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Differences in the association of oral health knowledge, attitudes, and practices with frailty among community-dwelling older people in China

BMC Oral Health volume 23, Article number: 782 (2023) Cite this article

Abstract

Background

Oral health and frailty are significantly related and should be well examined, especially in late life. Few studies have explored the relationship of oral health knowledge, attitudes, and practices with frailty and examined sociodemographic variations in this association. This study aimed to examine the association between oral health knowledge, attitudes, practices and frailty, with a special focus on comparing differences in their association among the Chinese community-dwelling older population.

Methods

This study included 4218 community-dwelling older adults (aged ≥ 60 years) who participated in a cross-sectional survey. Sociodemographic characteristics, oral health knowledge, attitudes, practices, and frail status (non-frailty, pre-frailty, and frailty) were collected with a face-to-face questionnaire-based interview. Multivariate logistic regression models were used to evaluate the association of oral health knowledge, attitudes, and practices with frailty.

Results

Of the 4218 participants, 36.2% (n = 1527) and 18.8% (n = 792) were classified as pre-frailty and frailty. Age, gender and educational attainments differences existed in the association of oral health knowledge with frailty. Urban-rural differences in the association of oral health knowledge and practices with frailty were also found. Specifically, oral health knowledge was significantly related to frailty only among participants aged 70–79 years (adjusted odds ratio [95% confidence interval]) (1.08 [1.02–1.15]), females (1.05 [1.00–1.10]), rural residents (1.06 [1.01–1.12]), and those who were primary school and lower education (1.06 [1.01–1.11]), whereas oral health practices were related to frailty only among urban participants (0.96 [0.92–1.00]).

Conclusion

This study confirmed the different associations of oral health knowledge and practices with frailty among community-dwelling older people in China. Further research is needed to better understand the abovementioned differences and public health strategies are required to improve oral health literacy and thereby contain the development of frailty in later life.

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Introduction

An increasing proportion of the aging population has exacerbated the incidence of frailty today [1, 2]. Frailty is a complex aging-related condition, resulting in a decreased physiological capacity of organ systems and enhanced susceptibility to stressors [3]. As an emerging global health problem challenge, frailty puts a great burden and challenge not only on older individuals but also on their families and society [4, 5]. Therefore, the exploration of frailty-associated factors has great significance for academic and practical research.

World Health Organisation (WHO) pointed out that oral health remains a significant, but overlooked, component of healthy aging and well-being in older people [6, 7]. Oral health literacy (OHL), which comprises oral health knowledge, attitudes, and practices, represents an individual’s motivation and ability to access, understand, and use information through cognitive and social skills to promote and maintain oral health [8]. The importance of oral health literacy in the oral care practice and oral health status has been recognized previously [9, 10]. Besides, much attention has been paid to the impact of oral health-related indicators on frailty in later life [11]. For example, oral health practices, especially infrequent brushing or dental service usage, were confirmed related to frailty in older adults [12]. In addition, decreased tooth numbers and increased demand for dentures were linked to a greater risk of frailty in later life [13]. Also, a systematic review revealed that self-reported oral pain or masticatory disorders are significantly associated with frailty [14].

The presence of oral health-related indicators and frailty has been confirmed to vary in terms of various demographic factors [15,16,17]. Previous studies have found that advanced age, females, residing in rural, and less educational attainment had a higher prevalence of frailty in later life [18,19,20]. Besides, compared with males, females were more likely to have more positive attitudes towards dental healthcare services and higher oral health attitudes, better self-care practices, and higher oral health literacy [21]. Furthermore, self-care-related attitudes and behaviours are influenced by the educational level among older males [22]. In a recent study, barriers to accessing remote services and health facilities were linked to the generally poor oral health status of rural older people, compared to their urban counterparts [23]. Therefore, differences in these factors should be examined when oral health literacy-related variables are linked to frailty.

However, to date, few studies have explored the influence of sociodemographic disparities on the association of oral health knowledge, attitudes, practices with frailty in older adults. Given this, this paper aimed to investigate the association of oral health knowledge, attitudes, and practices with frailty, with a special focus on examining the differences in age, gender, residence, and educational attainment. The findings would contribute to providing evidence on the future supportive strategies to improve frailty in China community-dwelling older people through the development of personalised oral policies, tailored to age, gender, residence, and educational attainment separately.

