The impact of self-management ability on oral frailty in older adults with hypertension: the chain mediating role of anxiety and nutritional status.

BACKGROUND

The incidence of oral frailty among older hypertensive adults is as high as 61.5%, which is mainly characterized by impairments in oral functions such as chewing and speech, which in turn increases the risk of adverse outcomes, and mortality. Previous studies have shown that hypertension self-management ability, anxiety, and nutritional status are influencing factors of oral frailty, yet the mechanisms underlying their interactions remain unclear.

METHODS

This study adopted a cross-sectional survey design. Using convenience sampling, 740 inpatients with hypertension were recruited from five medical institutions in Jiangsu Province. Data were collected through structured face-to-face interviews using the following scales: Self-Management Scale for Patients with Hypertension (SMSPH), Generalized Anxiety Disorder 7-item Scale (GAD-7), Short-Form Mini-Nutritional Assessment (MNA-SF), and Oral Frailty Index-8 (OFI-8). Spearman's correlation analysis was used to test the pairwise correlations among variables, and structural equation modeling (SEM) was employed to analyze mediating effects.

RESULTS

There were significant pairwise correlations between hypertension self-management ability, oral frailty, anxiety, and nutritional status (p < 0.001). Self-management ability not only exerted a direct negative effect on oral frailty (β = -0.037, 95% CI: -0.054 to -0.019) but also acted through three indirect pathways: the anxiety pathway (β = -0.017, 95% CI: -0.024 to -0.011), the nutritional status pathway (β = -0.008, 95% CI: -0.014 to -0.004), and the serial mediation pathway of anxiety-nutritional status (β = -0.009, 95% CI: -0.019 to -0.003). The total mediating effect accounted for 47.90% of the total effect.

CONCLUSION

Anxiety and nutritional status play mediating roles in the relationship between hypertension self-management ability and oral frailty in older hypertensive adults, with a serial mediating effect of anxiety-nutritional status. Clinicians could implement comprehensive intervention measures to improve patients' self-management ability, alleviate anxiety, and optimize nutritional status, thereby preventing and controlling oral frailty.