Abstract
Background
Since the introduction of the concept of oral frailty, various studies in China have primarily focused on individual chronic diseases. However, there is a significant gap in integrated data concerning the prevalence of oral frailty among older patients with multiple chronic conditions. Furthermore, research on associated factors remains fragmented. These gaps highlight the urgent need for comprehensive analyses that can provide robust evidence for the management of oral health in older adults suffering from chronic diseases.
Methods
We systematically searched multiple databases, including PubMed, the Cochrane Library, Web of Science, CINAHL, Embase, CNKI, Wanfang Database, VIP Database, and CBM. Our search encompassed studies published from the inception of each database until August 30, 2025. Statistical analyses were conducted using STATA 17.0. We calculated pooled prevalence estimates of oral frailty and identified associated factors using fixed-effects or random-effects models, as deemed appropriate. We assessed heterogeneity through subgroup analyses and sensitivity analyses, while potential publication bias was evaluated using funnel plots and Egger’s test.
Results
A total of 16 studies involving 5045 participants were included. The overall prevalence of oral frailty among older adults with chronic diseases was found to be 54.33%. Subgroup analyses indicated that the prevalence was notably higher in populations with two or more chronic diseases. Moreover, the meta-analysis identified six factors as risk correlates for oral frailty (advanced age, smoking, frailty, number of comorbid chronic diseases, duration of chronic diseases, and malnutrition) and one factor as a protective correlate (oral self-efficacy).
Conclusion
Based on cross-sectional data from Chinese populations, this systematic review indicates a high prevalence of oral frailty among older adults with chronic diseases, associated with multiple risk and protective correlates. Given its multifactorial nature, integrating structured, multidisciplinary oral frailty management into routine geriatric care is strongly recommended for this population.
Trial registration
The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD420251128575.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12877-026-07524-5.
Keywords: Frailty, Mouth, Chronic Disease, Aged, Systematic Review, Risk Factors
Introduction
The global population is aging at an accelerating pace, making the management of chronic diseases as a central public health challenge. In China, more than 180 million older adults live with chronic conditions, with approximately 75.8% affected by at least one such condition [1]. In this context, maintaining the health of the aging population has become a critical priority. Oral health—a key component of overall health and quality of life—is closely linked to age-related physiological decline [2]. Since its introduction by Japanese scholars in 2013, the concept of “oral frailty” has been recognized as an important clinical precursor, reflecting a mild decline in oral function with potential implications for systemic health [3, 4].
Accumulating evidence indicates a close bidirectional relationship between chronic diseases and oral frailty. For instance, diabetes is a well-established risk factor for periodontitis [5], while antihypertensive medications commonly prescribed for hypertension may contribute to xerostomia [6]. Conversely, oral frailty—through impairments in chewing and swallowing—can exacerbate malnutrition and physical frailty [7, 8]. Moreover, systemic low-grade inflammation triggered by oral infections has been linked to increased cardiovascular risk [9]. This reciprocal interaction forms a detrimental cycle that gradually erodes health reserves in older adults and increases the risk of disability and mortality [10, 11]. Notably, oral frailty is considered reversible, making its early identification a key intervention point to disrupt this cycle and improve health outcomes [4, 12].
Despite its clinical relevance, the evidence base to inform healthcare strategies and policy in China remains fragmented. Existing epidemiological studies are largely confined to specific regions or single chronic diseases, yielding widely varying prevalence estimates and lacking nationally representative data across diverse chronic conditions. Moreover, findings on associated factors—including age, education, health behaviors, and oral health self-efficacy—remain inconsistent, hindering the development of robust risk-assessment models and targeted interventions.
Therefore, we conducted this systematic review and meta-analysis to synthesize the available but scattered evidence and to clarify the overall prevalence and key associated factors of oral frailty among older Chinese adults with chronic diseases. Our findings provide an integrated evidence base to support early screening, risk stratification, and the development of tailored preventive strategies for this growing population.
Methods
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251128575.
