The Relationship between Dysphagia and Frailty among Chinese Hospitalized Older Patients: A Multiple Mediation Model through Oral Health and Nutritional Status

Abstract OBJECTIVES Frailty contributes to adverse outcomes in older adults and places a heavy burden on healthcare resources. Dysphagia is associated with frailty, but the underlying mechanisms are unclear. This study aimed to investigate the multiple mediating effects of oral health and nutritional status in the relationship between dysphagia and frailty among hospitalized older patients in China. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS The study was conducted at a university-affiliated tertiary hospital in Xi′an, Shaanxi Province, China from May 2022 to December 2022. A total of 980 patients aged ≥65 years were enrolled. METHODS We used 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). Descriptive analysis, univariate analysis, multivariate regression analysis, Spearman′s correlation analysis, and mediation effect test were performed using SPSS 26.0 and Mplus 8.3 software. RESULTS Dysphagia, oral health, nutritional status, and frailty were significantly correlated ( P <0.001). Dysphagia was found to directly affect frailty ( β = 0.196, 95%CI = 0.136 ~ 0.257) and through three significant mediation pathways: 1) the path through oral health ( β = 0.130, 95%CI = 0.102 ~ 0.162), accounting for 28.14% of the total effect; 2) the path through nutritional status ( β = 0.073, 95%CI = 0.046 ~ 0.104), accounting for 15.80% of the total effect; 3) the path through oral health and nutritional status ( β = 0.063, 95%CI = 0.049 ~ 0.082), accounting for 13.64% of the total effect. The total mediation effect was 57.58%. CONCLUSIONS This study indicated that dysphagia was significantly associated with frailty. Oral health and nutritional status were mediators of this relationship. Improving the oral health and nutritional status of hospitalized older patients may prevent or delay the frailty caused by dysphagia.