aspiration pneumonia, a leading cause of morbidity and mortality especially in long term care older adults [ 7 ]. According to recent national surveillance data, pneumonia was the greatest cause of death in Bangkok in 2024, exceeding other noncommunicable and infectious diseases [ 8 ]. This trend underlines the increased prevalence of respiratory difficulties among older people, particularly those in long-term care facilities where aspiration risk is high. The high mortality rate associated with pneumonia emphasizes the significance of early detection and management of associated variables such as oral hypofunction, which is known to increase aspiration risk and overall vulnerability. According to the Department of Older Persons, the number of registered long-term care facilities and residents has steadily increased over the past decade, reflecting a broader societal shift toward formalized older care [ 9 ]. In Thailand, the Social Welfare Development Center for Older Persons is commonly known as Baan Bang Khae which hosts the largest population of older adults in long-term care in Bangkok under government support [ 10 ]. Older adults residing in long-term care facilities often present with greater functional impairments and higher prevalence of chronic conditions compared to community-dwelling counterparts. Notably, aspiration pneumonia is significantly more common in long-term care settings due to factors such as dysphagia, reduced mobility, and compromised oral function [ 11 ]. In Japan, oral hypofunction has been incorporated into national health insurance since 2018, underscoring its clinical importance [ 12 ]. However, in Thailand, awareness remains limited, particularly in long term care settings. Previous studies in Japan have reported prevalence rates ranging from 39.9% to 60% among community-dwelling older adults [ 4 , 6 , 12 – 14 ], while a Thai study in rural Ubon Ratchathani reported a prevalence of 34.6% [ 15 ]. Data on long term care’s older adults in Thailand are lacking. This study aimed to determine the prevalence of oral hypofunction and its association with sarcopenia and malnutrition among older adults residing in a government long-term care facility in Bangkok. Methods Study design and participants This cross-sectional study was conducted at Baan Bang Khae, a government long-term care facility in Bangkok, from October 2024 to June 2025. Participants were Thai adults aged ≥ 60 years who were able to communicate and provide informed consent. Participants were provided with a clear explanation of the study objectives and data collection procedures. They were informed that refusal to participate would not affect the standard of care received. Prior to obtaining written informed consent, the voluntary nature of participation, as well as the anonymity and confidentiality of all responses, were emphasized. Exclusion criteria included cognitive impairment (Mini-Cog score <3), dependent older adults (Barthel ADL score <5), older adults with stroke, Parkinson disease, history of glossectomy, present of head and neck cancer and alternative routes of nutrition support (e.g., tube feeding). Sample size was calculated based on a 49.07% prevalence of oral hypofunction [14], with a 95% confidence interval, yielding a minimum required sample of 100 participants. A total of 105 participants were enrolled. Data collection All assessments were conducted by one trained dentist to reduce measurement variability. Demographic and medical information including age, gender and comorbidities were collected via questionnaires and confirmed with medical history records. To minimize potential sources of bias, standardized protocols were employed for all assessments, including validated tools for oral function sarcopenia and nutritional status. Selection bias was addressed by recruiting participants from a long-term care facility with diverse functional profiles. Confounding factors were controlled through multivariable logistic regression models, adjusting for age, gender and comorbidities. Assessment of Demographic data Demographic information was collected through structured interviews using a questionnaire*. Functional status was evaluated using the Thai version of the Barthel Index of Activities of Daily Living (ADL), with scores ranging from 0 to 20; lower scores indicated greater functional impairment. Participants scoring below 5 were classified as dependent and excluded from the study [16, 17]. Cognitive status was assessed using the Thai version of the Mini-Cog, with scores below 3 indicating cognitive impairment; these individuals were also excluded to ensure reliable participation and data integrity [19]. Nutritional status was assessed using the Thai version of the Short-Form Mini Nutritional Assessment (MNA-SF). Scores were categorized as follows: 12–14 indicated normal nutrition, 8–11 indicated risk of malnutrition, and 0–7 indicated malnutrition [20, 21]. *Supplementary file Assessment of Oral Function Oral hypofunction was evaluated using seven diagnostic criteria established by the Japanese Society of Gerodontology. Individuals exhibiting impairment in three or more items were classified as having oral hypofunction. The assessment procedures for each condition are detailed below [3]. Oral hygiene Oral hygiene was assessed through visual inspection using the Tongue Coating Index (TCI). The tongue surface was divided into nine segments (three vertical and three horizontal) and each segment was scored on a 3-point scale (0–2) based on the extent of coating adherence. The overall TCI was then calculated, with scores ≥ 50% indicating poor oral hygiene [22, 23]. Oral dryness Oral moisture was assessed at the central dorsum of the tongue using an 5. Oral moisture checker (Mucus, Life Co., Ltd.). Measurements were taken three times and the median value was used for analysis. A median score below 27 was considered indicative of oral dryness [24, 25, 26]. Occlusal Force Occlusal force was estimated by counting the number of remaining natural teeth, excluding retained roots and teeth with grade III mobility. A total of fewer than 20 natural teeth was considered indicative of reduced occlusal force [3, 27]. The presence of 20 or more natural teeth has been linked to a lower risk of frailty when compared to complete edentulism. Evidence from longitudinal studies further suggests that individuals without natural teeth are more susceptible to both frailty and cognitive decline [28, 29]. Tongue-Lip Motor Function Tongue-lip motor function was assessed using oral diadochokinesis. Participants were instructed to rapidly articulate the syllables /pa/, /ta/, and /ka/ for five seconds each. The number of repetitions per syllable was recorded using an automatic counter (Kenkokun Handy, Takei Scientific Instruments Co., Ltd). A repetition rate of fewer than six syllables per second for any articulation was considered indicative of decreased tongue-lip motor function [30-32]. Tongue pressure Tongue pressure was assessed using a tongue pressure measuring device (JMS tongue pressure measuring instrument TPM-01, JMS Co., Ltd.) Three measurements were taken at the center of the tongue, and the mean value was calculated. An average tongue pressure below 30 kPa was considered indicative of decreased tongue pressure [3, 33]. Masticatory function Masticatory function was evaluated using a standardized gummy jelly test (Test Gummy Jelly for Evaluating Masticatory Performance; UHA Mikakuto Co., Ltd.). Participants were instructed to chew the jelly for 30 strokes, after which the degree of fragmentation was assessed by visual comparison with a reference chart. A performance score ranging from 0 to 9 was assigned, with scores below 2 indicating decreased masticatory function [35]. Swallowing function Swallowing function was assessed using the Repetitive Saliva Swallowing Test (RSST). While seated in a relaxed position, participants were instructed to perform voluntary swallows as rapidly as possible over a 30-second interval. Swallow frequency was determined by palpating laryngeal elevation using the examiner’s index and middle fingers [36]. When seated opposite the participant, the examiner placed the middle finger on the hyoid bone and the index finger on the thyroid cartilage; when positioned beside the participant, finger placement was reversed. An RSST score of fewer than three swallows within 30 seconds was considered indicative of deterioration swallowing function [37]. Assessment of sarcopenia Sarcopenia was diagnosed in accordance with the criteria established by the Asian Working Group for Sarcopenia 2019 (AWGS2019), which incorporate assessments of muscle mass, muscle strength, and physical performance. Participants were classified as having sarcopenia if they demonstrated low muscle mass in combination with either reduced muscle strength or impaired physical performance [38]. Muscle mass Muscle mass was assessed via calf circumference measurement. While seated with the left leg relaxed, the widest portion of the calf was measured using a flexible, non-elastic tape. To enhance precision, supplementary measurements were taken slightly above and below the primary site. If the left leg was unsuitable, the right leg was used as an alternative. Calf circumference values <34 cm for men and <33 cm for women were classified as indicative of low muscle mass [39]. Muscle Strength Muscle strength was assessed using a handgrip dynamometer (CAMRY Digital Hand Dynamometer Grip Strength Measurement Meter). Measurements were performed twice on the dominant hand, and the highest value was used for analysis. Grip strength values <28 kg for men and <18 kg for women were classified as low muscle strength [38]. Physical performance Physical performance was evaluated by measuring gait speed over a 6-meter straight path at the participant’s usual walking pace. To ensure consistent velocity, a 1-meter acceleration and deceleration zone was included before and after the measurement area. Gait speed was calculated in meters per second, with values below 1.0 m/s classified as indicative of reduced physical performance [38]. All equipments used in this study were shown in Fig.1, including a. Oral moisture checker (Mucus, Life Co., Ltd.) b. JMS tongue pressure measuring instrument (TPM-01, JMS Co., Ltd.) c. Gummy jelly test (20 × 20 × 10 mm, 5.5 g, UHA Mikakuto Co., Ltd.) d. Automatic counter (Kenkokun Handy, Takei Scientific Instruments Co., Ltd.) e. Handgrip dynamometer for measuring Grip strength (CAMRY Digital Hand Dynamometer Grip Strength Measurement Meter Auto Capturing Electronic Hand Grip Power) f. Non-elastic tape for measuring Calf circumference. Data analysis Data analysis was performed using IBM SPSS Statistics version 29.0 (IBM Corp., Chicago, IL, USA). Descriptive statistics were used to represent participant characteristics in quantitative variables, including frequency, percentage, and median values with interquartile ranges (IQR). Bivariable comparisons between groups were performed using the χ 2 -square test for categorical variables and the Mann–Whitney U test for continuous variables. A p-value < 0.05 was considered statistically significant. Prior to multivariable analysis, collinearity diagnostics were conducted on independent variables; those with a variance inflation factor (VIF) 0.1 were retained. To adjust for potential confounding factors, general health indicators (age, gender, and comorbidities) were included as covariates. Associations between oral hypofunction and sarcopenia or malnutrition were examined using binary logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) reported. Results Participant’s characteristics and prevalence estimation were summarized in Table 1. 105 older adults were included in this study. The majority of participants were aged 70–79 years (49.5%) and female (66.7%). Hypertension was the most frequently reported comorbidity (46.7%). Oral hypofunction was identified in 70.5% of participants. Among the seven diagnostic domains, the most prevalent condition was decreased tongue-lip motor function (88.6%), followed by reduced occlusal force (69.5%), decreased tongue pressure (60.9%), decreased masticatory function (48.6%), poor oral hygiene (39.0%), oral dryness (23.8%), and deterioration swallowing function (22.9%). The prevalence of sarcopenia and malnutrition were 57.1% and 41.9%, respectively. Number of participants in each item of oral hypofunction was shown in Fig.2. Impairments in concise function and continuous function were higher than oral environment items. Participant characteristics and oral function parameters were compared between individuals with and without sarcopenia, as shown in Table 2. In bivariate analysis, with sarcopenia status as the dependent variable, statistically significant differences were observed across all variables except age, gender, comorbidities, oral moisture, and oral dryness (p < 0.05). The comparison of participant characteristics and oral function parameters between the normal nutrition and malnutrition groups were shown in Table 3. Bivariate analysis, with malnutrition status as the dependent variable, revealed statistically significant differences across all variables except age, gender, diabetes mellitus, cardiovascular disease, tongue coating index, poor oral hygiene, and oral dryness (p < 0.05). The comparison of participant characteristics and oral function parameters between individuals with and without oral hypofunction were shown in Table 4. Bivariate analysis, using oral hypofunction status as the dependent variable, revealed statistically significant differences across all variables except age and comorbidities (p < 0.05). The findings from binary logistic regression analyses were summarized only significant variables in Table 5. When sarcopenia was used as the dependent variable, tongue pressure (OR = 0.045; 95% CI: 0.010–0.192), tongue-lip motor function (OR = 0.071; 95% CI: 0.005–0.951), and swallowing function (OR = 0.096; 95% CI: 0.014–0.663) were significantly associated. If these factors were increased, the probability of having sarcopenia was reduced. For malnutrition, swallowing function emerged as a significant predictor (OR = 0.240; 95% CI: 0.069–0.833), with improved swallowing function associated with lower odds of malnutrition. In the model with oral hypofunction as the dependent variable, absence of sarcopenia (OR = 0.008; 95% CI: 0.000–0.225) and higher MNA scores (OR = 0.340; 95% CI: 0.183–0.630) were significantly associated with reduced risk of oral