Literature search strategy
A systematic literature search was conducted to identify all potentially relevant studies on oral frailty among older patients with chronic conditions, aiming to synthesize evidence specific to the Chinese population. We used a combination of subject headings and free-text terms across Chinese databases (CNKI, Wanfang, VIP, CBM) and international databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library). To ensure comprehensive coverage, no language or geographical restrictions were imposed during the initial search, allowing us to include studies on Chinese populations published worldwide. The search covered all records from database inception to August 30, 2025. No time limits were applied due to the relative novelty of the topic.
For the Chinese databases, searches were uniformly conducted across the title, abstract, and keyword fields. Given that ‘oral frailty’ is an emerging concept with no standardized Chinese terminology, we expanded the search strategy was expanded through preliminary scoping to include related functional terms (e.g., chewing function, swallowing function) in order to maximize sensitivity. The complete search syntax for all databases (Embase, Cochrane Library, Web of Science, etc.) is provided in Supplementary Material 1. For illustrative purposes, the detailed search strategy for PubMed is presented in Table 1.
Table 1.
The literature search strategy of PubMed
| Step | Retrieval term |
|---|---|
| #1 | (Chronic Disease [MeSH Terms) OR (Chronic illnesses [MeSH Terms]) |
| #2 | (Hypertension [MeSH Terms]) OR (Diabetes Mellitus [MeSH Terms]) |
| OR (Neoplasms [MeSH Terms]) OR (Heart Diseases [MeSH Terms]) | |
| OR (Asthma [MeSH Terms]) OR (Rheumatic Diseases [MeSH Terms]) | |
| OR (Hyperlipidaemia [MeSH Terms] OR (Mental Disorders [MeSH Terms]) | |
| OR (Stroke [MeSH Terms]) OR (Parkinson Disease [MeSH Terms]) | |
| #3 | (Aged [MeSH Terms]) OR (Elderly [MeSH Terms]) |
| #4 | (Oral Frailty [Title/Abstract]) OR (Oral Weakness [Title/Abstract]) |
| #5 | #1 OR #2 |
| #6 | #5 AND #3 AND #4 |
Footnotes 1: The detailed search strategies for all databases are available in Supplementary Material 1
Inclusion and exclusion criteria
Inclusion criteria
(1) Study design: Observational studies (cross-sectional or cohort studies) conducted in China; (2) Participants: Chinese older adults (aged ≥ 60 years) with a confirmed diagnosis of one or more chronic diseases (e.g., hypertension, diabetes, cardiovascular diseases), recruited from community or hospital settings; (3) Outcome: Studies employing a validated oral frailty instrument (e.g., OFI-8) to ensure reliable assessment of oral frailty; (4) Data reporting: Studies that reported quantitative data on the prevalence of oral frailty and/or its associated factors; (5) Language: Published in either Chinese or English.
Exclusion criteria
(1) Reviews, meta-analyses, case reports, conference abstracts, commentaries, or study protocols; (2) Studies focusing on individuals with acute, terminal illnesses, or severe cognitive impairment that precluded oral assessment; (3) Duplicate publications; (4) Non-Chinese or non-English publications.
Literature screening and data extraction
Two reviewers (JXL and JL) independently screened the titles, abstracts, and then the full texts of retrieved records against the inclusion and exclusion criteria. They also performed the data extraction independently. Any discrepancies were resolved by consensus or by consulting a third reviewer (TZ). We used EndNote software for reference management and deduplication. The extracted data included: first author, publication year, sample size, gender ratio, chronic disease type, prevalence of oral frailty, and assessment tools used.
Quality assessment
Two reviewers (XMZ and JT) independently evaluated the methodological quality of the included cross-sectional studies using the Agency for Healthcare Research and Quality (AHRQ) criteria. This 11-item tool assigns a rating of "Yes," "No," or "Unclear" to each item. We classified studies as high (total score 8–11), moderate (4–7), or low quality (0–3) based on the cumulative score. In case of disagreements, we sought consensus through discussion or, when necessary, by consulting a third reviewer (TZ).
Statistical methods
We processed and analyzed data using Stata 17.0 software. We calculated the oral frailty rate with 95% confidence intervals (CIs) and generated forest plots. We used the Q test combined with I2 to assess heterogeneity. When I2 ≤ 50% and p > 0.10, indicating acceptable heterogeneity, we selected the fixed-effects model for effect size pooling. When I2 > 50%, indicating substantial heterogeneity, we selected a random-effects model and conducted subgroup analyses to identify sources of heterogeneity. When more than 10 studies were included, we assessed publication bias using Egger's test and a funnel plot, followed by sensitivity analysis through the individual exclusion of studies. We considered p ≤ 0.05 statistically significant.