Materials and methods

Sampling and recruitment

In November–December 2020, a multi-stage stratified-cluster random sampling-based cross-sectional survey was conducted at Jinshan of Shanghai; Huzhou of Zhejiang Province; Changzhou of Jiangsu Province; and Huainan of Anhui Province. We categorised the participants into urban and rural based on their household registration and residence information. In other words, those whose household registration was in urban areas and who live in urban areas were included in the urban population, and while were included in the rural population. With the support and coordination of local community workers, trained graduate students used structured questionnaires to conduct face-to-face interviews with the participants. The eligibility criteria for this study were: age ≥ 60 years, no obvious communicative or cognitive impairments, and willingness to participate in the study.

After excluding invalid questionnaires, 4218 valid questionnaires were included in this study. Prior to any data collection, each participant or their legally authorised representative provided written informed consent for participation in this study. For more information on the study design and data collection process for this paper, please refer to our previously published articles [24, 25].

Measures

Independent variables

On the basis of the 4th Chinese National Oral Health Epidemiological Survey [26], a structured questionnaire was developed and implemented in accordance with the procedures described in Oral Health Surveys Basic Methods 5th Edition [27]. Our study elicited data on oral health knowledge, attitudes, and practices among older people. (Full content has been provided in Supplementary Material S1).

For the 8 questionnaire items on oral health knowledge, responses were coded as correct, unknown, or incorrect (2, 1, or 0 points, respectively; total score: 0–16). Oral health attitudes were assessed from 6 items (total score: 0–12; negative attitude, 0 points; gradual positive attitude: 1–2 points), with a higher score indicating a more positive attitude towards oral health. For each of the 12 items on oral health practices (per item, maximum score: 3 points; minimum score: 0 points; total score: 0–36), higher scores were associated with less frequent adverse behaviours and more regulated oral health practices.

Outcome variables

In this study, frailty was assessed with a four-dimensional (physical, psychological, social, and environmental), 23-item measurement tool. First, we calculated the score for each item and divided it by 23 separately to obtain the frailty score, classified as follows: <0.12 as non-frailty, 0.12–0.24 as pre-frailty, and ≥ 0.25 as frailty [25, 28]. The Cronbach’s alpha of 0.771 proved that the scale had good internal consistency. Detailed content of this measurement has been provided in Supplementary Material S1.

Co-variables

Based on the findings of a literature review [20, 29,30,31], data on other variables, such as age (years), body mass index (BMI, kg/m2), gender (male or female), educational attainment (primary school and lower, junior school, or high school and above), residence (urban or rural), living status (living alone, living with others, etc.), and marital status, were also included. Moreover, data on smoking and drinking status, sources of income (salary, pension, family providing, subsidy, and others), depressive status, and functional ability (robust or limited) were also obtained.

Data analysis

Based on the presence of frail status (non-frailty, pre-frailty, and frailty), the participants were divided into three groups. The participant demographics were presented through descriptive statistics. Logistic regression models were established to identify differences in the correlation of oral health knowledge, attitudes, and practices with frail status.

Multiple logistic regression analyses were conducted accordingly to determine differences, concerning age, gender, residence, and educational attainment, in the unadjusted and adjusted relationships between oral health knowledge, attitudes, practices and frailty. With reference to literatures [31, 32], we adjusted for potential covariates to obtain multiple logistic regression models. The adjusted odds ratio (AOR) and the corresponding 95% confidence interval (95% CI) were used to express the results of these models. All analyses in this study were conducted in SPSS 23.0.

Results

Participant characteristics

The characteristics of the participants, stratified by frail status as non-frailty (n = 1899/4218, 45.0%), pre-frailty (1527/4218, 36.2%), and frailty (792/4218, 18.8%), are shown in Table 1: 42.2% (n = 1779/4218) of participants were in the 60–69 age group, and the majority of respondents were female (n = 2734, 65.8%), urban residents (n = 2316, 54.9%), and lived with their family (n = 3650, 86.5%); 61.0% of older adults had primary or lower education (n = 2571/4218) and 78.8% (n = 3325/4218) were married/cohabiting. With regard to health practices, the majority of participants (n = 3332, 79.0%) had never smoked or consumed alcohol (n = 3386, 80.3%). More than half of the participants had no depression (n = 2355, 55.8%), but 45.6% (n = 1923/4218) had limited functional ability.