hypofunction. These results were shown as flowchart diagram in Fig.3. Collinearity diagnostics confirmed the absence of multicollinearity, with all tolerance values exceeding 0.481 and variance inflation factors (VIFs) below 2.081. Discussion This study revealed a high prevalence of oral hypofunction (70.5%) among older adults residing in long-term care facilities in Bangkok, which is markedly higher than the 34.6% reported in community-dwelling older adults in rural Thailand [ 15 ]. Compared to previous studies in Japan, our prevalence of oral hypofunction is higher than prevalence of oral hypofunction (39.9% to 60%) among community-dwelling older adults in Japan [ 4 , 6 , 12 – 14 ]. This may be attributed to differences in study populations, with our participants residing in long-term care settings. The discrepancy may reflect differences in living environments, social support, and access to oral healthcare. Residents in long-term care settings often experience greater physical decline, reduced autonomy, and limited preventive dental services, all of which contribute to deteriorating oral function [ 3 , 4 ]. Among the number and percentage of participants in each item of oral hypofunction shown in Fig. 2 and Table 1 , within each subgroup of oral hypofunction [ 5 ], impairments in concise function (oral diadochokinesis: 88.6%; occlusal force: 69.5%) and continuous function (masticatory function: 48.6%; tongue pressure: 60.9%) were higher than oral environment items (oral hygiene: 39%; oral moisture: 23.8%). This was likely because caregivers and staff lack knowledge about concise and continuous function and focus mainly on oral environmental items. This pattern was consistent across subgroups with oral hypofunction, sarcopenia, and malnutrition indicating that motor and masticatory deficits may contribute more substantially to systemic decline than environmental oral conditions. These findings are consistent with prior studies demonstrating declines in oral motor skills and strength [ 34 , 36 ]. Notably, tongue pressure and tongue-lip motor function have been shown to correlate with systemic muscle strength, suggesting a pathophysiological mechanism between oral and skeletal muscle deterioration [ 6 , 13 ]. Both bivariate analysis and logistic regression demonstrated that components within the concise and continuous function were significantly associated with sarcopenia and malnutrition. Notably, logistic regression revealed that tongue pressure, tongue-lip motor function, and swallowing function exhibited associations with sarcopenia, while swallowing function was also significantly associated with malnutrition. Tongue-lip motor function, assessed via oral diadochokinesis (ODK), was the most frequently impaired item (88.6%). This may reflect the unique sociobehavioral context of older adults residing in long-term care facilities. Many participants had relocated from other regions and exhibited limited social engagement, preferring solitude over communal interaction. Compared to community-dwelling older adults, those in long-term care settings may have fewer opportunities for regular verbal communication, which is essential for maintaining articulatory agility. Reduced conversational frequency and social withdrawal may contribute to diminished tongue-lip motor function, highlighting the interplay between environmental, behavioral, and functional factors. Social isolation has been linked to reduced ODK scores and accelerated oral decline. Shimazaki et al. found that socially active older adults had significantly better tongue-lip motor function and lower rates of oral hypofunction [ 4 ]. Interventions such as karaoke training, oral exercises [ 44 ], and structured conversation programs have shown promise in improving ODK and promoting social engagement [ 40 , 41 ]. In our study, male participants had a higher prevalence of oral hypofunction (85.7%) compared to females (62.9%), which may reflect gender differences in social engagement. Women are more likely to participate in communal activities and maintain verbal interaction, which supports oral motor function [ 5 ]. Tongue pressure was impaired in 60.9% of participants and emerged as one of the most frequently impaired and strongly associated oral functions in relation to sarcopenia. This finding was biologically plausible given that tongue pressure reflects the strength of intrinsic and extrinsic tongue muscles which sarcopenia may directly affect perioral and tongue muscles [ 13 ]. Mihara et al. (2018) demonstrated that tongue pressure correlates with handgrip strength, suggesting a shared neuromuscular degeneration pathway [ 36 ]. Kugimiya et al. (2022) further confirmed that sarcopenia was independently associated with reduced tongue pressure [ 13 ]. Moreover, impaired tongue pressure can compromise bolus formation and propulsion during swallowing, contributing to reduced dietary intake and subsequent nutritional deficits, which further exacerbate sarcopenia [ 36 ]. Swallowing function, assessed via the Repetitive Saliva Swallowing Test (RSST), was impaired in 22.9% of participants in this study. Although this was the least affected among the seven oral hypofunction criteria, its clinical significance is substantial. Logistic regression analysis revealed that swallowing function was a significant protective factor of both sarcopenia (OR = 0.096) and malnutrition (OR = 0.240), underscoring its role in systemic decline. Swallowing is a complex neuromuscular process involving coordinated activity of the tongue, pharynx, and laryngeal structures. Sarcopenia, characterized by generalized loss of muscle, can weaken the suprahyoid and pharyngeal muscles, leading to reduced swallowing efficiency and increased risk of dysphagia. Satake et al. (2019) introduced the concept of “sarcopenic dysphagia,” describing dysphagia caused by sarcopenia-related muscle loss, which is particularly relevant in frail older adults [ 42 ]. Malnutrition further exacerbates swallowing dysfunction. Inadequate nutritional intake leads to muscle catabolism, including the muscles involved in deglutition. Iwasaki et al. (2021) found that older adults with impaired swallowing function had significantly lower MNA-SF scores and were at higher risk of malnutrition and frailty [ 6 ]. In our study, participants with low RSST scores were more likely to be malnourished, suggesting a bidirectional relationship between swallowing impairment and nutritional status. Swallowing dysfunction also increases the risk of aspiration pneumonia which is the leading cause of morbidity and mortality in long-term care residents. Maeda et al. (2015) demonstrated that impaired oral function, particularly swallowing inefficiency, is a major contributor to aspiration events [ 7 ]. Aspiration of food or saliva into the lower respiratory tract can trigger infection, leading to hospitalization and functional decline. Rehabilitation strategies may include swallowing exercises, postural adjustments, dietary modifications, and compensatory techniques. Chen. et al. (2021) reported that structured swallowing rehabilitation could reduce aspiration risk in older adults [ 43 ]. In long-term care settings, implementing routine swallowing assessments and individualized therapy plans can significantly enhance safety and quality of life. These findings suggest that declines in specific oral functions may reflect underlying systemic deterioration. Routine assessment of these criteria could support early identification of individuals at risk for sarcopenia and malnutrition. On the other hand, the present study also identified sarcopenia and nutritional status as significant predictors of oral hypofunction. Absence of sarcopenia and higher MNA-SF scores were independently associated with reduced likelihood of oral hypofunction. These findings suggest that both sarcopenia and malnutrition are not only consequences of oral hypofunction but may also serve as early indicators for screening and intervention, especially in long term care facilities. Based on these findings, incorporating sarcopenia and MNA-SF screening into routine geriatric assessments may enhance early detection of oral hypofunction. These emphasized the importance of multidimensional screening approaches that integrate physical, nutritional, and oral health indicators to identify older adults at risk of functional deterioration. In long-term care settings, where access to dental professionals may be limited, using sarcopenia and MNA-SF as alternative indicators can facilitate sensible referral for oral evaluation and intervention. Their integration into primary care and institutional health protocols can support early identification of oral hypofunction and guide multidisciplinary management strategies. To improve oral function outcomes in Thai government long-term care facilities, it is essential to raise awareness among staff and caregivers about the importance of concise and continuous oral functions. After that, interventions such as oral and tongue exercises, swallowing training, karaoke-based or social activities, physical activities, dietary counseling, and dental prosthetic treatment are being introduced. However, many older adults also lack denture due to long waiting time in public hospital and being unaffordable to private care because of higher cost. Additional support from academic or any organizations is needed to supplement national oral function schemes. Limited access to dental services, compounded by transportation challenges, places burdens on staff. It is particularly difficult for staff to take older adults to dental appointments together. Allocating a permanent dentist to long-term care facilities could help ensure consistent and accessible oral health care. Given the irreversible nature of advanced oral dysfunction, early detection and management of oral hypofunction are critical. These interventions may help reverse early-stage oral frailty and prevent progression to systemic decline. Integrating oral function assessments into routine geriatric care could reduce risks of aspiration pneumonia, improve physical and nutritional status, and enhance overall quality of life. This study is limited by its cross-sectional design and single-center setting, which may affect generalization. However, this is the first time to examine oral function among older adults in Thai government long-term care facilities. Its novelty contributes to raising awareness and promoting knowledge distribution for future studies in other long-term care facilities. Longitudinal research is needed to clarify causal relationships and further explore these associations. Conclusion This study identified a notably high prevalence of oral hypofunction among older adults residing in long-term care facilities in Bangkok, with over 70% of participants affected. Tongue pressure, tongue-lip motor function and swallowing function were significant predictors of sarcopenia, while swallowing function also predicted malnutrition. Additionally, absence of sarcopenia and higher MNA-SF scores were associated with reduced probability of oral hypofunction. These findings highlight the utility of targeted oral function assessments, physical and nutritional screening tools as key components in early detection strategies among older adults in long-term care facilities. Abbreviations ADL: Activities of Daily Living MNA-SF: Mini Nutritional Assessment–Short Form ODK: Oral Diadochokinesis RSST: Repetitive Saliva Swallowing Test TCI: Tongue Coating Index Declarations Ethics approval and consent to participate This study was approved by the Human Research Ethics Committee of the Faculty of Dentistry, Chulalongkorn University (HREC-DCU 2024-024) and conformed to the Declaration of Helsinki on human research. Written informed consent was obtained from all participants prior to enrollment. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This research project was supported by Ratchadapiseksomphot Fund Chulalongkorn University [Grant number GCUGR1125681006M]. Authors’ contributions KI and OK contributed the study design, KI collected all data from participants. KI and PP analyzed the data using statistical analysis, KI and OK drafted and edited the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors gratefully acknowledge the staff and participants of Baan Bang Kae for their invaluable contributions to this study. References United Nations Department of Economic and Social Affairs, Population Division. World Population Ageing 2023: Challenges and opportunities of population ageing in the least developed countries. New York: United Nations; 2023. Department of Older Persons. Statistics of the older persons in Thailand, 77 provinces as of December 31, 2023. 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Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21(3):300–7. Champaiboon J, Petchlorlian A, Manasvanich BA, Ubonsutvanich N, Jitpugdee W, Kittiskulnam P, et al. Calf circumference as a screening tool for low skeletal muscle mass: cut-off values in independent Thai older adults. BMC Geriatr. 2023;23(1):826. Tun TZ, Thwin KM, Takehara S, Ogawa H. Oral diadochokinesis and potential associated factors in Japanese older adult outpatients. Oral Health Prev Dent. 2024;22:601–8. Miyazaki A, Mori H. Frequent karaoke training improves frontal executive cognitive skills, tongue pressure, and respiratory function in elderly people: pilot study from a randomized controlled trial. Int J Environ Res Public Health. 2020;17(4):1459. Satake S, Shimada H, Yamada M, Kim H, Yoshida H, Gondo Y, et al. Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria. Geriatr Gerontol Int. 2019;19(7):717–22. Chen S, Kent B, Cui Y. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review. BMC Geriatr. 