Results
Literature screening process and outcomes
A total of 839 records were identified from the selected databases. After removing 517 duplicates, 322 records underwent title and abstract screening, resulting in the exclusion of 234 records. Subsequently, 88 full-text articles were assessed for eligibility. Of these, 72 articles were excluded with reasons: 68 due to unsuitable study subjects or content, 2 for having a low quality, and 2 for not reporting the prevalence of oral frailty. Ultimately, 16 studies met all eligibility criteria and were included in this review. Figure 1 illustrates the screening process (See Additional File 1).
Basic characteristics of included studies
All 16 included studies had a cross-sectional in design, collectively enrolling a total of 5045 community-dwelling older adults aged 60 years or above. Sample sizes ranged from 150 to 578 participants. These studies covered diverse geographical regions in China, spanning nine provinces and municipalities. The study locations included eastern coastal areas (e.g., Zhejiang, Guangdong, Jiangsu) [10, 13–17], central regions (e.g., Shanxi, Anhui, Henan) [9, 18–22], and western regions (e.g., Sichuan, Guizhou, Xinjiang Uygur Autonomous Region) [23–26].
The included participants presented with a variety of chronic conditions. The spectrum of diseases encompassed diabetes [9, 10, 14, 16, 18, 21, 23, 26], hypertension [9, 16, 26], chronic obstructive pulmonary disease (COPD) [16, 24], malignant tumors [9, 17, 25], stroke [9, 22], Parkinson's disease [15], end-stage renal disease [13], and coronary heart disease [9]. Two studies did not specify the type of chronic disease [19, 20].
All studies uniformly assessed oral frailty using the Oral Frailty Index-8 (OFI-8). Specifically, seven studies [9, 15, 17, 18, 20, 24, 25] employed the original instrument developed by Tanaka et al. [11], while the remaining studies [10, 13, 14, 16, 19, 21–23, 26] utilized a formally translated and culturally adapted Chinese version validated by Chen et al. [12]. Table 2 summarizes the detailed characteristics of each included study (See Additional File 2).
Quality assessment
Following the screening process, no low-quality studies were included in the final analysis. Based on the AHRQ evaluation criteria, five studies were rated as high quality, and the remainder as moderate quality. Table 3 presents the detailed (See Additional File 3).
Pooled prevalence of oral frailty in older adults with chronic diseases
A total of 16 studies reporting the prevalence of oral frailty were included. We observed significant heterogeneity across studies (I2 = 97.56%, p < 0.001), as shown in Figure 2 (see Additional File 4). Using a random-effects model, the pooled prevalence of oral frailty among older adults with chronic diseases was 54.33% (95% CI = 52.95% – 55.71%). We performed subgroup analyses based on study initiation year, geographic region, sample source, gender ratio, number of chronic conditions, and quality score; we provide the forest plots in Supplementary material 2. These analyses indicated a higher prevalence of oral frailty in studies where participants predominantly had two or more chronic conditions and in those with a male-to-female ratio greater than 1 (predominantly male), as detailed in Table 4 (See Additional File 5).
To further explore the sources of heterogeneity and assess the independent effects of these two factors, we conducted a multivariable meta-regression using restricted maximum likelihood (REML) with Knapp–Hartung adjustment. The model was statistically significant overall (F (2,12) = 4.58, p = 0.033) and accounted for 39.43% of the between-study variance (R2 = 39.43%). After adjusting for gender ratio, the number of chronic conditions emerged as a significant independent moderator, whereas gender ratio was not independently associated with the effect size. Table 5 presents the full results (See Additional File 6).
Factors associated with oral frailty in older adults with chronic diseases
We conducted a meta-analysis on influencing factors reported in at least two studies, encompassing eight factors. The results indicated that advanced age (≥ 70 years), smoking history, frailty, number of chronic diseases (≥ 2), disease duration (≥ 10 years), and malnutrition were risk factors for oral frailty, whereas good oral self-efficacy was a protective factor. Table 6 provides details (See Additional File 7).