Table 1 Demographic, socioeconomic and oral health characteristics of the study sample of older adults stratified by frail status (N = 4218) [N (%)]
Full size table

Age-stratified association between independent and outcome variables

In Table 2, oral health knowledge and pre-frailty were associated in participants aged 60–69 years (AOR = 1.05, 95% CI: 1.00–1.10) and 70–79 years (AOR = 1.08, 95% CI: 1.03–1.13). However, a significant association with frailty was seen only in participants aged 70–79 years (AOR = 1.08, 95% CI: 1.02–1.15). In all age groups, oral health attitudes were linked to both pre-frailty and frailty at all age groups (P < 0.05), whereas significant association of oral health practices was not observed (P > 0.05).

Table 2 Results of the logistic regression models on the association between oral health literacy and frail status among different age groups †
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Gender-stratified association between independent and outcome variables

Table 3 presents the results of the logistic regression models after adjusting the co-variables. Oral health knowledge was correlated with pre-frailty among males (AOR = 1.09, 95% CI: 1.04–1.15) and females (AOR = 1.04, 95% CI: 1.00–1.08), but oral health knowledge was linked to frailty only in female (AOR = 1.05, 95% CI: 1.00–1.10). In both males and females, oral health attitudes were significantly correlated with pre-frailty and frailty (P < 0.05), whereas oral health practices were not (P > 0.05).

Table 3 Results of the logistic regression models on the association between oral health literacy and frail status among different genders†
Full size table

Residence-stratified association between independent and outcome variables

As shown in Table 4, oral health knowledge, among rural participants, was significantly linked to frailty (AOR = 1.06, 95% CI: 1.01–1.12). Among urban and rural participants, oral health attitudes were significantly related to pre-frailty and frailty (P < 0.05). Moreover, oral health practices were associated with frailty only among urban participants (AOR = 0.96, 95% CI: 0.92–1.00).

Table 4 Results of the logistic regression models on the association between oral health literacy and frail status among different residences†
Full size table

Educational attainment-stratified association between independent and outcome variables

In Table 5, oral health knowledge was significantly related to pre-frailty among all participant groups whereas oral health knowledge was significantly associated with frailty only among participants with primary school or lower education (AOR = 1.06, 95% CI: 1.01–1.11). Oral health attitudes were significantly related to both pre-frailty and frailty among different educational attainment groups (P < 0.05), whereas oral health practices were not (P > 0.05).

Table 5 Results of the logistic regression models on the association between oral health literacy and frail status among different educational attainments†
Full size table

Discussion

To our knowledge, this study is the first to explore the association of oral health knowledge, attitudes, and practices with frail status and whether this association is varied by age, gender, residence and educational attainment among community-dwelling older people. Based on the results, age, gender and educational attainment differences existed in the association of oral health knowledge with frail status. Urban-rural differences in the association of oral health knowledge and practices with frail status were also found.

Specifically, age differences were observed in the significant association of oral health knowledge with frailty and pre-frailty among those aged 60–69 and 70–79 years. Our findings are in line with previous research which suggested that poor oral health knowledge is more likely to be related to oral disease, which may affect the quality of life in older adults and thereby increase the potential risk of frailty [33, 34]. Similarly, the result of this paper also further illustrates the importance of oral health knowledge in maintaining the quality of life-related to oral health [35]. These results can be explained by studies that have proven that knowledge literacy is a prerequisite for cultivating healthy behaviour [36]. The poor oral knowledge reserve of Chinese older people makes it difficult to achieve behavioural changes, which indirectly affects their oral health status [37].

Our study found that gender differences in the association of oral health knowledge with frailty, while oral health attitudes and oral health practices were not. In particular, oral health knowledge was statistically significant for frailty in older females, this result may be attributed to gender differences in oral health knowledge and frailty [38, 39]. According to a prior study, females had less access to education and lacked formal or informal oral knowledge, resulting in lower levels of oral health knowledge, which led to incorrect lifestyles and affected oral health [40]. Besides, this might be explained by frailty is more common among older females [19]. Therefore, it is particularly important to prevent and control frailty by improving oral health knowledge among older females. However, in previous studies, gender differences existed in oral health attitudes and practices [21]. Compared to males, females generally paid more attention to the impact of oral health on quality of life and well-being [34]. Thus, females place more emphasis on oral health and prevention, and they have more positive attitudes toward dental visits. In addition, females are more interested in appearance and beauty, and as a result, they are more interested in flossing and brushing than males [22]. Hence, further research is needed to confirm these differences.

