School of Nursing, Xi'an Jiaotong University, 76 Yanta West Road, 710061, Xi'an, China.
Department of Geriatrics, Shaanxi Provincial People's Hospital, 256 Youyi West Road, 710068, Xi'an, China.
BMC Geriatr. 2024 Jan 29;24(1):110. doi: 10.1186/s12877-024-04684-0.
Frailty contributes to adverse outcomes in older adults and places a heavy burden on healthcare resources. Dysphagia is associated with frailty, but the mechanisms by which dysphagia affects frailty in older adults are unclear. This study aimed to investigate a serial mediating effect of self-perceived oral health and self-reported nutritional status in the relationship between dysphagia and frailty among hospitalized older patients in China.
This cross-sectional study included 1200 patients aged ≥ 65 years in the Department of Geriatrics, Shaanxi Provincial People's Hospital. A structured face-to-face interview was used to survey the following questionnaires: General Information Questionnaire, Tilburg Frailty Indicators (TFI), Eating Assessment Tool-10 (EAT-10), 30mL Water Swallow Test (WST), Geriatric Oral Health Assessment Index (GOHAI), and Short-Form Mini-Nutritional Assessment (MNA-SF). A total of 980 participants with complete data were included in the analysis. Statistical analysis was performed using SPSS 26.0 and Amos 28.0 software. Spearman's correlation analysis was used for correlation analysis of study variables. The results of the multivariate linear regression analysis for frailty were used as covariates in the mediation analysis, and the structural equation model (SEM) was used to analyze the mediating effects among the study variables.
Dysphagia, self-perceived oral health, self-reported nutritional status, and frailty were significantly correlated (P<0.001). Dysphagia was found to directly affect frailty (β = 0.161, 95%CI = 0.089 to 0.235) and through three significant mediation pathways: (1) the path through self-perceived oral health (β = 0.169, 95%CI = 0.120 to 0.221), accounting for 36.98% of the total effect; (2) the path through self-reported nutritional status (β = 0.050, 95%CI = 0.023 to 0.082), accounting for 10.94% of the total effect; (3) the path through self-perceived oral health and self-reported nutritional status (β = 0.077, 95%CI = 0.058 to 0.102), accounting for 16.85% of the total effect. The total mediation effect was 64.77%.
This study indicated that dysphagia was significantly associated with frailty. Self-perceived oral health and self-reported nutritional status were serial mediators of this relationship. Improving the oral health and nutritional status of hospitalized older patients may prevent or delay the frailty caused by dysphagia.
衰弱与老年人的不良结局有关，并给医疗资源带来沉重负担。吞咽困难与衰弱有关，但吞咽困难影响老年人衰弱的机制尚不清楚。本研究旨在探讨中国住院老年患者中吞咽困难与衰弱之间关系的自我感知口腔健康和自我报告营养状况的系列中介效应。
本横断面研究纳入了陕西省人民医院老年病科 1200 名年龄≥65 岁的患者。采用结构化面对面访谈调查以下问卷：一般信息问卷、蒂尔堡衰弱指标（TFI）、饮食评估工具-10 （EAT-10）、30 毫升水吞咽测试（WST）、老年口腔健康评估指数（GOHAI）和简易营养评估量表（MNA-SF）。共有 980 名数据完整的参与者纳入分析。使用 SPSS 26.0 和 Amos 28.0 软件进行统计分析。采用 Spearman 相关分析对研究变量进行相关性分析。衰弱的多变量线性回归分析结果被用作中介分析中的协变量，并采用结构方程模型（SEM）分析研究变量之间的中介效应。
吞咽困难、自我感知口腔健康、自我报告营养状况和衰弱之间存在显著相关性（P<0.001）。吞咽困难被发现直接影响衰弱（β=0.161，95%CI=0.089 至 0.235），并通过三个显著的中介途径：（1）通过自我感知口腔健康的途径（β=0.169，95%CI=0.120 至 0.221），占总效应的 36.98%；（2）通过自我报告营养状况的途径（β=0.050，95%CI=0.023 至 0.082），占总效应的 10.94%；（3）通过自我感知口腔健康和自我报告营养状况的途径（β=0.077，95%CI=0.058 至 0.102），占总效应的 16.85%。总中介效应为 64.77%。
本研究表明，吞咽困难与衰弱显著相关。自我感知口腔健康和自我报告营养状况是这种关系的连续中介因素。改善住院老年患者的口腔健康和营养状况可能预防或延迟吞咽困难引起的衰弱。