2021;21:429. Somsak K, Komin O, Tangwongchai S. The effects of the oral exercises on the oral function of people with dementia [master’s thesis]. Bangkok: Chulalongkorn University; 2021. Available from: https://digital.car.chula.ac.th/chulaetd/4873. Tables Table 1. Characteristics of participants and items for oral function, sarcopenia and malnutrition assessment. ( n =105) Characteristics/Items Criteria for each aspect n (%) Age (years) 60-69 70-79 80-89 90 above 8 (7.6) 52 (49.5) 39 (37.1) 6 (5.7) Gender Female Male 70 (66.7) 35 (33.3) Comorbidities Hypertension Diabetes mellites Heart disease 49 (46.7) 18 (17.1) 14 (13.3) Oral function assessment Poor oral hygiene TCI ≥ 50% 41 (39) Oral dryness < 27.0 25 (23.8) Reduced occlusal force < 20 Remaining teeth 73 (69.5) Decreased tongue-lip motor function - /pa/sounds - /ta/sounds - /ka/sounds Either /pa/ or /ta/ or ka/ < 6 /s < 6 /s < 6 /s 93 (88.6) 84 (80) 90 (85.7) 92 (87.6) Decreased Tongue pressure < 30 kPa 64 (60.9) Decreased masticatory function < 3 score of gummy jelly 51 (48.6) Deterioration of swallowing function RSST 3 criteria Female Male With sarcopenia With malnutrition 74 (70.5) 44 (62.9*) 30 (85.7*) 59 (79.7) 44 (59.5) Sarcopenia assessment Low muscle mass Calf circumference (cm) < 33 in female < 34 in male 66 (62.9) Low muscle strength Grip strength (kg/m 2 ) < 18 in female < 28 in male 68 (64.8) Low muscle performance Gait speed (m/s) < 1 m/s 58 (55.2) Sarcopenia Low muscle mass and Low muscle strength or Low muscle performance Sarcopenia with oral hypofunction 60 (57.1) 59 (98.3) Malnutrition assessment Malnutrition MNA-SF score 0 – 7 (Malnutrition) 8 – 11 (At-risk) 12 – 14 (Normal) No malnutrition (At-risk and normal) Malnutrition with oral hypofunction 44 (41.9) 25 (23.8) 36 (34.3) 61 (58.1) 44 (100) *Percentage within gender. Table 2. The bivariate analysis between normal and sarcopenia group. All ( n = 105) Normal ( n = 45) Sarcopenia ( n = 60) p -value # Variables Median (Q1,Q3) /N(%) Median (Q1, Q3) /N(%) Median (Q1, Q3) /N(%) Characteristics Age (years) 78 (75, 82.5) 78 (75, 81) 78 (74.5, 83) 0.785 Gender (male) 35 (33.3) 11 (24.4), (31.4)* 24 (40), (68.6)* 0.094 Gender (female) 70 (66.7) 34 (75.6), (48.6)* 36 (60), (51.4)* Comorbidities Hypertension 49 (46.7) 25 (55.6) 24 (40) 0.114 Diabetes mellites 18 (17.1) 7 (15.6) 11 (18.3) 0.709 Cardiovascular disease 14 (13.3) 9 (20) 5 (8.3) 0.082 Variables of oral hypofunction Tongue coating index (%) 38.9 (27.8, 61.1) 33.3 (27.8, 44.4) 47.2 (30.6, 61.1) 0.048 Poor oral hygiene 41 (39) 11 (24.4) 30 (50) 0.008 Oral moisture 28.1 (27, 29.6) 28.3 (27.1, 29.9) 27.8 (26.7, 29.2) 0.110 Oral dryness 25 (23.8) 8 (17.8) 17 (28.3) 0.209 Number of remaining teeth 10 (3, 22) 20 (10, 25) 6 (1.5, 14) < 0.001 Low occlusal force 73 (69.5) 21 (46.7) 52 (86.7) < 0.001 Oral diadochokinesis /pa/sounds (times/s) 5 (4, 5.6) 5.2 (5, 6) 4.6 (3.7, 5.4) < 0.001 /ta/sounds (times/s) 4.6 (3.8, 5.3) 5.2 (4.6, 6) 4.2 (3.8, 5) < 0.001 /ka/sounds (times/s) 4.6 (3.8, 5.2) 5 (4.4, 6) 4.2 (3.6, 4.8) < 0.001 Low tongue-lip motor function 93 (88.6) 34 (75.6) 59 (98.3) < 0.001 Tongue pressure (kPa) 27.2 (20.9, 32.8) 32.6 (28.5, 37.2) 22.4 (18.4, 27.6) < 0.001 Low tongue pressure 64 (61) 13 (28.9) 51 (85) < 0.001 Gummy jelly score 3 (0, 6) 6 (2, 8) 1 (0, 4) < 0.001 Low masticatory function 51 (48.6) 12 (26.7) 39 (65) < 0.001 RSST 3 (3, 4.5) 4 (3, 5) 3 (2, 4) 0.005 Low swallowing function 24 (22.9) 3 (6.7) 21 (35) < 0.001 Oral hypofunction score 4 (2, 5) 2 (1, 4) 5 (4, 5) < 0.001 Oral hypofunction 74 (70.5) 15 (33.3) 59 (98.3) < 0.001 Variables of sarcopenia Calf circumference (cm) 32.5 (30.5, 34) 34 (33.5, 37.5) 30.5 (30, 32) < 0.001 Low muscle mass 66 (62.9) 6 (13.3) 60 (100) < 0.001 Grip strength (kg/m 2 ) 17.3 (14.6, 22.3) 19 (15.8, 25.5) 16 (14.1, 20) 0.001 Low muscle strength 68 (64.8) 18 (40) 50 (83.3) < 0.001 Gait speed (m/s) 0.9 (0.5, 1.1) 1 (0.7, 1.2) 0.7 (0.5, 1) < 0.001 Low muscle performance 58 (55.2) 17 (37.8) 41 (68.3) 0.002 Sarcopenia 60 (57.1) 0 (0) 60 (100) < 0.001 Variables of malnutrition MNA-SF score 9 (6, 12.5) 13 (10, 14) 7 (6, 9) < 0.001 Malnutrition 44 (41.9) 4 (8.9) 40 (66.7) < 0.001 *Percentage within gender. # p -value for continuous variables using Mann–Whitney U-test and for categorical variables using χ 2 -test. Table 3. The bivariate analysis between malnutrition and no malnutrition group. All ( n = 105) No malnutrition ( n = 61) Malnutrition ( n = 44) p -value # Variables Median (Q1,Q3) /N(%) Median (Q1, Q3) /N(%) Median (Q1, Q3) /N(%) Characteristics Age (years) 78 (75, 82.5) 77 (75, 81) 80 (75.5, 83) 0.088 Gender (male) 35 (33.3) 16 (26.2), (45.7)* 19 (43.2), (54.3)* 0.069 Gender (female) 70 (66.7) 45 (73.8), (64.3)* 25 (56.8), (35.7)* Comorbidities Hypertension 49 (46.7) 34 (55.7) 15 (34.1) 0.028 Diabetes mellites 18 (17.1) 11 (18) 7 (15.9) 0.776 Cardiovascular disease 14 (13.3) 10 (16.4) 4 (9.1) 0.277 Variables of oral hypofunction Tongue coating index (%) 38.9 (27.8, 61.1) 38.9 (27.8, 55.6) 38.9 (22.2, 61.1) 0.627 Poor oral hygiene 41 (39) 23 (37.7) 18 (40.9) 0.740 Oral moisture 28.1 (27, 29.6) 28.3 (27.5, 29.8) 27.8 (25.8, 28.7) 0.033 Oral dryness 25 (23.8) 11 (18) 14 (31.8) 0.102 Number of remaining teeth 10 (3, 22) 18 (5, 24) 6 (0.5, 13.5) < 0.001 Low occlusal force 73 (69.5) 34 (55.7) 39 (88.6) < 0.001 Oral diadochokinesis /pa/sounds (times/s) 5 (4, 5.6) 5.2 (4.8, 6) 4.4 (3.7, 5.4) 0.001 /ta/sounds (times/s) 4.6 (3.8, 5.3) 5 (4.4, 5.4) 4 (3.6, 5) < 0.001 /ka/sounds (times/s) 4.6 (3.8, 5.2) 4.8 (4.2, 5.4) 4 (3.4, 4.7) 0.002 Low tongue-lip motor function 93 (88.6) 50 (82) 43 (97.7) 0.012 Tongue pressure (kPa) 27.2 (20.9, 32.8) 30.2 (23.1, 34) 22.2 (17.8, 28.9) < 0.001 Low tongue pressure 64 (61) 30 (49.2) 34 (77.3) 0.004 Gummy jelly score 3 (0, 6) 6 (1, 7) 0 (0, 4) < 0.001 Low masticatory function 51 (48.6) 21 (34.4) 30 (68.2) < 0.001 RSST 3 (3, 4.5) 4 (3, 5) 3 (2, 4) 0.002 Low swallowing function 24 (22.9) 6 (9.8) 18 (40.9) < 0.001 Oral hypofunction score 4 (2, 5) 2 (1, 4) 5 (4, 5) < 0.001 Oral hypofunction 74 (70.5) 30 (49.2) 44 (100) < 0.001 Variables of sarcopenia Calf circumference (cm) 32.5 (30.5, 34) 33.5 (32.5, 35) 30.5 (29.3, 31.8) < 0.001 Low muscle mass 66 (62.9) 25 (41) 41 (93.2) < 0.001 Grip strength (kg/m 2 ) 17.3 (14.6, 22.3) 18.9 (15.5, 23.8) 15.1 (14, 18.5) < 0.001 Low muscle strength 68 (64.8) 31 (50.8) 37 (84.1) < 0.001 Gait speed (m/s) 0.9 (0.5, 1.1) 1 (0.7, 1.2) 0.6 (0.4, 0.8) < 0.001 Low muscle performance 58 (55.2) 21 (34.4) 37 (84.1) < 0.001 Sarcopenia 60 (57.1) 20 (32.8) 40 (90.9) < 0.001 Variables of malnutrition MNA-SF score 9 (6, 12.5) 12 (10, 14) 6 (5, 7) < 0.001 Malnutrition 44 (41.9) 0 (0) 44 (100) < 0.001 *Percentage within gender. # p -value for continuous variables using Mann–Whitney U-test and for categorical variables using χ 2 -test. Table 4. The bivariate analysis between oral hypofunction and normal group. All ( n = 105) Normal ( n = 31) Oral hypofunction ( n = 74) p -value # Variables Median (Q1,Q3) /N(%) Median (Q1, Q3) /N(%) Median (Q1, Q3) /N(%) Characteristics Age (years) 78 (75, 82.5) 78 (75, 81) 78 (75, 83) 0.638 Gender (male) 35 (33.3) 5 (16.1), (14.3)* 30 (40.5), (85.7)* 0.015 Gender (female) 70 (66.7) 26 (83.9), (37.1)* 44 (59.5), (62.9)* Comorbidities Hypertension 49 (46.7) 17 (54.8) 32 (43.2) 0.277 Diabetes mellites 18 (17.1) 5 (16.1) 13 (17.6) 0.858 Cardiovascular disease 14 (13.3) 6 (19.4) 8 (10.8) 0.344 Variables of oral hypofunction Tongue coating index (%) 38.9 (27.8, 61.1) 33.3 (27.8, 38.9) 50 (27.8, 66.7) 0.002 Poor oral hygiene 41 (39) 3 (9.7) 38 (51.4) < 0.001 Oral moisture 28.1 (27, 29.6) 28.9 (27.8, 30.1) 27.8 (26.3, 29.1) 0.003 Oral dryness 25 (23.8) 2 (6.5) 23 (31.1) 0.007 Number of remaining teeth 10 (3, 22) 24 (20, 25.5) 5.5 (0, 14) < 0.001 Low occlusal force 73 (69.5) 7 (22.6) 66 (89.2) < 0.001 Oral diadochokinesis /pa/sounds (times/s) 5 (4, 5.6) 5.6 (5, 6.1) 4.8 (4, 5.4) < 0.001 /ta/sounds (times/s) 4.6 (3.8, 5.3) 5.2 (4.6, 6) 4.4 (3.8, 5) < 0.001 /ka/sounds (times/s) 4.6 (3.8, 5.2) 5 (4.5, 6) 4.4 (3.6, 4.8) < 0.001 Low tongue-lip motor function 93 (88.6) 20 (64.5) 73 (98.6) < 0.001 Tongue pressure (kPa) 27.2 (20.9, 32.8) 33.9 (31.8, 37.6) 23.1 (18.7, 28.7) < 0.001 Low tongue pressure 64 (61) 5 (16.1) 59 (79.7) < 0.001 Gummy jelly score 3 (0, 6) 7 (6, 8.5) 1 (0, 4) < 0.001 Low masticatory function 51 (48.6) 1 (3.2) 50 (67.6) < 0.001 RSST 3 (3, 4.5) 4 (3, 6) 3 (2, 4) < 0.001 Low swallowing function 24 (22.9) 1 (3.2) 23 (31.1) 0.002 Oral hypofunction score 4 (2, 5) 1 (1, 2) 4.5 (4, 5) < 0.001 Oral hypofunction 74 (70.5) 0 (0) 74 (100) < 0.001 Variables of sarcopenia Calf circumference (cm) 32.5 (30.5, 34) 34 (33, 35.3) 31.5 (30, 33) < 0.001 Low muscle mass 66 (62.9) 3 (9.7) 63 (81.5) < 0.001 Grip strength (kg/m 2 ) 17.3 (14.6, 22.3) 19 (16.4, 23.1) 16.8 (14.1, 21.2) 0.021 Low muscle strength 68 (64.8) 12 (38.7) 56 (75.7) < 0.001 Gait speed (m/s) 0.9 (0.5, 1.1) 1.1 (1, 1.2) 0.7 (0.5, 1) < 0.001 Low muscle performance 58 (55.2) 7 (22.6) 51 (68.9) < 0.001 Sarcopenia 60 (57.1) 1 (3.2) 59 (79.7) < 0.001 Variables of malnutrition MNA-SF score 9 (6, 12.5) 13 (12, 14) 7 (6, 9) < 0.001 Malnutrition 44 (41.9) 0 (0) 44 (59.5) < 0.001 *Percentage within gender. # p -value for continuous variables using Mann–Whitney U-test and for categorical variables using χ 2 -test. Table 5. The association between oral hypofunction, sarcopenia and malnutrition by logistic regression analyses. Variables Sarcopenia a OR 95% C.I. for OR p -value Lower Upper Tongue pressure 0.045 0.010 0.192 < 0.001 Tongue-lip motor function 0.071 0.005 0.951 0.046 Swallowing function 0.096 0.014 0.663 0.017 Variables Malnutrition b OR 95% C.I. for OR p -value Lower Upper Swallowing function 0.240 0.069 0.833 0.025 Variables Oral hypofunction c OR 95% C.I. for OR p -value Lower Upper No Sarcopenia 0.008 0.000 0.225 0.005 MNA-SF score 0.340 0.183 0.630 0.019 a Age, gender, comorbidities, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were included as covariates when sarcopenia was used as the dependent variable b Age, gender, comorbidities, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were included as covariates when malnutrition was used as the dependent variable. c Age, gender, comorbidities, sarcopenia and MNA-SF score were included as covariates when oral hypofunction was used as the dependent variable. Additional Declarations No competing interests reported. Supplementary Files KrtisadaPagapornOrapinSupplementaryfile.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 18 Dec, 2025 Editor invited by journal 26 Nov, 2025 Editor assigned by journal 26 Nov, 2025 Submission checks completed at journal 25 Nov, 2025 First submitted to journal 25 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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16:05:54","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11598,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/7ea6ff8d0c0e35c62fbf217f.png"},{"id":99307295,"identity":"8484b2f9-f96f-4a1e-bee3-d74f6e8b01ee","added_by":"auto","created_at":"2025-12-31 16:05:54","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":999,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/fd3b6d0f8546e77ee4e01955.png"},{"id":99307798,"identity":"5086abb0-0ec6-49c6-9bb8-fdb203884c11","added_by":"auto","created_at":"2025-12-31 16:06:46","extension":"png","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":525,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinegroupimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/98f5140a5088aa83d812d6af.png"},{"id":98820794,"identity":"80121835-0023-4e1b-8b7f-46836841d70b","added_by":"auto","created_at":"2025-12-22 17:18:30","extension":"xml","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":161590,"visible":true,"origin":"","legend":"","description":"","filename":"89e84063a1304dc1aac2af5c76c153001structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/081b3f5435f43d37988d0c8d.xml"},{"id":98820795,"identity":"89737b1b-ef6d-4c86-a77a-85ecb75a502f","added_by":"auto","created_at":"2025-12-22 17:18:30","extension":"html","order_by":23,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":177141,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/132c9317d5c7891bd67b00dd.html"},{"id":99307936,"identity":"f986f99a-4d04-4611-acda-db4de619fcef","added_by":"auto","created_at":"2025-12-31 16:07:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1195595,"visible":true,"origin":"","legend":"\u003cp\u003eEquipment for assessment of oral function and sarcopenia a. Oral moisture checker (Mucus, Life Co., Ltd.) b. JMS tongue pressure measuring instrument (TPM-01, JMS Co., Ltd.) c. Gummy jelly test (20 × 20 × 10 mm, 5.5 g, UHA Mikakuto Co., Ltd.) d. Automatic counter (Kenkokun Handy, Takei Scientific Instruments Co., Ltd.) e. Handgrip dynamometer for measuring Grip strength (CAMRY Digital Hand Dynamometer Grip Strength Measurement Meter Auto Capturing Electronic Hand Grip Power) f. Non-elastic tape for measuring Calf circumference.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/c8969005d4a7569fedd34ae7.png"},{"id":98820770,"identity":"952e9f38-d24e-4119-9cec-94211ebc5019","added_by":"auto","created_at":"2025-12-22 17:18:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":148088,"visible":true,"origin":"","legend":"\u003cp\u003eNumber of participants in each item of oral hypofunction.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/0a324e62a646603b7d2cbe5b.png"},{"id":99307448,"identity":"5d6baefe-70f3-4418-97fa-59629be6ebc5","added_by":"auto","created_at":"2025-12-31 16:06:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":76281,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart diagram of oral hypofunction and its association.\u003c/p\u003e\n\u003cp\u003e*Tongue pressure was the strongest protective factor to sarcopenia.\u003c/p\u003e\n\u003cp\u003e**Swallowing function by RSST was the strongest protective factor to malnutrition.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/23e6e719560d446679e1e8d2.png"},{"id":99322335,"identity":"5d8289bf-fa8a-4d3d-9a13-23ed7053aedb","added_by":"auto","created_at":"2025-12-31 16:43:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3157199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/2a56df25-bb26-4b87-94ed-4d4a46507316.pdf"},{"id":98820768,"identity":"9ea5199f-69af-40e0-9bec-812dc29b1979","added_by":"auto","created_at":"2025-12-22 17:18:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":69239,"visible":true,"origin":"","legend":"","description":"","filename":"KrtisadaPagapornOrapinSupplementaryfile.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8046380/v1/21a7b577c6b3eadd61741f15.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Oral Hypofunction in Long term care facilities’ older adults in Bangkok, Under- Recognized Geriatric Condition: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global population is aging rapidly, with individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years comprising 21.5% of the world\u0026rsquo;s population in 2023 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Thailand, older adults account for 20.08% of the population, marking its transition into a super-aged society [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This demographic shift presents significant challenges for healthcare systems, particularly in managing age-related conditions such as oral hypofunction.