Sensitivity analysis and publication bias
Sensitivity analysis of oral frailty prevalence showed no significant difference in the pooled prevalence when any individual study was removed (Figure 3, see Additional File 8), indicating the robustness and stability of the meta-analysis. We assessed publication bias using a funnel plot in conjunction with Egger's test. Although the funnel plot exhibited some visual asymmetry (Figure 4, see Additional File 9), Egger's test yielded a non-significant result (p = 0.329), indicating no statistically significant publication bias in the present study.
Discussion
This study included 16 studies involving 5,045 older adult patients with chronic diseases. The main findings were as follows: (1) the pooled prevalence of oral frailty among Chinese older adults with chronic diseases was 54.33%; (2) subgroup analyses revealed significantly higher prevalence in individuals with ≥ 2 chronic conditions and in those with a male-to-female ratio > 1; multivariable meta-regression further identified the number of chronic conditions as an independent moderator of heterogeneity (β = 1.03, 95% CI: 0.13–1.92, p = 0.028), whereas gender ratio showed no independent effect after adjustment; and (3) good oral self-efficacy emerged as a protective correlate, whereas advanced age (≥ 70 years), smoking, frailty, multimorbidity (≥ 2 chronic conditions), disease duration ≥ 10 years, and malnutrition were identified as significant risk correlates.
The pooled prevalence of 54.33% indicates a high burden of oral frailty in this population. Given the substantial heterogeneity (I2 = 97.56%), this estimate should be interpreted with caution. Although multivariable meta-regression identified the number of chronic conditions as a significant moderator explaining 39.43% of the between-study variance, considerable residual heterogeneity persisted. Regarding the associated factors, our findings confirm the associations of advanced age, frailty, and malnutrition with oral frailty, consistent with prior research [27, 28]. Notably, the number of chronic conditions emerged as the key independent factor linked to oral frailty prevalence, explaining nearly 40% of the between-study variance in the meta-regression model. Patients with two or more chronic diseases experience cumulative physiological burdens that may collectively underpin oral frailty. First, multimorbidity is frequently accompanied by low-grade systemic inflammation, which may be associated with periodontal tissue destruction and impaired oral mucosal integrity [22, 29]. Second, polypharmacy—common in patients with multiple chronic conditions—can induce xerostomia, alter salivary composition, and disrupt oral microbiota homeostasis; these changes, in turn, may increase susceptibility to oral dysfunction [29, 30]. Collectively, these interconnected mechanisms suggest that chronic disease burden relates to oral frailty through multiple synergistic pathways. From a clinical perspective, this finding underscores the importance of assessing the number of chronic conditions when identifying high-risk populations and suggests that effective management of oral frailty may benefit from integrating oral health screening into routine care for patients with multimorbidity.
Regarding gender differences, subgroup analyses showed a higher prevalence among older male patients with chronic diseases, contrasting with previous reports indicating a higher risk among females in the general older adult population [27, 31]. However, multivariable meta-regression revealed that after adjusting for the number of chronic conditions, gender ratio was no longer independently associated with oral frailty. This suggests that the observed subgroup differences may be attributable to the uneven distribution of chronic disease burden across gender groups rather than an independent effect of gender itself—a finding that highlights the need for caution when interpreting subgroup analyses without accounting for potential confounders. Nevertheless, in the general population, men tend to exhibit higher rates of risk behaviors such as smoking and alcohol consumption, and typically show lower adherence to oral health behaviors [32, 33]; whether similar patterns exist among patients with chronic diseases and whether these factors interact synergistically with chronic disease burden to influence oral frailty warrants further investigation.
Beyond these demographic and clinical moderators, oral frailty arises from complex interactions across multiple domains. Its mechanisms span physiological, psychological, and socio-behavioral dimensions, with these factors often exhibiting synergistic effects.