Meanwhile, it is worth noting that residential disparities were identified in the linkage of oral health knowledge and practices with frailty in this paper. Specifically, we determined that the correlation of oral health knowledge with frailty was statistically significant for rural, but not urban participants. This is in accordance with previous findings that older residents in rural areas generally have lower levels of oral health knowledge and poorer oral health, reducing their quality of life [23, 41] and leading to a higher risk of frailty [18]. This may also be due to the fact that rural older people have more negative oral health knowledge compared to urban older people [42]. According to a prior study which reported that older people from rural areas are unaware of the importance of regular dental cleaning and oral care services and thereby this community has a low willingness to participate and adhere to these services [43].

On the other hand, this study concluded that the association between oral health practices and frailty was statistically significant in the urban older population. Based on previous research, this result could be explained by the following reasons. First, studies have proved that urban older people have a higher consumption level of soft drinks, fruits, candies and other high-sugar products, which leads to dental problems such as cavities and tooth loss [44]. In addition, studies have shown that social participation could build up social control and improve their oral health habits [45]. In contrast, a study found that urban older people whose social network and social engagement were decreased due to infrequent social contact with their children were more likely to experience poor oral function [46]. Simultaneously, the low level of social networks of older people may also limit sources of relevant health information and reduce the utilization of dental care services [47], which are indirectly associated with frailty [48].

In contrast, the association of oral health practices with frailty was not significant after adjusting for confounders, and this was inconsistent with the results of previous studies. Studies based on the health behavior model show that changes in individual behavior would directly and indirectly lead to changes in physical and mental health outcomes [49]. For instance, a study from the Netherlands showed that oral health practices, especially lower frequency of use dental services, resulting in poorer oral health outcomes and related quality of life, are also associated with frailty-related factors in the older population [12]. Simultaneously, previous research indicated that poor oral hygiene habits (less frequent brushing of teeth and denture cleaning) lead to oral diseases and increase the risk of frailty [50]. These inconsistent results may be because different subjects from varied social backgrounds were included for analysis. Therefore, the relevant research needs to be further explored concerning these differences.

Currently, evidence from this paper has confirmed that the association of oral health knowledge with frailty had statistical discrepancies concerning educational attainments. Our study revealed that the connection between oral health knowledge and frailty was significant only in older people with primary school or lower education, which corresponds to the conclusions of a previous study [51]. Also, this may because older people with lower education levels do not fully understand or receive appropriate oral hygiene maintenance training, they may not be aware of the importance of regular dental examinations [52, 53].

Drawing on our results, the association between oral health attitudes and frail status was statistically significant, which suggested that oral health attitudes are a protective factor for pre-frailty and frailty. In other words, the more positive the oral health attitude, the lower likelihood of frailty in older people. The findings are consistent with previous research that positive attitudes accompanied by healthy behavioural habits have a direct impact on the quality of life of older people [54]. However, research from China has shown that older people living in communities often have extremely negative attitudes toward the severity of oral diseases and the maintenance of oral health [29, 55]. This may affect the perception and management of oral health, eventually affecting the maintenance of oral health, reducing the quality of life of older people, and increasing the risk of frailty [8, 29]. Therefore, improving the attitude of older people towards oral health is particularly important for intervention in frailty.

From the perspective of healthy aging, mixed-association models are committed to preventing and controlling frailty via improving oral health literacy regarding to knowledge, attitudes, and practices of older adults. At the same time, different age groups, genders, residences, and educational attainments should be fully considered to develop individualized interventions.

Nonetheless, some limitations of this study need to be pointed out. First, a cross-sectional study design may be a limitation for ascertaining a causal relationship of oral health knowledge, attitudes, and practices with frailty. Thus, longitudinal studies are warranted to further ascertain the causal relationships in future research. Second, oral health data are only obtained through self-reported measurement at the individual level, which may confer certain information biases, including recall bias and social desirability bias, etc. Despite the aforementioned limitations, we firmly believe that the use of a representative large sample and good response rates constitute the strengths of this study. The results of this study could develop our understanding of factors that would help decrease the development of frailty through good oral health knowledge, attitudes, and practices.