\u003c/p\u003e \u003cp\u003e Oral hypofunction is a clinical condition characterized by the decline of multiple oral functions, including oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. A diagnosis is made when three or more of these functions are impaired [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Unlike structural dental diseases, oral hypofunction reflects systemic vulnerability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Emerging evidence suggests that oral hypofunction is closely linked to geriatric syndromes, particularly physical frailty, sarcopenia, and malnutrition. Impaired masticatory and swallowing functions can lead to reduced dietary intake, contributing to muscle loss and nutritional deficits [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, oral hypofunction has also been associated with aspiration pneumonia, a leading cause of morbidity and mortality especially in long term care older adults [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to recent national surveillance data, pneumonia was the greatest cause of death in Bangkok in 2024, exceeding other noncommunicable and infectious diseases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This trend underlines the increased prevalence of respiratory difficulties among older people, particularly those in long-term care facilities where aspiration risk is high. The high mortality rate associated with pneumonia emphasizes the significance of early detection and management of associated variables such as oral hypofunction, which is known to increase aspiration risk and overall vulnerability.\u003c/p\u003e \u003cp\u003eAccording to the Department of Older Persons, the number of registered long-term care facilities and residents has steadily increased over the past decade, reflecting a broader societal shift toward formalized older care [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In Thailand, the Social Welfare Development Center for Older Persons is commonly known as Baan Bang Khae which hosts the largest population of older adults in long-term care in Bangkok under government support [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Older adults residing in long-term care facilities often present with greater functional impairments and higher prevalence of chronic conditions compared to community-dwelling counterparts. Notably, aspiration pneumonia is significantly more common in long-term care settings due to factors such as dysphagia, reduced mobility, and compromised oral function [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Japan, oral hypofunction has been incorporated into national health insurance since 2018, underscoring its clinical importance [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, in Thailand, awareness remains limited, particularly in long term care settings. Previous studies in Japan have reported prevalence rates ranging from 39.9% to 60% among community-dwelling older adults [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], while a Thai study in rural Ubon Ratchathani reported a prevalence of 34.6% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Data on long term care\u0026rsquo;s older adults in Thailand are lacking.\u003c/p\u003e \u003cp\u003e This study aimed to determine the prevalence of oral hypofunction and its association with sarcopenia and malnutrition among older adults residing in a government long-term care facility in Bangkok.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cu\u003eStudy design and participants\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted at Baan Bang Khae, a government long-term care facility in Bangkok, from October 2024 to June 2025. Participants were Thai adults aged \u0026ge; 60 years who were able to communicate and provide informed consent. Participants were provided with a clear explanation of the study objectives and data collection procedures. They were informed that refusal to participate would not affect the standard of care received. Prior to obtaining written informed consent, the voluntary nature of participation, as well as the anonymity and confidentiality of all responses, were emphasized. Exclusion criteria included cognitive impairment (Mini-Cog score \u0026lt;3), dependent older adults (Barthel ADL score \u0026lt;5), older adults with stroke, Parkinson disease, history of glossectomy, present of head and neck cancer and alternative routes of nutrition support (e.g., tube feeding).\u003c/p\u003e\n\u003cp\u003eSample size was calculated based on a 49.07% prevalence of oral hypofunction [14], with a 95% confidence interval, yielding a minimum required sample of 100 participants. A total of 105 participants were enrolled.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData collection\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll assessments were conducted by one trained dentist to reduce measurement variability. Demographic and medical information including age, gender and comorbidities were collected via questionnaires and confirmed with medical history records. To minimize potential sources of bias, standardized protocols were employed for all assessments, including validated tools for oral function sarcopenia and nutritional status. Selection bias was addressed by recruiting participants from a long-term care facility with diverse functional profiles. Confounding factors were controlled through multivariable logistic regression models, adjusting for age, gender and comorbidities.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssessment of Demographic data\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eDemographic information was collected through structured interviews using a questionnaire*. Functional status was evaluated using the Thai version of the Barthel Index of Activities of Daily Living (ADL), with scores ranging from 0 to 20; lower scores indicated greater functional impairment. Participants scoring below 5 were classified as dependent and excluded from the study\u0026nbsp;[16, 17]. Cognitive status was assessed using the Thai version of the Mini-Cog, with scores below 3 indicating cognitive impairment; these individuals were also excluded to ensure reliable participation and data integrity [19].\u003c/p\u003e\n\u003cp\u003eNutritional status was assessed using the Thai version of the Short-Form Mini Nutritional Assessment (MNA-SF). Scores were categorized as follows: 12\u0026ndash;14 indicated normal nutrition, 8\u0026ndash;11 indicated risk of malnutrition, and 0\u0026ndash;7 indicated malnutrition [20, 21].\u003c/p\u003e\n\u003cp\u003e*Supplementary file\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssessment of Oral Function\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOral hypofunction was evaluated using seven diagnostic criteria established by the Japanese Society of Gerodontology. Individuals exhibiting impairment in three or more items were classified as having oral hypofunction. The assessment procedures for each condition are detailed below [3].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOral hygiene\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOral hygiene was assessed through visual inspection using the Tongue Coating Index (TCI). The tongue surface was divided into nine segments (three vertical and three horizontal) and each segment was scored on a 3-point scale (0\u0026ndash;2) based on the extent of coating adherence. The overall TCI was then calculated, with scores \u0026ge; 50% indicating poor oral hygiene [22, 23].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOral dryness\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOral moisture was assessed at the central dorsum of the tongue using an 5.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Oral moisture checker (Mucus, Life Co., Ltd.). Measurements were taken three times and the median value was used for analysis. A median score below 27 was considered indicative of oral dryness [24, 25, 26].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eOcclusal Force\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOcclusal force was estimated by counting the number of remaining natural teeth, excluding retained roots and teeth with grade III mobility. A total of fewer than 20 natural teeth was considered indicative of reduced occlusal force [3, 27]. The presence of 20 or more natural teeth has been linked to a lower risk of frailty when compared to complete edentulism. Evidence from longitudinal studies further suggests that individuals without natural teeth are more susceptible to both frailty and cognitive decline [28, 29].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTongue-Lip Motor Function\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTongue-lip motor function was assessed using oral diadochokinesis. Participants were instructed to rapidly articulate the syllables /pa/, /ta/, and /ka/ for five seconds each. The number of repetitions per syllable was recorded using an automatic counter (Kenkokun Handy, Takei Scientific Instruments Co., Ltd). A repetition rate of fewer than six syllables per second for any articulation was considered indicative of decreased tongue-lip motor function [30-32].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTongue pressure\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTongue pressure was assessed using a tongue pressure measuring device (JMS tongue pressure measuring instrument TPM-01, JMS Co., Ltd.) Three measurements were taken at the center of the tongue, and the mean value was calculated. An average tongue pressure below 30 kPa was considered indicative of decreased tongue pressure [3, 33].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMasticatory function\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMasticatory function was evaluated using a standardized gummy jelly test (Test Gummy Jelly for Evaluating Masticatory Performance; UHA Mikakuto Co., Ltd.). Participants were instructed to chew the jelly for 30 strokes, after which the degree of fragmentation was assessed by visual comparison with a reference chart. A performance score ranging from 0 to 9 was assigned, with scores below 2 indicating decreased masticatory function [35].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eSwallowing function\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSwallowing function was assessed using the Repetitive Saliva Swallowing Test (RSST). While seated in a relaxed position, participants were instructed to perform voluntary swallows as rapidly as possible over a 30-second interval. Swallow frequency was determined by palpating laryngeal elevation using the examiner\u0026rsquo;s index and middle fingers [36]. When seated opposite the participant, the examiner placed the middle finger on the hyoid bone and the index finger on the thyroid cartilage; when positioned beside the participant, finger placement was reversed. An RSST score of fewer than three swallows within 30 seconds was considered indicative of deterioration swallowing function [37].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAssessment of sarcopenia\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSarcopenia was diagnosed in accordance with the criteria established by the Asian Working Group for Sarcopenia 2019 (AWGS2019), which incorporate assessments of muscle mass, muscle strength, and physical performance. Participants were classified as having sarcopenia if they demonstrated low muscle mass in combination with either reduced muscle strength or impaired physical performance [38].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMuscle mass\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMuscle mass was assessed via calf circumference measurement. While seated with the left leg relaxed, the widest portion of the calf was measured using a flexible, non-elastic tape. To enhance precision, supplementary measurements were taken slightly above and below the primary site. If the left leg was unsuitable, the right leg was used as an alternative. Calf circumference values \u0026lt;34 cm for men and \u0026lt;33 cm for women were classified as indicative of low muscle mass [39].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eMuscle Strength\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eMuscle strength was assessed using a handgrip dynamometer (CAMRY Digital Hand Dynamometer Grip Strength Measurement Meter). Measurements were performed twice on the dominant hand, and the highest value was used for analysis. Grip strength values \u0026lt;28 kg for men and \u0026lt;18 kg for women were classified as low muscle strength [38].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003ePhysical performance\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003ePhysical performance was evaluated by measuring gait speed over a 6-meter straight path at the participant\u0026rsquo;s usual walking pace. To ensure consistent velocity, a 1-meter acceleration and deceleration zone was included before and after the measurement area. Gait speed was calculated in meters per second, with values below 1.0 m/s classified as indicative of reduced physical performance [38].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll equipments used in this study were shown in Fig.1, including a. Oral moisture checker (Mucus, Life Co., Ltd.) b.\u0026nbsp;JMS tongue pressure measuring instrument (TPM-01, JMS Co., Ltd.) c.\u0026nbsp;Gummy jelly test (20 \u0026times; 20 \u0026times; 10 mm, 5.5 g, UHA Mikakuto Co., Ltd.) d. Automatic counter (Kenkokun Handy, Takei Scientific Instruments Co., Ltd.) e. Handgrip dynamometer for measuring Grip strength (CAMRY Digital Hand Dynamometer Grip Strength Measurement Meter Auto Capturing Electronic Hand Grip Power) f. Non-elastic tape for measuring Calf circumference.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eData analysis\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was performed using IBM SPSS Statistics version 29.0 (IBM Corp., Chicago, IL, USA). Descriptive statistics were used to represent participant characteristics in quantitative variables, including frequency, percentage, and median values with interquartile ranges (IQR). Bivariable comparisons between groups were performed using the \u0026chi;\u003csup\u003e2\u003c/sup\u003e-square test for categorical variables and the Mann\u0026ndash;Whitney U test for continuous variables. A p-value \u0026lt; 0.05 was considered statistically significant. Prior to multivariable analysis, collinearity diagnostics were conducted on independent variables; those with a variance inflation factor (VIF) \u0026lt; 10 and tolerance \u0026gt; 0.1 were retained. To adjust for potential confounding factors, general health indicators (age, gender, and comorbidities) were included as covariates. Associations between oral hypofunction and sarcopenia or malnutrition were examined using binary logistic regression, with odds ratios (ORs) and 95% confidence intervals (CIs) reported.