At the physiological level, advanced age is closely associated with reductions in alveolar bone density, oral muscle strength, and salivary secretion [34, 35]. Inadequate intake of protein and key micronutrients (i.e., malnutrition) impairs oral mucosal repair and tooth mineralization, thereby increasing oral vulnerability [36]. Systemic frailty is often accompanied by generalized muscle weakness, including the masticatory muscles—a characteristic linked to reduced chewing efficiency and diminished ability to maintain oral hygiene. Reduced chewing function may in turn limit adequate nutrient intake, creating a mutually reinforcing cycle [35, 37]. Additionally, multimorbidity frequently involves sustained low-grade inflammation and polypharmacy, both associated with oral dryness and tissue damage [29]. A longer disease duration (e.g., ≥ 10 years) has been identified as a risk correlate for oral frailty, as reported in patients with long-standing diabetes [10]. Prolonged illness course likely exacerbates oral vulnerability through cumulative exposure to chronic inflammation and long-term polypharmacy [29, 30], which can lead to persistent xerostomia, altered salivary composition, and disruption of oral microbiota homeostasis, thereby progressively impairing oral function. Behavioral and psychosocial factors also play important roles. Smoking is closely associated with chronic inflammation and irritation of the oral mucosa [38]. In contrast, higher oral self-efficacy appears protective, potentially by promoting positive health behaviors and more timely engagement with professional care [39]. Additionally, although depression did not show a significant association in the present study, previous research suggests it may increase oral frailty risk through effects on oral health behaviors and medication-induced dry mouth [40]; its potential role nonetheless warrants attention.
One methodological consideration warrants attention when interpreting these findings. All included studies assessed oral frailty using the OFI-8, which was originally developed in Japan. However, two types of versions were employed: some studies used a direct translation of the original English version, while others used a formally adapted Chinese version with established reliability and validity. This coexistence introduces heterogeneity, as differences in item wording, response formats, or cultural appropriateness may affect measurement equivalence. Moreover, the cross-cultural validity of the OFI-8—whether its conceptual framework and item performance are transferable from the original English version to Chinese populations—has not been systematically established. These considerations limit comparability across studies and warrant caution when interpreting pooled estimates.
It is noteworthy to distinguish between the two related concepts of oral frailty and oral sarcopenia. Oral sarcopenia specifically refers to the loss of masticatory muscle mass, strength, and function, with its core lying in the muscular dimension [41]. Oral frailty, however, is a broader multidimensional syndrome encompassing not only chewing function but also swallowing, oral hygiene, salivary function, and related health behaviors [3, 4]. Based on this, we strongly advocate for establishing a structured multidisciplinary collaborative intervention model in clinical practice. A core team should be formed consisting of geriatricians, dentists, clinical dietitians, nurses, and mental health professionals to develop integrated care plans for individuals at high risk of or already presenting with oral frailty. For example, geriatricians can optimize medications to reduce dry mouth side effects, dentists can manage oral diseases and guide oral function training, clinical dietitians can design nutritionally balanced and easy-to-chew meal plans, nursing staff can provide personalized oral hygiene instruction and health education, and mental health professionals can assess and support psychological status.
Limitations
A key strength of this study lies in the systematic synthesis of evidence on the prevalence and influencing factors of oral frailty among Chinese older adults with chronic diseases, providing detailed subgroup analyses and multivariable meta-regression that form a basis for identifying high-risk groups and developing stratified intervention strategies. However, several limitations must be acknowledged. First, the included studies were predominantly cross-sectional, which precludes causal inference. Moreover, although we extracted adjusted effect sizes from multivariate models, the possibility of residual confounding cannot be ruled out, as the original studies may have lacked adjustment for important confounders (e.g., oral health behaviors, socioeconomic status, medication details). Second, the exclusive focus on Chinese samples limits the generalizability of our findings to other ethnic or cultural groups, where differences in socio-cultural and behavioral factors (e.g., smoking habits, dietary practices) may exist. Therefore, whether our conclusions apply to non-Chinese populations remains to be determined. Third, although meta-regression identified the number of chronic conditions as an independent moderator, substantial residual heterogeneity remained, suggesting that other unmeasured factors (e.g., specific types of chronic diseases, disease severity, medication regimens, oral health literacy) may also contribute and warrant further investigation. Fourth, although Egger’s test did not reach statistical significance (p > 0.05), the limited number of included studies (n = 16) limits the statistical power of the test, reducing its ability to detect true publication bias. Moreover, asymmetry was observed in the funnel plot, which may indicate potential small‑study effects, differences in methodological quality across studies, or genuine heterogeneity in effect sizes. Given the relatively small number of original studies, all pooled estimates—particularly those with high heterogeneity or based on few studies—should be interpreted with caution. Additionally, the gender differences observed in subgroup analyses should be interpreted with caution, as this difference was not statistically significant after adjusting for chronic disease burden in the multivariable model. Finally, all included studies used the OFI-8, limiting comparability with studies using other assessment tools (e.g., OFI-5, OFI-6). Additionally, the coexistence of direct translation versions (with unverified cross-cultural applicability) and formally adapted Chinese versions introduces potential measurement heterogeneity that remains unexamined.