Conclusion

In summary, based on the results of our study, we observed the linkages between oral health knowledge, attitudes, practices and frailty across demographic variables among community-dwelling older people. The correlation of oral health knowledge and practices with frailty varied with age, gender, residence, and educational attainments, whereas oral health attitudes were not. Our results cast a new light on the development of individualized strategies that can be tailored to improve frailty from the perspective of oral health literacy, which are crucial for achieving healthy aging.

Data Availability

The datasets analyzed during the current study are not publicly available due to data management regulations but are available from the corresponding author on reasonable request.

Abbreviations

95%CI:

Confidence interval of 95%

AOR:

Adjusted Odds Ratio

BMI:

Body mass index

References

  1. Partridge L, Deelen J, Slagboom PE. Facing up to the global challenges of ageing. Nature. 2018;561(7721):45–56.

    PubMed  Google Scholar 

  2. Cesari M, Calvani R, Marzetti E. Frailty in older persons. Clin Geriatr Med. 2017;33(3):293–303.

    PubMed  Google Scholar 

  3. Proietti M, Cesari M. Frailty: what is it? Adv Exp Med Biol. 2020;1216:1–7.

    PubMed  Google Scholar 

  4. Andrew MK, Dupuis-Blanchard S, Maxwell C, Giguere A, Keefe J, Rockwood K, St John P. Social and societal implications of frailty, including impact on canadian healthcare systems. J Frailty Aging. 2018;7(4):217–23.

    PubMed  Google Scholar 

  5. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet (London England). 2019;394(10206):1365–75.

    PubMed  Google Scholar 

  6. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO global oral health Programme. Commun Dent Oral Epidemiol. 2005;33(2):81–92.

    Google Scholar 

  7. Gibney JM, Naganathan V, Lim M. Oral health is essential to the Well-Being of Older People. Am J Geriatric Psychiatry: Official J Am Association Geriatric Psychiatry. 2021;29(10):1053–7.

    Google Scholar 

  8. Valdez R, Spinler K, Kofahl C, Seedorf U, Heydecke G, Reissmann DR, Lieske B, Dingoyan D, Aarabi G. Oral health literacy in migrant and ethnic minority populations: a systematic review. J Immigr Minor Health. 2022;24(4):1061–80.

    PubMed  Google Scholar 

  9. Wiener RC, Meckstroth R. The oral Health Self-Care Behavior and Dental attitudes among nursing Home Personnel. J Stud Social Sci. 2014;6(2):1–12.

    Google Scholar 

  10. Dharamsi S, Jivani K, Dean C, Wyatt C. Oral care for frail elders: knowledge, attitudes, and practices of long-term care staff. J Dent Educ. 2009;73(5):581–8.

    PubMed  Google Scholar 

  11. Hakeem FF, Bernabé E, Sabbah W. Association between oral health and frailty: a systematic review of longitudinal studies. Gerodontology. 2019;36(3):205–15.

    PubMed  Google Scholar 

  12. Niesten D, Witter DJ, Bronkhorst EM, Creugers NHJ. Oral health care behavior and frailty-related factors in a care-dependent older population. J Dent. 2017;61:39–47.

    PubMed  Google Scholar 

  13. Zhang Y, Ge M, Zhao W, Hou L, Xia X, Liu X, Zuo Z, Zhao Y, Yue J, Dong B. Association between Number of Teeth, Denture Use and Frailty: findings from the West China Health and Aging Trend Study. J Nutr Health Aging. 2020;24(4):423–8.

    PubMed  Google Scholar 

  14. Kamdem B, Seematter-Bagnoud L, Botrugno F, Santos-Eggimann B. Relationship between oral health and Fried’s frailty criteria in community-dwelling older persons. BMC Geriatr. 2017;17(1):174.

    PubMed  PubMed Central  Google Scholar 

  15. Yu P, Song X, Shi J, Mitnitski A, Tang Z, Fang X, Rockwood K. Frailty and survival of older Chinese adults in urban and rural areas: results from the Beijing Longitudinal Study of Aging. Arch Gerontol Geriatr. 2012;54(1):3–8.

    PubMed  Google Scholar 

  16. Moreira VG, Lourenço RA. Prevalence and factors associated with frailty in an older population from the city of Rio de Janeiro, Brazil: the FIBRA-RJ Study. Clin (Sao Paulo Brazil). 2013;68(7):979–85.