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipant\u0026rsquo;s characteristics and prevalence estimation were summarized in Table 1. 105 older adults were included in this study. The majority of participants were aged 70\u0026ndash;79 years (49.5%) and female (66.7%). Hypertension was the most frequently reported comorbidity (46.7%). Oral hypofunction was identified in 70.5% of participants. Among the seven diagnostic domains, the most prevalent condition was decreased tongue-lip motor function (88.6%), followed by reduced occlusal force (69.5%), decreased tongue pressure (60.9%), decreased masticatory function (48.6%), poor oral hygiene (39.0%), oral dryness (23.8%), and deterioration swallowing function (22.9%). The prevalence of sarcopenia and malnutrition were 57.1% and 41.9%, respectively. Number of participants in each item of oral hypofunction was shown in Fig.2. Impairments in concise function and continuous function were higher than oral environment items.\u003c/p\u003e\n\u003cp\u003eParticipant characteristics and oral function parameters were compared between individuals with and without sarcopenia, as shown in Table 2. In bivariate analysis, with sarcopenia status as the dependent variable, statistically significant differences were observed across all variables except age, gender, comorbidities, oral moisture, and oral dryness (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe comparison of participant characteristics and oral function parameters between the normal nutrition and malnutrition groups were shown in Table 3. Bivariate analysis, with malnutrition status as the dependent variable, revealed statistically significant differences across all variables except age, gender, diabetes mellitus, cardiovascular disease, tongue coating index, poor oral hygiene, and oral dryness (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe comparison of participant characteristics and oral function parameters between individuals with and without oral hypofunction were shown in Table 4. Bivariate analysis, using oral hypofunction status as the dependent variable, revealed statistically significant differences across all variables except age and comorbidities (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003eThe findings from binary logistic regression analyses were summarized only significant variables in Table 5. When sarcopenia was used as the dependent variable, tongue pressure (OR = 0.045; 95% CI: 0.010\u0026ndash;0.192), tongue-lip motor function (OR = 0.071; 95% CI: 0.005\u0026ndash;0.951), and swallowing function (OR = 0.096; 95% CI: 0.014\u0026ndash;0.663) were significantly associated. If these factors were increased, the probability of having sarcopenia was reduced. \u0026nbsp;For malnutrition, swallowing function emerged as a significant predictor (OR = 0.240; 95% CI: 0.069\u0026ndash;0.833), with improved swallowing function associated with lower odds of malnutrition. In the model with oral hypofunction as the dependent variable, absence of sarcopenia (OR = 0.008; 95% CI: 0.000\u0026ndash;0.225) and higher MNA scores (OR = 0.340; 95% CI: 0.183\u0026ndash;0.630) were significantly associated with reduced risk of oral hypofunction. These results were shown as flowchart diagram in Fig.3. Collinearity diagnostics confirmed the absence of multicollinearity, with all tolerance values exceeding 0.481 and variance inflation factors (VIFs) below 2.081.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed a high prevalence of oral hypofunction (70.5%) among older adults residing in long-term care facilities in Bangkok, which is markedly higher than the 34.6% reported in community-dwelling older adults in rural Thailand [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Compared to previous studies in Japan, our prevalence of oral hypofunction is higher than prevalence of oral hypofunction (39.9% to 60%) among community-dwelling older adults in Japan [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This may be attributed to differences in study populations, with our participants residing in long-term care settings. The discrepancy may reflect differences in living environments, social support, and access to oral healthcare. Residents in long-term care settings often experience greater physical decline, reduced autonomy, and limited preventive dental services, all of which contribute to deteriorating oral function [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong the number and percentage of participants in each item of oral hypofunction shown in Fig.\u0026nbsp;2 and Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, within each subgroup of oral hypofunction [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], impairments in concise function (oral diadochokinesis: 88.6%; occlusal force: 69.5%) and continuous function (masticatory function: 48.6%; tongue pressure: 60.9%) were higher than oral environment items (oral hygiene: 39%; oral moisture: 23.8%). This was likely because caregivers and staff lack knowledge about concise and continuous function and focus mainly on oral environmental items. This pattern was consistent across subgroups with oral hypofunction, sarcopenia, and malnutrition indicating that motor and masticatory deficits may contribute more substantially to systemic decline than environmental oral conditions. These findings are consistent with prior studies demonstrating declines in oral motor skills and strength [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Notably, tongue pressure and tongue-lip motor function have been shown to correlate with systemic muscle strength, suggesting a pathophysiological mechanism between oral and skeletal muscle deterioration [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth bivariate analysis and logistic regression demonstrated that components within the concise and continuous function were significantly associated with sarcopenia and malnutrition. Notably, logistic regression revealed that tongue pressure, tongue-lip motor function, and swallowing function exhibited associations with sarcopenia, while swallowing function was also significantly associated with malnutrition.\u003c/p\u003e \u003cp\u003eTongue-lip motor function, assessed via oral diadochokinesis (ODK), was the most frequently impaired item (88.6%). This may reflect the unique sociobehavioral context of older adults residing in long-term care facilities. Many participants had relocated from other regions and exhibited limited social engagement, preferring solitude over communal interaction. Compared to community-dwelling older adults, those in long-term care settings may have fewer opportunities for regular verbal communication, which is essential for maintaining articulatory agility. Reduced conversational frequency and social withdrawal may contribute to diminished tongue-lip motor function, highlighting the interplay between environmental, behavioral, and functional factors. Social isolation has been linked to reduced ODK scores and accelerated oral decline. Shimazaki et al. found that socially active older adults had significantly better tongue-lip motor function and lower rates of oral hypofunction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Interventions such as karaoke training, oral exercises [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], and structured conversation programs have shown promise in improving ODK and promoting social engagement [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In our study, male participants had a higher prevalence of oral hypofunction (85.7%) compared to females (62.9%), which may reflect gender differences in social engagement. Women are more likely to participate in communal activities and maintain verbal interaction, which supports oral motor function [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Tongue pressure was impaired in 60.9% of participants and emerged as one of the most frequently impaired and strongly associated oral functions in relation to sarcopenia. This finding was biologically plausible given that tongue pressure reflects the strength of intrinsic and extrinsic tongue muscles which sarcopenia may directly affect perioral and tongue muscles [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Mihara et al. (2018) demonstrated that tongue pressure correlates with handgrip strength, suggesting a shared neuromuscular degeneration pathway [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Kugimiya et al. (2022) further confirmed that sarcopenia was independently associated with reduced tongue pressure [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Moreover, impaired tongue pressure can compromise bolus formation and propulsion during swallowing, contributing to reduced dietary intake and subsequent nutritional deficits, which further exacerbate sarcopenia [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Swallowing function, assessed via the Repetitive Saliva Swallowing Test (RSST), was impaired in 22.9% of participants in this study. Although this was the least affected among the seven oral hypofunction criteria, its clinical significance is substantial. Logistic regression analysis revealed that swallowing function was a significant protective factor of both sarcopenia (OR\u0026thinsp;=\u0026thinsp;0.096) and malnutrition (OR\u0026thinsp;=\u0026thinsp;0.240), underscoring its role in systemic decline. Swallowing is a complex neuromuscular process involving coordinated activity of the tongue, pharynx, and laryngeal structures. Sarcopenia, characterized by generalized loss of muscle, can weaken the suprahyoid and pharyngeal muscles, leading to reduced swallowing efficiency and increased risk of dysphagia. Satake et al. (2019) introduced the concept of \u0026ldquo;sarcopenic dysphagia,\u0026rdquo; describing dysphagia caused by sarcopenia-related muscle loss, which is particularly relevant in frail older adults [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Malnutrition further exacerbates swallowing dysfunction. Inadequate nutritional intake leads to muscle catabolism, including the muscles involved in deglutition. Iwasaki et al. (2021) found that older adults with impaired swallowing function had significantly lower MNA-SF scores and were at higher risk of malnutrition and frailty [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In our study, participants with low RSST scores were more likely to be malnourished, suggesting a bidirectional relationship between swallowing impairment and nutritional status.\u003c/p\u003e \u003cp\u003eSwallowing dysfunction also increases the risk of aspiration pneumonia which is the leading cause of morbidity and mortality in long-term care residents. Maeda et al. (2015) demonstrated that impaired oral function, particularly swallowing inefficiency, is a major contributor to aspiration events [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Aspiration of food or saliva into the lower respiratory tract can trigger infection, leading to hospitalization and functional decline. Rehabilitation strategies may include swallowing exercises, postural adjustments, dietary modifications, and compensatory techniques. Chen. et al. (2021) reported that structured swallowing rehabilitation could reduce aspiration risk in older adults [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In long-term care settings, implementing routine swallowing assessments and individualized therapy plans can significantly enhance safety and quality of life.\u003c/p\u003e \u003cp\u003eThese findings suggest that declines in specific oral functions may reflect underlying systemic deterioration. Routine assessment of these criteria could support early identification of individuals at risk for sarcopenia and malnutrition. On the other hand, the present study also identified sarcopenia and nutritional status as significant predictors of oral hypofunction. Absence of sarcopenia and higher MNA-SF scores were independently associated with reduced likelihood of oral hypofunction. These findings suggest that both sarcopenia and malnutrition are not only consequences of oral hypofunction but may also serve as early indicators for screening and intervention, especially in long term care facilities.\u003c/p\u003e \u003cp\u003eBased on these findings, incorporating sarcopenia and MNA-SF screening into routine geriatric assessments may enhance early detection of oral hypofunction. These emphasized the importance of multidimensional screening approaches that integrate physical, nutritional, and oral health indicators to identify older adults at risk of functional deterioration. In long-term care settings, where access to dental professionals may be limited, using sarcopenia and MNA-SF as alternative indicators can facilitate sensible referral for oral evaluation and intervention. Their integration into primary care and institutional health protocols can support early identification of oral hypofunction and guide multidisciplinary management strategies.\u003c/p\u003e \u003cp\u003e To improve oral function outcomes in Thai government long-term care facilities, it is essential to raise awareness among staff and caregivers about the importance of concise and continuous oral functions. After that, interventions such as oral and tongue exercises, swallowing training, karaoke-based or social activities, physical activities, dietary counseling, and dental prosthetic treatment are being introduced. However, many older adults also lack denture due to long waiting time in public hospital and being unaffordable to private care because of higher cost. Additional support from academic or any organizations is needed to supplement national oral function schemes. Limited access to dental services, compounded by transportation challenges, places burdens on staff. It is particularly difficult for staff to take older adults to dental appointments together. Allocating a permanent dentist to long-term care facilities could help ensure consistent and accessible oral health care.