{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:51:12Z","timestamp":1792173072696,"version":"4.4.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002634","name":"Hoseo University","doi-asserted-by":"publisher","award":["20230306"],"award-info":[{"award-number":["20230306"]}],"id":[{"id":"10.13039\/501100002634","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frailty in older adults is a critical public health concern associated with increased morbidity, disability, and healthcare utilization. Although systemic health and socioeconomic factors are well-established determinants of frailty, the multidimensional nature of oral health has received relatively limited attention in previous research. The aim of this study was to examine the associations between general characteristics, health-related factors, oral health factors, and frailty among community-dwelling older adults, and to identify sex differences in frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study used data from the 2022 Korean Longitudinal Study of Aging (KLoSA) and included 3,729 individuals aged 65 years and older. Frailty was categorized as robust, pre-frail, or frail using the Frailty Instrument developed for older Korean adults. General characteristics, health-related factors, and oral health-related factors (structural, behavioral, and subjective) were assessed through structured questionnaires. Hierarchical logistic regression analysis was performed in three steps to identify factors associated with frailty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the participants, 16.0% were frail and 84.0% were non-frail (31.5% pre-frail and 52.5% robust). Sex-stratified analyses also showed that structural oral health factors were most strongly associated with frailty in both sexes. Edentulous status without denture use was associated with the highest odds of frailty in both women (OR = 3.76, 95% CI\u2009=\u20093.72\u20133.80) and men (OR = 2.95, 95% CI\u2009=\u20092.91\u20132.98). In contrast, sex differences were observed for some subjective oral health factors: tooth sensitivity was associated with higher odds of frailty in women (OR = 1.82, 95% CI\u2009=\u20091.80\u20131.84) but lower odds in men (OR = 0.85, 95% CI\u2009=\u20090.84\u20130.86).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Oral health conditions, including untreated tooth loss, difficulty in chewing or swallowing, and oral pain, were significantly associated with frailty. These findings suggest that oral health may be an important factor to consider in relation to frailty among community-dwelling older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360682","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:23:24Z","timestamp":1792171404000},"page":"e0360682","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidimensional oral health and frailty in older adults: A sex-stratified cross-sectional study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1602-1071","authenticated-orcid":true,"given":"Jeong-Eun","family":"Yang","sequence":"first","affiliation":[{"name":"Jesus University","place":["Jeonju, Jeonbuk State, Republic of Korea"],"department":["Department of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8270-4524","authenticated-orcid":true,"given":"SeolHwa","family":"Moon","sequence":"additional","affiliation":[{"name":"Hoseo University","place":["Asan, Chungcheongnam-do, Republic of Korea"],"department":["Department of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"pone.0360682.ref001","unstructured":"World Health Organization. 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Korean Longitudinal Study of Aging (KLoSA). https:\/\/survey.keis.or.kr\/eng\/klosa\/klosa01.jsp. Accessed 2026 April 15."},{"issue":"2","key":"pone.0360682.ref016","first-page":"107","article-title":"The development of Korean activities of daily living (K-ADL) and Korean instrumental activities of daily living (K-IADL) scale","volume":"6","author":"CW Won","year":"2002","journal-title":"J Korean Geriatr Soc"},{"issue":"1","key":"pone.0360682.ref017","doi-asserted-by":"crossref","DOI":"10.2174\/18742106-v16-e2209270","article-title":"Modifiable and non-modifiable risk factors affecting oral and periodontal health and quality of life in South Asia","volume":"16","author":"MI Karobari","year":"2022","journal-title":"TODENTJ"},{"issue":"11","key":"pone.0360682.ref018","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s12603-022-1858-9","article-title":"association between poor oral health and frailty in middle-aged and older individuals: A cross-sectional national study","volume":"26","author":"F Diaz-Toro","year":"2022","journal-title":"J Nutr Health 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Epidemiol"},{"issue":"5","key":"pone.0360682.ref025","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s12603-019-1179-9","article-title":"Prevalence and risk factors for frailty among community-dwelling older people in China: A systematic review and meta-analysis","volume":"23","author":"B He","year":"2019","journal-title":"J Nutr Health Aging"},{"issue":"3","key":"pone.0360682.ref026","doi-asserted-by":"crossref","DOI":"10.1016\/S2666-7568(23)00263-5","article-title":"The relationship between frailty and social vulnerability: A systematic review","volume":"5","author":"P Hanlon","year":"2024","journal-title":"Lancet Healthy Longev"},{"issue":"15","key":"pone.0360682.ref027","doi-asserted-by":"crossref","first-page":"7918","DOI":"10.3390\/ijerph18157918","article-title":"Health Literacy and Frailty in Community-Dwelling Older Adults: Evidence from a Nationwide Cohort Study in South Korea","volume":"18","author":"H-R Shin","year":"2021","journal-title":"Int J Environ Res 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study","volume":"20","author":"S Takahashi","year":"2020","journal-title":"BMC Geriatr"},{"issue":"5","key":"pone.0360682.ref031","doi-asserted-by":"crossref","first-page":"3813","DOI":"10.3390\/ijerph20053813","article-title":"Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review","volume":"20","author":"M Dram\u00e9","year":"2023","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pone.0360682.ref032","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1007\/s12603-023-2014-x","article-title":"Number of teeth and denture use are associated with frailty among chinese older adults: A cohort study based on the CLHLS from 2008 to 2018","volume":"27","author":"J Zhang","year":"2023","journal-title":"J Nutr Health Aging"},{"issue":"19","key":"pone.0360682.ref033","doi-asserted-by":"crossref","first-page":"3233","DOI":"10.1080\/10408398.2020.1793729","article-title":"Breaking the vicious circle of diet, malnutrition and oral health for 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