    Google Scholar 

  17. Mielke N, Schneider A, Huscher D, Ebert N, Schaeffner E. Gender differences in frailty transition and its prediction in community-dwelling old adults. Sci Rep. 2022;12(1):7341.

    PubMed  PubMed Central  Google Scholar 

  18. Jang IY, Jung HW, Lee CK, Lee YS, Kim KI, Kim KW, Oh H, Ji MY, Lee E, Kim DH. Rural and urban disparities in Frailty and Aging-Related Health Conditions in Korea. J Am Geriatr Soc. 2016;64(4):908–11.

    PubMed  PubMed Central  Google Scholar 

  19. Ofori-Asenso R, Chin KL, Mazidi M, Zomer E, Ilomaki J, Zullo AR, Gasevic D, Ademi Z, Korhonen MJ, LoGiudice D, et al. Global incidence of Frailty and Prefrailty among Community-Dwelling older adults: a systematic review and Meta-analysis. JAMA Netw Open. 2019;2(8):e198398.

    PubMed  PubMed Central  Google Scholar 

  20. Wang X, Hu J, Wu D. Risk factors for frailty in older adults. Med (Baltim). 2022;101(34):e30169.

    Google Scholar 

  21. Su S, Lipsky MS, Licari FW, Hung M. Comparing oral health behaviours of men and women in the United States. J Dent. 2022;122:104157.

    PubMed  Google Scholar 

  22. Sfeatcu R, Balgiu BA, Mihai C, Petre A, Pantea M, Tribus L. Gender differences in oral health: self-reported attitudes, values, behaviours and literacy among romanian adults. J Personalized Med 2022, 12(10).

  23. Cericato GO, Agostini BA, Costa FDS, Thomson WM, Demarco FF. Rural-urban differences in oral health among older people in Southern Brazil. Brazilian oral Research. 2021;35:e135.

    PubMed  Google Scholar 

  24. Cao C, Cao W, Zheng X, Ji K, Wu Y, Hu Z, Chen R, Bai Z. Association of social capital with self-perceived eHealth literacy among community-dwelling older people: age and gender differences. Front Public Health. 2023;11:1088863.

    PubMed  PubMed Central  Google Scholar 

  25. Cao W, Cao C, Zheng X, Ji K, Liang Q, Wu Y, Hu Z, Bai Z. Factors Associated with Medication Adherence among Community-Dwelling Older People with Frailty and Pre-Frailty in China. Int J Environ Res Public Health 2022, 19(23).

  26. Lu HX, Tao DY, Lo ECM, Li R, Wang X, Tai BJ, Hu Y, Lin HC, Wang B, Si Y, et al. The 4th national oral health survey in the mainland of China: background and methodology. Chin J Dent Research: Official J Sci Sect Chin Stomatological Association (CSA). 2018;21(3):161–5.

    Google Scholar 

  27. Wang CX, Ma LL, Yang Y, Xu MR, Wang X, Feng XP, Tai BJ, Hu Y, Lin HC, Wang B, et al. Oral health knowledge, attitudes, behaviour and oral Health Status of Chinese Diabetic Patients aged 55 to 74 years. Chin J Dent Research: Official J Sci Sect Chin Stomatological Association (CSA). 2018;21(4):267–73.

    Google Scholar 

  28. Qiao X, Wang C, Tian X, Dong L, Liu N, Jin Y, Si H. Cross-cultural adaptation and validation of the Comprehensive Frailty Assessment Instrument in Chinese community-dwelling older adults. Geriatr Gerontol Int. 2018;18(2):301–7.

    PubMed  Google Scholar 

  29. Ye S, Chen L. Oral health knowledge, beliefs and practices among community-dwelling older adults in Shanghai, China: a cross-sectional analysis. Gerodontology. 2020;37(2):191–9.

    PubMed  Google Scholar 

  30. Zhao Q, Wang SB, Xu G, Song Y, Han X, Liu Z, Zhou X, Zhang T, Huang K, Yang T, et al. Periodontal health: a national cross-sectional study of knowledge, attitudes and practices for the public oral health strategy in China. J Clin Periodontol. 2019;46(4):406–19.

    PubMed  Google Scholar 

  31. Xu M, Cheng M, Gao X, Wu H, Ding M, Zhang C, Wang X, Feng X, Tai B, Hu D, et al. Factors associated with oral health service utilization among adults and older adults in China, 2015–2016. Commun Dent Oral Epidemiol. 2020;48(1):32–41.

