Factors Associated with Oral Frailty in Older Adults: A Systematic Review and Meta-Analysis

Yanru Chen^1,2Ling Zhang^1,2Wen Yan^2,3Liu Fan^2,4*

• ¹State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases &, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Sichuan University West China School of Stomatology, Chengdu, China
• ²West China Hospital of Stomatology, Chengdu, China
• ³State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases &, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan Province, China, Sichuan University West China School of Stomatology, Chengdu, China
• ⁴State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases &, Department of Nursing, West China Hospital of Stomatology, Sichuan University, Sichuan University West China School of Stomatology, Chengdu, China

Background: Oral frailty (OF) is defined as a series of age-related decline of oral function, which caused malnutrition and many other negative health outcomes. This study aimed to comprehensively examine the factors associated with OF in older adults, in order to provide a further direction for the early identification and tailored interventions of OF in this population. Methods: PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), CQVIP and Wanfang database were comprehensively searched for observational studies from inception to April, 2025. All analyses were performed by RevMan5 (version 5.4) and Stata 16.0 software. Results: A total of 39 studies were selected from 10863 references, which involves 41854 older adults were included in this systematic review. A meta-analysis was performed on 27 influencing factors. Age (WMD=4.21, 95%CI: 3.09-5.33), female gender (OR=1.76, 95%CI: 1.41-2.20), years of education (WMD=0.68, 95%CI: -0.04-1.41), low income (OR=1.94, 95%CI: 1.20-2.68), BMI (WMD=1.50, 95%CI: 0.41-5.59), sarcopenia (OR=2.92, 95%CI: 2.54-3.36), stroke (OR=2.68, 95%CI: 1.28-5.61), osteoporosis (OR=1.50, 95%CI: 1.05-2.13), cognitive impairment (OR=4.25, 95%CI: 1.72-10.51), ≥2 chronic conditions (OR=6.07, 95%CI: 2.32-15.90), taking ≥5 medications (OR=2.48, 95%CI: 1.59-3.88), poor sleep quality (OR=3.79, 95%CI: 1.47-9.80), physical frailty (OR=2.21, 95%CI: 1.63-3.00), low physical activity level (OR=1.77, 95%CI: 1.41-2.22), ADL impairment (OR=4.46, 95%CI: 1.81-11.01), depression (OR=3.76, 95%CI: 2.69-5.24), social isolation (OR=1.95, 95%CI: 1.43-2.65), malnutrition (OR=2.58, 95%CI: 1.55-4.28), low dietary variety (OR=1.69, 95%CI: 1.37-2.08) and poor appetite (OR=2.11, 95%CI: 1.62-2.74) were found a significant associations with oral frailty in older adults. Conclusion: We identified a total of 20 factors associated with oral frailty in older adults, categorized into five primary domains: sociodemographic factors, comorbidity factors, physical function factors, social and psychological factors, and dietary factors. It is advisable for public health policymakers and healthcare practitioners to undertake a comprehensive evaluation of these associated factors, and to develop targeted intervention strategies designed to reduce oral frailty, thereby enhancing the overall health of the older population.