| Background:The prevalence of frailty among older people in China is increasing because of population aging,which means frailty has become a major public health problem.However,interventions to prevent frailty in older people pose serious challenges.Oral health,which is a common problem among older patients,is a risk factor for frailty that has not received sufficient attention.Previous studies reported a strong association between oral health and frailty,and suggested that malnutrition may have a mediating effect.However,the intrinsic mechanism underlying the impact of oral health on frailty is complex and involves the combined effects of nutritional status,psychosocial factors,cognitive function,inflammatory factors,and neurological pathways.Therefore,it is necessary to analyze the relationships between these factors to clarify how oral health leads to frailty.This will inform frailty prevention efforts and improve clinical outcomes among older patients.Objectives:1)Construct a model to investigate the intrinsic mechanism for the impact of oral health on frailty in older patients in China,and identify the core elements of oral health that lead to frailty.2)Construct a comprehensive frailty prevention intervention program for older patients based on these elements by integrating evidence-based nursing data and the Delphi expert consultation method.Methods:Part Ⅰ.Based on the model hypothesis,two cross-sectional surveys were used to construct and validate an inherent model for the mechanism underlying the impact of oral health on frailty in older patients at different phases.1)Based on the Castrejon-Perez model,we hypothesized a new conceptual framework model through an analysis of the literature.2)Convenience sampling was used to survey older patients hospitalized at Peking Union Medical College Hospital from January to May 2022.Studied variables included oral health-related factors,frailty,and other factors.Structural equation modeling(SEM)was used to explore the mechanism underlying the impact of oral health on frailty in older patients.3)Convenience sampling was used to survey older patients hospitalized at Peking Union Medical College Hospital from August to November 2022.SEM was used to examine the fit of the model constructed for the inherent mechanism whereby older patients’ oral health leads to frailty.Model fit parameters were evaluated to verify and explain the inherent mechanism for the impact of oral health on frailty in older patients.Part Ⅱ.Based on the core elements that comprised direct and indirect factors in the model,a preliminary comprehensive frailty prevention intervention program for older patients was developed using the evidence summaries.The program was evaluated through two rounds of Delphi expert consultation to assess the feasibility,suitability,clinical significance,and effectiveness of each program component and provide recommendations.The program then underwent external review and was further revised to form a final comprehensive program.Results:Part Ⅰ.1)The new conceptual framework offered a comprehensive mechanism model that included nutritional,inflammatory,cognitive function,psychosocial,and neural pathways.2)This study included 421 older patients for model construction.The prevalence of frailty was 42.99%.The average frailty score was 3.71±2.28 and average number of natural teeth was 19.29±9.95.The median of oral health assessment score was 3.00(2.00-6.00),mean oral health-related quality of life score was 52.54±7.35,mean chewing ability score was 6.09±2.70,and mean selfassessed oral health score was 4.00±1.41.The results of the internal mechanism model analysis for oral health causing frailty in older patients showed that oral health knowledge had an effect on oral health belief,which in turn affected oral health behavior.Finally,oral health behavior affected oral health(path coefficient 0.552).The oral disease and comorbidity index for older patients had a direct negative impact on oral health(path coefficients-0.310 and-0.197,respectively).Oral health and comorbidity index had a direct effect on frailty(path coefficients-0.357 and 0.100,respectively).In addition,oral health indirectly affected frailty through malnutrition(path coefficient-0.186),depression(path coefficient-0.080),cognitive function(path coefficient-0.036),and social support(standardized path coefficient-0.043).Oral health also indirectly affected frailty with chain mediation through balance function and daily life ability(standardized coefficient-0.072).Model fit indices were:χ2/df=2.94,comparative fit index(CFI)=0.944,Tucker-Lewis index(TLI)=0.930,root mean square error of approximation(RMSEA)=0.06,and standardized root mean squared residual(SRMR)=0.05.3)We included 298 older patients for model validation,with a prevalence of frailty of 45.30%.The validation of the mechanism model for frailty caused by oral health in older patients showed that all paths were validated except for oral health affecting frailty through social support and the correlation between oral disease and oral health behaviors,which did not reach statistical significance(P=0.095).The model fit evaluation indices were:χ2/df=2.90,CFI=0.931,TLI=0.914,RMSEA=0.06,and SRMR=0.08.Part Ⅱ.The comprehensive program for preventing frailty in older patients targeted oral health,malnutrition,cognitive function,balance function,depression,and social support.Based on these targets,relevant literature was retrieved and quality evaluation and evidence summaries were conducted to develop a comprehensive frailty prevention intervention program.This program included frailty screening and assessment,oral health intervention,nutrition intervention,cognitive function intervention,depression symptom intervention,balance exercise,and social support intervention.The program comprised seven dimensions and 40 items.Fourteen experts(seven nursing experts,three medical experts,and four professors)were consulted in two Delphi rounds,and the coefficient of authority level of these experts was 0.87.The feasibility scores for the program items ranged from 4.28 to 4.92,suitability scores from 4.28 to 5.00,clinical significance scores from 4.85 to 5.00,and effectiveness scores from 4.71 to 5.00.In addition,87.5%of the items were strongly recommended,and 12.5%were weakly recommended.Conclusion:This study highlighted the high prevalence of frailty and poor oral health status among older patients.Based on the Castrejón-Pérez model,a hypothetical model for the mechanism underlying the impact of oral health on frailty in older Chinese patients was established.Older patients can influence their oral health status through oral health-related knowledge,beliefs,and behaviors.Oral diseases and comorbidity index have a negative impact on the oral health of older patients,as these factors can directly lead to frailty.Oral health can also indirectly lead to frailty through malnutrition,depression,cognitive function,social support,and balance function.Evaluation of the feasibility,suitability,clinical significance,and effectiveness of the comprehensive program for preventing frailty in older patients developed in this study indicated that the program has broad application prospects.This study provided a theoretical basis and practical guidance for the prevention and treatment of oral health and frailty among older patients in China,which are important for promoting healthy aging. |
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