    Google Scholar 

  32. Wong FMF. Factors Associated with Knowledge, Attitudes, and Practices related to oral care among the Elderly in Hong Kong Community. Int J Environ Res Public Health 2020, 17(21).

  33. Velázquez-Olmedo LB, Borges-Yáñez SA, Andrade Palos P, García-Peña C, Gutiérrez-Robledo LM, Sánchez-García S. Oral health condition and development of frailty over a 12-month period in community-dwelling older adults. BMC Oral Health. 2021;21(1):355.

    PubMed  PubMed Central  Google Scholar 

  34. Divaris K, Lee JY, Baker AD, Vann WF Jr. The relationship of oral health literacy with oral health-related quality of life in a multi-racial sample of low-income female caregivers. Health Qual Life Outcomes. 2011;9:108.

    PubMed  PubMed Central  Google Scholar 

  35. Mariño R, Hopcraft M, Ghanim A, Tham R, Khew CW, Stevenson C. Oral health-related knowledge, attitudes and self-efficacy of australian rural older adults. Gerodontology. 2016;33(4):530–8.

    PubMed  Google Scholar 

  36. Saleem H, Waly N, Abdelgawad F. Knowledge, attitude, and practice (KAP) of post exposure prophylaxis for fifth year dental students at a private Egyptian university: a cross-sectional study. BMC Oral Health. 2023;23(1):167.

    PubMed  PubMed Central  Google Scholar 

  37. Kwan SY, Holmes MA. An exploration of oral health beliefs and attitudes of Chinese in West Yorkshire: a qualitative investigation. Health Educ Res. 1999;14(4):453–60.

    PubMed  Google Scholar 

  38. Wong FMF, Ng YTY, Leung WK. Oral health and its Associated factors among older institutionalized Residents-A systematic review. Int J Environ Res Public Health 2019, 16(21).

  39. Lipsky MS, Su S, Crespo CJ, Hung M. Men and oral health: a review of sex and gender differences. Am J Men’s Health. 2021;15(3):15579883211016361.

    Google Scholar 

  40. Lee CJ, Ho MH, Joo JY, Montayre J, Lin YK, Chang CC, Liu MF. Gender differences in the association between oral health literacy and oral health-related quality of life in older adults. BMC Oral Health. 2022;22(1):205.

    PubMed  PubMed Central  Google Scholar 

  41. Gaikwad RN. Quantifying OHIP in the context with oral health literacy in Rural and Urban Population. J Contemp Dent Pract. 2019;20(7):834–7.

    PubMed  Google Scholar 

  42. Varenne B, Petersen PE, Ouattara S. Oral health behaviour of children and adults in urban and rural areas of Burkina Faso, Africa. Int Dent J. 2006;56(2):61–70.

    PubMed  Google Scholar 

  43. Ogunbodede EO, Kida IA, Madjapa HS, Amedari M, Ehizele A, Mutave R, Sodipo B, Temilola S, Okoye L. Oral health inequalities between rural and urban populations of the African and Middle East Region. Adv Dent Res. 2015;27(1):18–25.

    PubMed  Google Scholar 

  44. Htun K, Peltzer K. Oral health-related quality of life among community dwelling middle-aged and older adults in an urban area in Magway region, Myanmar. Nagoya J Med Sci. 2019;81(1):103–12.

    PubMed  PubMed Central  Google Scholar 

  45. Aysola J, Rewley J, Xu C, Schapira M, Hubbard RA. Primary care patient Social Networks and Tobacco Use: an observational study. J Prim care Community Health. 2022;13:21501327211037894.

    PubMed  PubMed Central  Google Scholar 

  46. Mikami Y, Watanabe Y, Motokawa K, Shirobe M, Motohashi Y, Edahiro A, Nakajima J, Osuka Y, Inagaki H, Fujiwara Y, et al. Association between decrease in frequency of going out and oral function in older adults living in major urban areas. Geriatr Gerontol Int. 2019;19(8):792–7.

    PubMed  Google Scholar 

  47. Takeuchi K, Aida J, Kondo K, Osaka K. Social participation and dental health status among older Japanese adults: a population-based cross-sectional study. PLoS ONE. 2013;8(4):e61741.