Recommendations for future research
Based on these limitations, future research should prioritize the following directions. First, large-scale longitudinal studies are needed to clarify the developmental trajectory of oral frailty and its causal relationship with chronic diseases, alongside intervention trials to evaluate the effectiveness of multidisciplinary collaborative models. To further address the high heterogeneity and potential residual confounding, future studies should adopt standardized protocols for oral frailty assessment and collect detailed information on a wide range of confounders. Second, comparative studies across different cultures and ethnicities are crucial for testing the generalizability of the current findings and elucidating the specific roles of socio-cultural and behavioral factors. Third, to address the potential for publication bias and small‑study effects, future well‑powered studies with larger sample sizes and prospective designs are necessary. Moreover, the registration of study protocols and the publication of studies with null or non‑significant results should be encouraged to reduce publication bias. Fourth, future research should compare different versions of oral frailty assessment tools (e.g., direct translation vs. formally adapted versions, OFI-5 vs. OFI-8) within the same population to establish measurement equivalence and cross-cultural validity. Fifth, given the independent role of chronic disease burden, future studies should explore how different disease types, combinations, and medication regimens differentially affect oral frailty risk. Finally, with advancements in digital technology, the potential of smart screening, personalized digital health records, and dynamic risk monitoring in oral health services should be explored to enhance prevention and management efficiency.
Conclusion
This study indicates a high prevalence of oral frailty among older adults with chronic diseases. Good oral self-efficacy is a protective correlate, while advanced age, smoking, frailty, multiple chronic conditions, long disease duration, and malnutrition are risk correlates. These findings highlight the multifactorial nature of oral frailty, involving intertwined medical, nutritional, functional, and psychosocial dimensions. This complexity renders single-discipline approaches insufficient, underscoring the urgent need to integrate screening and management of oral frailty into comprehensive geriatric care through a structured, multidisciplinary approach.
Supplementary Information
Supplementary Material 1: Fig. 1 Literature Screening Process.
Supplementary Material 2: Table 2 Characteristics of included studies. Footnotes 2: OFI-8, Oral Frailty Index-8; a Original English version developed by Tanaka et al. [11]; b Formally translated and validated Chinese version by Chen et al. [12].
Supplementary Material 3: Table 3 Quality Appraisal of Included Cross-Sectional Studies. Footnotes 3: a Specified data sources; b Detailed inclusion/exclusion criteria for exposed and unexposed groups, or referenced published criteria; c Specified study population timeframe; d Continuity of inclusion of all subjects within a specific time period if not population-based; e Isolation of assessors for subjective measures from other objective information; f Description of any quality-assuring assessments; g Explanation of reasons for excluding subjects; h Description of how confounding variables were assessed and controlled; i Reporting of missing data rates and handling methods; j Summarized patient response rates and data collection completeness; k Reported loss-to-follow-up rates and incomplete data proportions if follow-up was conducted.
Supplementary Material 4: Fig. 2 Forest Plot of the Pooled Prevalence of Oral Frailty in Older Patients with Chronic Diseases.
Supplementary Material 5: Table 4 Subgroup Analysis of Oral Frailty Prevalence in Older Patients with Chronic Diseases.
Supplementary Material 6: Table 5 Multivariable Meta-Regression Analysis of Factors Associated with Oral Frailty Prevalence. Footnotes: CI = confidence interval. The dependent variable was the logit-transformed prevalence of oral frailty. The model was fitted using random-effects meta-regression with restricted maximum likelihood (REML) estimation and Knapp-Hartung standard error adjustment. *One of the 16 included studies did not report gender ratio and was excluded from the meta regression, therefore n = 15 for this analysis.