\u003c/p\u003e \u003cp\u003eGiven the irreversible nature of advanced oral dysfunction, early detection and management of oral hypofunction are critical. These interventions may help reverse early-stage oral frailty and prevent progression to systemic decline. Integrating oral function assessments into routine geriatric care could reduce risks of aspiration pneumonia, improve physical and nutritional status, and enhance overall quality of life.\u003c/p\u003e \u003cp\u003eThis study is limited by its cross-sectional design and single-center setting, which may affect generalization. However, this is the first time to examine oral function among older adults in Thai government long-term care facilities. Its novelty contributes to raising awareness and promoting knowledge distribution for future studies in other long-term care facilities. Longitudinal research is needed to clarify causal relationships and further explore these associations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e This study identified a notably high prevalence of oral hypofunction among older adults residing in long-term care facilities in Bangkok, with over 70% of participants affected. Tongue pressure, tongue-lip motor function and swallowing function were significant predictors of sarcopenia, while swallowing function also predicted malnutrition. Additionally, absence of sarcopenia and higher MNA-SF scores were associated with reduced probability of oral hypofunction. These findings highlight the utility of targeted oral function assessments, physical and nutritional screening tools as key components in early detection strategies among older adults in long-term care facilities.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADL: Activities of Daily Living\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMNA-SF: Mini Nutritional Assessment\u0026ndash;Short Form\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eODK: Oral Diadochokinesis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRSST: Repetitive Saliva Swallowing Test\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTCI: Tongue Coating Index\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Human Research Ethics Committee of the Faculty of Dentistry, Chulalongkorn University (HREC-DCU 2024-024) and conformed to the Declaration of Helsinki on human research. Written informed consent was obtained from all participants prior to enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research project was supported by Ratchadapiseksomphot Fund Chulalongkorn University [Grant number GCUGR1125681006M].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKI and OK contributed the study design, KI collected all data from participants. KI and PP analyzed the data using statistical analysis, KI and OK drafted and edited the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the staff and participants of Baan Bang Kae for their invaluable contributions to this study.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Department of Economic and Social Affairs, Population Division. World Population Ageing 2023: Challenges and opportunities of population ageing in the least developed countries. New York: United Nations; 2023.\u003c/li\u003e\n\u003cli\u003eDepartment of Older Persons. Statistics of the older persons in Thailand, 77 provinces as of December 31, 2023. Bangkok: Ministry of Social Development and Human Security; 2023. Available from: https://www.dop.go.th/th/know/side/1/1/2449\u003c/li\u003e\n\u003cli\u003eMinakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, et al. Oral hypofunction in the older population: Position paper of the Japanese Society of Gerodontology in 2016. Gerodontology. 2018;35(4):317\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eShimazaki Y, Nonoyama T, Tsushita K, Arai H, Matsushita K, Uchibori N. Oral hypofunction and its association with frailty in community-dwelling older people. Geriatr Gerontol Int. 2020;20(10):917\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eLimpuangthip N, Komin O. Association between oral hypofunction and general health: a systematic review. BMC Oral Health. 2023;23:591. \u003c/li\u003e\n\u003cli\u003eIwasaki M, Motokawa K, Watanabe Y, Shirobe M, Ohara Y, Edahiro A, et al. Oral hypofunction and malnutrition among community-dwelling older adults: evidence from the Otassha study. 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Long-term care (LTC) policy in Thailand on the homebound and bedridden elderly happiness. Health Policy Open. 2021;2:100026. \u003c/li\u003e\n\u003cli\u003eLi X, Dai J, Zhao S, Liu W, Li H. Comparison of the value of Mini-Cog and MMSE screening in the rapid identification of Chinese outpatients with mild cognitive impairment. Medicine (Baltimore). 2018;97(22):e10966.\u003c/li\u003e\n\u003cli\u003eSoysal P, Veronese N, Arik F, Kalan U, Smith L, Isik AT. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. Clin Interv Aging. 2019;14:693\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eNestl\u0026eacute; Nutrition Institute. A guide to completing the Mini Nutritional Assessment (MNA\u0026reg;). Vevey: Soci\u0026eacute;t\u0026eacute; des Produits Nestl\u0026eacute; SA; 2021. Available from: Mini Nutritional Assessment guide\u003c/li\u003e\n\u003cli\u003eKikutani T, Tamura F, Tashiro H, et al. Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents. Geriatr Gerontol Int. 2015;15:417\u0026ndash;21.\u003c/li\u003e\n\u003cli\u003eShimizu T, Ueda T, Sakurai K. New method for evaluation of tongue-coating status. J Oral Rehabil. 2007;34:442\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eLiu B, Dion MR, Jurasic MM, et al. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:52\u0026ndash;60.\u003c/li\u003e\n\u003cli\u003eYamada H, Nakagawa Y, Nomura Y, et al. Preliminary results of moisture checker for mucus in diagnosing dry mouth. Oral Dis. 2005;11:405\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eFukushima Y, Yoda T, Kokabu S, et al. Evaluation of an oral moisture-checking device for screening dry mouth. Open J Stomatol. 2013;3:440\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eIkebe K, Matsuda K, Kagawa R, et al. Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol. 2011;56:991\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003ede Andrade FB, Lebrao ML, Santos JL, et al. Relationship between oral health and frailty in community-dwelling elderly individuals in Brazil. J Am Geriatr Soc. 2013;61:809\u0026ndash;14.\u003c/li\u003e\n\u003cli\u003eTsakos G, Watt RG, Rouxel PL, et al. Tooth loss associated with physical and cognitive decline in older adults. J Am Geriatr Soc. 2015;63:91\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eYamada A, Kanazawa M, Komagamine Y, et al. Association between tongue and lip functions and masticatory performance in young dentate adults. J Oral Rehabil. 2015;42:833\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eIzuno H, Hori K, Sawada M, et al. Physical fitness and oral function in community-dwelling older people: a pilot study. Gerodontology. 2016;33:470\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eSakayori T, Maki Y, Hirata S, et al. Evaluation of a Japanese \u0026ldquo;Prevention of long-term care\u0026rdquo; project for the improvement in oral function in the high-risk elderly. Geriatr Gerontol Int. 2013;13:451\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eYoshikawa M, Yoshida M, Tsuga K, et al. Comparison of three types of tongue pressure measurement devices. Dysphagia. 2011;26:232\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eYoshida M, Kikutani T, Tsuga K, et al. Decreased tongue pressure reflects symptom of dysphagia. Dysphagia. 2006;21:61\u0026ndash;5.\u003c/li\u003e\n\u003cli\u003eKosaka T, Ono T, Kida M, et al. A multi-factorial model of masticatory performance: the Suita study. J Oral Rehabil. 2016;43:340\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eMihara Y, Matsuda KI, Ikebe K, Hatta K, Fukutake M, Enoki K, et al. Association of handgrip strength with various oral functions in 82- to 84-year-old community-dwelling Japanese. Gerodontology. 2018;35(4):317\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eOguchi K, Saitoh E, Baba M, Kusudo S, Tanaka T, Onogi K. The Repetitive Saliva Swallowing Test (RSST) as a screening test of functional dysphagia. Jpn J Rehabil Med. 2000;37(6):375\u0026ndash;82.\u003c/li\u003e\n\u003cli\u003eChen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, et al. Asian Working Group for Sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment. J Am Med Dir Assoc. 2020;21(3):300\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eChampaiboon J, Petchlorlian A, Manasvanich BA, Ubonsutvanich N, Jitpugdee W, Kittiskulnam P, et al. Calf circumference as a screening tool for low skeletal muscle mass: cut-off values in independent Thai older adults. BMC Geriatr. 2023;23(1):826.\u003c/li\u003e\n\u003cli\u003eTun TZ, Thwin KM, Takehara S, Ogawa H. Oral diadochokinesis and potential associated factors in Japanese older adult outpatients. Oral Health Prev Dent. 2024;22:601\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eMiyazaki A, Mori H. Frequent karaoke training improves frontal executive cognitive skills, tongue pressure, and respiratory function in elderly people: pilot study from a randomized controlled trial. Int J Environ Res Public Health. 2020;17(4):1459.\u003c/li\u003e\n\u003cli\u003eSatake S, Shimada H, Yamada M, Kim H, Yoshida H, Gondo Y, et al. Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria. Geriatr Gerontol Int. 2019;19(7):717\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eChen S, Kent B, Cui Y. Interventions to prevent aspiration in older adults with dysphagia living in nursing homes: a scoping review. BMC Geriatr. 2021;21:429.\u003c/li\u003e\n\u003cli\u003eSomsak K, Komin O, Tangwongchai S. The effects of the oral exercises on the oral function of people with dementia [master\u0026rsquo;s thesis]. Bangkok: Chulalongkorn University; 2021. Available from: https://digital.car.chula.ac.th/chulaetd/4873. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Characteristics of participants and items for oral function, sarcopenia and malnutrition assessment. (\u003cem\u003en\u003c/em\u003e=105)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics/Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCriteria for\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eeach aspect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003cp\u003e80-89\u003c/p\u003e\n \u003cp\u003e90 above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e8 (7.6)\u003c/p\u003e\n \u003cp\u003e52 (49.5)\u003c/p\u003e\n \u003cp\u003e39 (37.1)\u003c/p\u003e\n \u003cp\u003e6 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e70 (66.7)\u003c/p\u003e\n \u003cp\u003e35 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003cp\u003eDiabetes mellites\u003c/p\u003e\n \u003cp\u003eHeart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e49 (46.7)\u003c/p\u003e\n \u003cp\u003e18 (17.1)\u003c/p\u003e\n \u003cp\u003e14 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral function assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePoor oral hygiene\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTCI \u0026ge; 50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e41 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral dryness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt; 27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e25 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReduced occlusal force\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt; 20 Remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e73 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecreased tongue-lip motor function\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp;/pa/sounds\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp;/ta/sounds\u003c/p\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp;/ka/sounds\u003c/p\u003e\u003cbr\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eEither /pa/ or /ta/ or ka/\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026lt; 6 /s\u003c/p\u003e\n \u003cp\u003e\u0026lt; 6 /s\u003c/p\u003e\n \u003cp\u003e\u0026lt; 6 /s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e93 (88.6)\u003c/p\u003e\n \u003cp\u003e84 (80)\u003c/p\u003e\n \u003cp\u003e90 (85.7)\u003c/p\u003e\n \u003cp\u003e92 (87.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecreased Tongue pressure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt; 30 kPa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e64 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecreased masticatory function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026lt; 3 score of gummy jelly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e51 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeterioration of swallowing function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eRSST \u0026lt; 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e24 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral hypofunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026gt; 3 criteria\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eWith sarcopenia\u003c/p\u003e\n \u003cp\u003eWith malnutrition \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e74 (70.5)\u003c/p\u003e\n \u003cp\u003e44 (62.9*)\u003c/p\u003e\n \u003cp\u003e30 (85.7*)\u003c/p\u003e\n \u003cp\u003e59 (79.7)\u003c/p\u003e\n \u003cp\u003e44 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSarcopenia assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow muscle mass\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCalf circumference (cm)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 33 in female\u003c/p\u003e\n \u003cp\u003e\u0026lt; 34 in male\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e66 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow muscle strength\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrip strength (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 18 in female\u003c/p\u003e\n \u003cp\u003e\u0026lt; 28 in male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e68 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow muscle performance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGait speed (m/s)\u003c/p\u003e\n \u003cp\u003e\u0026lt; 1 m/s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e58 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle mass and\u003c/p\u003e\n \u003cp\u003eLow muscle strength or Low muscle performance\u003c/p\u003e\n \u003cp\u003eSarcopenia with oral hypofunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e60 (57.