    PubMed  PubMed Central  Google Scholar 

  48. Abe T, Nofuji Y, Seino S, Murayama H, Yoshida Y, Tanigaki T, Yokoyama Y, Narita M, Nishi M, Kitamura A, et al. Healthy lifestyle behaviors and transitions in frailty status among independent community-dwelling older adults: the Yabu cohort study. Maturitas. 2020;136:54–9.

    PubMed  Google Scholar 

  49. Rejeski WJ, Fanning J. Models and theories of health behavior and clinical interventions in aging: a contemporary, integrative approach. Clin Interv Aging. 2019;14:1007–19.

    PubMed  PubMed Central  Google Scholar 

  50. Tuuliainen E, Nihtilä A, Komulainen K, Nykänen I, Hartikainen S, Tiihonen M, Suominen AL. The association of frailty with oral cleaning habits and oral hygiene among elderly home care clients. Scand J Caring Sci. 2020;34(4):938–47.

    PubMed  Google Scholar 

  51. Rajeh MT. Gender differences in oral Health Knowledge and Practices among adults in Jeddah, Saudi Arabia. Clin Cosmet Invest Dentistry. 2022;14:235–44.

    Google Scholar 

  52. Márquez-Arrico CF, Almerich-Silla JM, Montiel-Company JM. Oral health knowledge in relation to educational level in an adult population in Spain. J Clin Experimental Dentistry. 2019;11(12):e1143–50.

    Google Scholar 

  53. Paulander J, Axelsson P, Lindhe J. Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds. J Clin Periodontol. 2003;30(8):697–704.

    PubMed  Google Scholar 

  54. Kim SH. Older people’s expectations regarding ageing, health-promoting behaviour and health status. J Adv Nurs. 2009;65(1):84–91.

    PubMed  Google Scholar 

  55. Zhu CLX, He F, Wang Y, Li Y, Wang X, Han W. Oral health knowledge,altitude and practice among the urban disabled elderly. Chin Rural Health Service Adm. 2012;32(02):205–7. [In Chinese].

    Google Scholar 

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Acknowledgements

The authors wish to express sincere gratitude to all subjects for their participation and collaboration, and support.

Funding

This work was supported by the National Natural Science Foundation of China (No.72304003 and No. 71573002), the China Scholarship Council (No. 202209095002), Research fund of Anhui Medical University (No. 2021xkjT049) and Key Laboratory of Public Health Social Governance, Philosophy and Social Sciences of Anhui Province (No. PHG202309). These organizations had no role in the research design, data collection, data analysis, manuscript writing, and submission.

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Author notes

  1. Chenglin Cao and Shengdong Liao contributed equally to this work.

Authors and Affiliations

  1. Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, Anhui, 230032, China

    Chenglin Cao, Wenwen Cao, Ying Guo, Zixuan Hong, Zhi Hu & Zhongliang Bai

  2. Academic Affairs Office, Anhui Medical University, Hefei, Anhui, 230032, China

    Shengdong Liao

  3. Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, 523808, China

    Bohua Ren

  4. Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, WV1 1QU, UK

    Bohua Ren & Zhongliang Bai

  5. Key Laboratory of Public Health Social Governance, Philosophy and Social Sciences of Anhui Province, Hefei, Anhui, 230032, China

    Zhongliang Bai

Authors
  1. Chenglin Cao
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  2. Shengdong Liao
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  3. Wenwen Cao
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  4. Ying Guo
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  5. Zixuan Hong
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  6. Bohua Ren
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  7. Zhi Hu
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  8. Zhongliang Bai
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Contributions

“CC and SL contributed to the design and writing of the article. WC, YG, ZH and BR contributed to the data collection. ZH and ZB contributed to funding acquisition, quality control, data processing, and revised the manuscript. All authors have read and approved the final version.“

Corresponding authors

Correspondence to Zhi Hu or Zhongliang Bai.

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Ethics approval and consent to participate

Informed consent was obtained from all subjects involved in the study. The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Anhui Medical University (No. 20150927).

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Not applicable.

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The authors declare no competing interests.

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Cao, C., Liao, S., Cao, W. et al. Differences in the association of oral health knowledge, attitudes, and practices with frailty among community-dwelling older people in China. BMC Oral Health 23, 782 (2023). https://doi.org/10.1186/s12903-023-03477-y

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Keywords

BMC Oral Health

ISSN: 1472-6831

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