The aging global population has brought increased attention to the health issues faced by elderly patients with chronic diseases. Cognitive decline, a key factor affecting their quality of life, is closely linked to adverse outcomes such as rehospitalization, functional impairment, and mortality. If left unaddressed, cognitive decline can progress to mild cognitive impairment (MCI) and eventually dementia, placing a significant burden on families and society. MCI is an intermediate stage between normal aging and dementia, characterized by a decline in memory and cognitive function. The prevalence of MCI and dementia is notably higher among patients with chronic diseases compared to the general population, posing a serious challenge to global public health. Therefore, early identification of cognitive decline and timely intervention are crucial for improving the quality of life of these patients and alleviating the burden on families and society.
To address oral health issues in older adults more comprehensively, the concept of "oral frailty" has emerged. This novel framework not only reflects the overall oral function of older adults but also offers a systematic perspective on the relationship between oral health and general health. Oral frailty is defined as a series of age-related changes in various oral conditions, such as the number of teeth, oral function, and oral hygiene, accompanied by a decline in interest in oral health and physical and psychological reserves. The core clinical manifestations include deteriorating oral health, impaired chewing, swallowing, and salivation, oral pain, and reduced oral motor function. Studies have shown that oral frailty is a significant risk factor for malnutrition, sarcopenia, cognitive decline, and reduced quality of life in older adults.
This study aims to investigate the mediating role of nutritional status and the inflammatory marker C-reactive protein (CRP) in the relationship between oral frailty and cognitive function in elderly patients with chronic diseases. The findings suggest that nutritional status and CRP have direct and chain-mediated effects on the relationship between oral frailty and cognitive function. Improving nutritional status and reducing chronic inflammation levels can help delay or even reverse the onset and progression of cognitive dysfunction in this patient population.
The study employed a cross-sectional design, selecting patients aged 60 years or older with chronic diseases from three tertiary hospitals in Henan Province using convenience sampling. Data were collected using questionnaires, including the general information questionnaire, the Oral Frailty Screening Index-8 (OFI-8), the Mini Nutritional Assessment Short Form, the Montreal Cognitive Assessment, and laboratory tests for CRP. Descriptive demographic analysis and Pearson correlation analysis were conducted using SPSS 26.0, and the model 6 in macro program Process 4.1 was used to test the chain mediation effect.
The results showed that oral frailty had a significant direct impact on cognitive function, and nutritional status and CRP also had significant effects on cognitive function. The mediating effect analysis revealed that nutritional status and CRP had simple mediating effects between oral frailty and cognitive function, and the chain mediating effect was significant.
The study highlights the importance of early identification of oral frailty and comprehensive intervention to improve cognitive function in elderly patients with chronic diseases. Future research should explore ways to slow down oral frailty and cognitive decline through effective nutritional intervention and reduction of chronic inflammation, ultimately enhancing the health status of this patient group.