Supplementary Material 7: Table 6 Meta-Analysis of Factors Associated with Oral Frailty in Older Patients with Chronic Diseases.
Supplementary Material 8: Fig. 3 Sensitivity Analysis of the Pooled Prevalence of Oral Frailty.
Supplementary Material 9: Fig. 4 Funnel Plot Estimating Publication Bias in the Reviewed Studies.
Supplementary Material 10: Complete Search Strategies.
Supplementary Material 11: Forest Plots for Each Subgroup Analysis.
Acknowledgements
None.
Abbreviations
- PRISMA
Preferred Reporting Items for Systematic Review and Meta-analysis
- PROSPERO
The International Prospective Register of Systematic Reviews
- AHRQ
The Agency for Healthcare Research and Quality
- NOS
Newcastle–Ottawa Scale
- CI
Confidence Interval
- OFI
Oral Frailty Index
- COPD
Chronic Obstructive Pulmonary Disease
- REML
Restricted Maximum Likelihood
Authors’ contributions
TZ and JZ Conceived the research question and the study design. TZ, JL, and JXL searched for manuscripts, registered study protocol on Prospero, and extracted the data. TZ, JZ, and JL contributed to the analysis and interpretation of data. TZ, XMJ and JT contributed to the quality assessment, all authors contributed to the writing and editing of the manuscript and agreed to the final manuscript.
Funding
This study was supported by the Sanming Project of Medicine in Shenzhen (SZSM 202111012, Oral and Maxillofacial Surgery Team, Professor Yu Guangyan, Peking University Hospital of Stomatology); Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties (No. SZGSP008).
Data availability
All data generated or analysed during this study are included in this published article and its supplementary materials.
Declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Material 1: Fig. 1 Literature Screening Process.
Supplementary Material 2: Table 2 Characteristics of included studies. Footnotes 2: OFI-8, Oral Frailty Index-8; a Original English version developed by Tanaka et al. [11]; b Formally translated and validated Chinese version by Chen et al. [12].
Supplementary Material 3: Table 3 Quality Appraisal of Included Cross-Sectional Studies. Footnotes 3: a Specified data sources; b Detailed inclusion/exclusion criteria for exposed and unexposed groups, or referenced published criteria; c Specified study population timeframe; d Continuity of inclusion of all subjects within a specific time period if not population-based; e Isolation of assessors for subjective measures from other objective information; f Description of any quality-assuring assessments; g Explanation of reasons for excluding subjects; h Description of how confounding variables were assessed and controlled; i Reporting of missing data rates and handling methods; j Summarized patient response rates and data collection completeness; k Reported loss-to-follow-up rates and incomplete data proportions if follow-up was conducted.
Supplementary Material 4: Fig. 2 Forest Plot of the Pooled Prevalence of Oral Frailty in Older Patients with Chronic Diseases.
Supplementary Material 5: Table 4 Subgroup Analysis of Oral Frailty Prevalence in Older Patients with Chronic Diseases.
Supplementary Material 6: Table 5 Multivariable Meta-Regression Analysis of Factors Associated with Oral Frailty Prevalence. Footnotes: CI = confidence interval. The dependent variable was the logit-transformed prevalence of oral frailty. The model was fitted using random-effects meta-regression with restricted maximum likelihood (REML) estimation and Knapp-Hartung standard error adjustment. *One of the 16 included studies did not report gender ratio and was excluded from the meta regression, therefore n = 15 for this analysis.
Supplementary Material 7: Table 6 Meta-Analysis of Factors Associated with Oral Frailty in Older Patients with Chronic Diseases.
Supplementary Material 8: Fig. 3 Sensitivity Analysis of the Pooled Prevalence of Oral Frailty.
Supplementary Material 9: Fig. 4 Funnel Plot Estimating Publication Bias in the Reviewed Studies.
Supplementary Material 10: Complete Search Strategies.
Supplementary Material 11: Forest Plots for Each Subgroup Analysis.
Data Availability Statement
All data generated or analysed during this study are included in this published article and its supplementary materials.