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e59 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalnutrition assessment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalnutrition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMNA-SF score\u003c/p\u003e\n \u003cp\u003e0 \u0026ndash; 7 (Malnutrition)\u003c/p\u003e\n \u003cp\u003e8 \u0026ndash; 11 (At-risk)\u003c/p\u003e\n \u003cp\u003e12 \u0026ndash; 14 (Normal)\u003c/p\u003e\n \u003cp\u003eNo malnutrition \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(At-risk and normal)\u003c/p\u003e\n \u003cp\u003eMalnutrition with \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;oral hypofunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (41.9)\u003c/p\u003e\n \u003cp\u003e25 (23.8) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36 (34.3)\u003c/p\u003e\n \u003cp\u003e61 (58.1) \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e44 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Percentage within gender.\u003c/p\u003e\n\u003cp\u003eTable 2. The bivariate analysis between normal and sarcopenia group.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSarcopenia\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMedian (Q1,Q3) /N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e78 (75, 82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e78 (75, 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e78 (74.5, 83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (24.4), (31.4)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e24 (40), (68.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (75.6), (48.6)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e36 (60), (51.4)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e49 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e25 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e24 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes mellites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e11 (18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.709\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e9 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of oral hypofunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue coating index (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38.9 (27.8, 61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33.3 (27.8, 44.4)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e47.2 (30.6, 61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePoor oral hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e41 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e30 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral moisture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e28.1 (27, 29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e28.3\u0026nbsp;(27.1, 29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e27.8 (26.7, 29.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral dryness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e17 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNumber of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (3, 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e20 (10, 25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e6 (1.5, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow occlusal force\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e73 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e52 (86.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral diadochokinesis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\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: 180px;\"\u003e\n \u003cp\u003e/pa/sounds (times/s) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4, 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.2 (5, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4.6 (3.7, 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ta/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.2 (4.6, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4.2 (3.8, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ka/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (4.4, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e4.2 (3.6, 4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue-lip \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; motor function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e93 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (75.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e59 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue pressure (kPa)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27.2 (20.9, 32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e32.6 (28.5, 37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e22.4 (18.4, 27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e64 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e13 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e51 (85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGummy jelly score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (0, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (2, 8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e1 (0, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow masticatory function\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e39 (65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;RSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (3, 4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e3 (2, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow swallowing function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e21 (35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (2, 5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (1, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e5 (4, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e59 (98.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCalf circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e32.5 (30.5, 34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (33.5, 37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e30.5 (30, 32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e66 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e60 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrip strength (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17.3 (14.6, 22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (15.8, 25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e16 (14.1, 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e68 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e50 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGait speed (m/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.9 (0.5, 1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.7, 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e0.7 (0.5, 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e58 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e41 (68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSarcopenia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e60 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of malnutrition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMNA-SF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6, 12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e13 (10, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e7 (6, 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMalnutrition\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e44 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (8.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e40 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Percentage within gender. \u0026nbsp;\u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e-value for continuous variables using Mann\u0026ndash;Whitney U-test and for categorical variables using \u0026chi;\u003csup\u003e2\u003c/sup\u003e-test.\u003c/p\u003e\n\u003cp\u003eTable 3. The bivariate analysis between malnutrition and no malnutrition group.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo malnutrition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e(\u003cem\u003en\u003c/em\u003e = 61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMalnutrition\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMedian (Q1,Q3) /N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e78 (75, 82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e77 (75, 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e80 (75.5, 83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16 (26.2), (45.7)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (43.2), (54.3)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e45 (73.8), (64.3)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e25 (56.8), (35.7)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e49 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15 (34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes mellites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.776\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e10 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of oral hypofunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue coating index (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38.9 (27.8, 61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e38.9 (27.8, 55.6)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e38.9 (22.2, 61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.627\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePoor oral hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e41 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e23 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral moisture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e28.1 (27, 29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e28.3 (27.5, 29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27.8 (25.8, 28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral dryness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e11 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e14 (31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNumber of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (3, 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (5, 24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (0.5, 13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow occlusal force\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e73 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (55.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e39 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral diadochokinesis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\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: 180px;\"\u003e\n \u003cp\u003e/pa/sounds (times/s) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4, 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.2 (4.8, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.4 (3.7, 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ta/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (4.4, 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3.6, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ka/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.8 (4.2, 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3.4, 4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue-lip \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; motor function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e93 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50 (82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e43 (97.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue pressure (kPa)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27.2 (20.9, 32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30.2 (23.1, 34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e22.2 (17.8, 28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e64 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (77.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\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: 180px;\"\u003e\n \u003cp\u003eGummy jelly score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (0, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (1, 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow masticatory function\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30 (68.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;RSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (3, 4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (2, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow swallowing function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18 (40.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (2, 5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (1, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (4, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCalf circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e32.5 (30.5, 34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33.5 (32.5, 35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30.5 (29.3, 31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e66 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e25 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e41 (93.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrip strength (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17.3 (14.6, 22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e18.9 (15.5, 23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e15.1 (14, 18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e68 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e31 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e37 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGait speed (m/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.9 (0.5, 1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0.7, 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.6 (0.4, 0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e58 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e21 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e37 (84.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSarcopenia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e20 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e40 (90.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of malnutrition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMNA-SF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6, 12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (10, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (5, 7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMalnutrition\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e44 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Percentage within gender. \u0026nbsp;\u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e-value for continuous variables using Mann\u0026ndash;Whitney U-test and for categorical variables using \u0026chi;\u003csup\u003e2\u003c/sup\u003e-test.\u003c/p\u003e\n\u003cp\u003eTable 4. The bivariate analysis between oral hypofunction and normal group.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 105)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOral hypofunction\u0026nbsp;\u003c/strong\u003e(\u003cem\u003en\u003c/em\u003e = 74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMedian (Q1,Q3) /N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\n \u003cp\u003e/N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e78 (75, 82.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e78 (75, 81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e78 (75, 83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.638\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e35 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (16.1), (14.3)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e30 (40.5), (85.7)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGender (female)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e70 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e26 (83.9), (37.1)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44 (59.5), (62.9)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e49 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e17 (54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e32 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes mellites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e18 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e13 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.858\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e14 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of oral hypofunction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue coating index (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e38.9 (27.8, 61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33.3 (27.8, 38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50 (27.8, 66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePoor oral hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e41 (39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e38 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral moisture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e28.1 (27, 29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e28.9 (27.8, 30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27.8 (26.3, 29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral dryness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e25 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e2 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e23 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eNumber of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;remaining teeth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e10 (3, 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e24 (20, 25.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.5 (0, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow occlusal force\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e73 (69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e66 (89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral diadochokinesis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\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: 180px;\"\u003e\n \u003cp\u003e/pa/sounds (times/s) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e5 (4, 5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.6 (5, 6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.8 (4, 5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ta/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.2 (4.6, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.4 (3.8, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e/ka/sounds (times/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4.6 (3.8, 5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (4.5, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.4 (3.6, 4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue-lip \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; motor function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e93 (88.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e20 (64.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e73 (98.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTongue pressure (kPa)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e27.2 (20.9, 32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e33.9 (31.8, 37.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e23.1 (18.7, 28.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow tongue pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e64 (61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e59 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGummy jelly score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (0, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (6, 8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (0, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow masticatory function\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e51 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e50 (67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;RSST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3 (3, 4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4 (3, 6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (2, 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow swallowing function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e23 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4 (2, 5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (1, 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4.5 (4, 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOral hypofunction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e74 (70.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e74 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of sarcopenia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCalf circumference (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e32.5 (30.5, 34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e34 (33, 35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e31.5 (30, 33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e66 (62.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e63 (81.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGrip strength (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e17.3 (14.6, 22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e19 (16.4, 23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e16.8 (14.1, 21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e68 (64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e56 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eGait speed (m/s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0.9 (0.5, 1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.1 (1, 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.7 (0.5, 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eLow muscle performance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e58 (55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e51 (68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSarcopenia\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e60 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e59 (79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables of malnutrition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMNA-SF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9 (6, 12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e13 (12, 14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e7 (6, 9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMalnutrition\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e44 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e44 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Percentage within gender. \u0026nbsp;\u003csup\u003e#\u003c/sup\u003e\u003cem\u003ep\u003c/em\u003e-value for continuous variables using Mann\u0026ndash;Whitney U-test and for categorical variables using \u0026chi;\u003csup\u003e2\u003c/sup\u003e-test.\u003c/p\u003e\n\u003cp\u003eTable 5. The association between oral hypofunction, sarcopenia and malnutrition by logistic regression analyses.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"453\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sarcopenia\u003c/strong\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e95% C.I. for OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eTongue pressure\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eTongue-lip motor function\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.951\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eSwallowing function\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Malnutrition\u003c/strong\u003e\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e95% C.I. for OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eSwallowing function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;0.069 \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.833\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp;Oral hypofunction\u003c/strong\u003e\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e95% C.I. for OR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eNo Sarcopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eMNA-SF score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.340\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.630\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003ea\u003c/sup\u003eAge, gender, comorbidities, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were included as covariates when sarcopenia was used as the dependent variable\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003eAge, gender, comorbidities, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were included as covariates when malnutrition was used as the dependent variable.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003eAge, gender, comorbidities, sarcopenia and MNA-SF score were included as covariates when oral hypofunction was used as the dependent variable.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\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-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oral function, Tongue pressure, Oral diadochokinesis, Sarcopenia, Malnutrition, Long term care","lastPublishedDoi":"10.21203/rs.3.rs-8046380/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8046380/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThailand\u0026rsquo;s aging population is rapidly increasing, yet oral hypofunction remains an under-recognized condition among older adults, particularly those in long-term care facilities. This cross-sectional study aimed to identify the prevalence of oral hypofunction (oral hygiene, oral dryness, occlusal force, tongue lip motor function, tongue pressure, masticatory function and swallowing function) and the association with sarcopenia and malnutrition in older adults in long term care facilities in Bangkok.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted from October 2024 to June 2025 at Baan Bang Khae, a government long-term care facility in Bangkok. A total of 105 participants aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years were assessed for seven oral function items: oral hygiene, oral moisture, occlusal force, tongue lip motor function, tongue pressure, masticatory function, and swallowing function. Sarcopenia was evaluated using calf circumference, handgrip strength and gait speed. Malnutrition was assessed using the Mini Nutritional Assessment\u0026ndash;Short Form (MNA-SF). Bivariate analysis and logistic regression were used to analyze associations.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of oral hypofunction was 70.5%. The most common impairments were decreased tongue-lip motor function (88.6%), reduced occlusal force (69.5%), and decreased tongue pressure (60.9%). Sarcopenia and malnutrition were present in 57.1% and 41.9% of participants, respectively. Tongue pressure, tongue-lip motor function, and swallowing function were significantly associated with sarcopenia, while swallowing function was associated with malnutrition. On the other hand, sarcopenia and MNA-SF scores were significant predictors of oral hypofunction.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOral hypofunction is highly prevalent among older adults in long-term care facilities in Bangkok and is significantly associated with sarcopenia and malnutrition. These findings highlight the need for early screening and integrative interventions targeting oral function, physical function and nutritional status to prevent progression toward dysfunction and dependent stage and enhance quality of life of older adults.\u003c/p\u003e","manuscriptTitle":"Oral Hypofunction in Long term care facilities’ older adults in Bangkok, Under- Recognized Geriatric Condition: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 17:18:25","doi":"10.21203/rs.3.rs-8046380/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-18T11:34:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-26T10:22:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-26T10:18:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-25T14:10:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-11-25T13:58:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfc3b943-aec2-447f-91e5-860f837ac238","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-22T17:18:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 17:18:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8046380","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8046380","identity":"rs-8046380","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}