{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:59:53Z","timestamp":1781240393774,"version":"3.54.1"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2019s correlation analysis was used to test the pairwise correlations among variables, and structural equation modeling (SEM) was employed to analyze mediating effects.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were significant pairwise correlations between hypertension self-management ability, oral frailty, anxiety, and nutritional status (\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). Self-management ability not only exerted a direct negative effect on oral frailty (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.037, 95% CI: \u22120.054 to \u22120.019) but also acted through three indirect pathways: the anxiety pathway (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.017, 95% CI: \u22120.024 to \u22120.011), the nutritional status pathway (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.008, 95% CI: \u22120.014 to \u22120.004), and the serial mediation pathway of anxiety-nutritional status (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.009, 95% CI: \u22120.019 to \u22120.003). The total mediating effect accounted for 47.90% of the total effect.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n 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\u2019 self-management ability, alleviate anxiety, and optimize nutritional status, thereby preventing and controlling oral frailty.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1796196","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:45:52Z","timestamp":1781239552000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of self-management ability on oral frailty in older adults with hypertension: the chain mediating role of anxiety and nutritional status"],"prefix":"10.3389","volume":"13","author":[{"given":"Min","family":"Xu","sequence":"first","affiliation":[{"name":"Office of Medical Consortium Administration, Nanjing Luhe People\u2019s Hospital, Yangzhou University","place":["Nanjing, China"]},{"name":"School of Nursing and School of Public Health, Yangzhou University","place":["Yangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Information, Luhe District Hospital of Traditional Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chernor Sulaiman","family":"Bah","sequence":"additional","affiliation":[{"name":"School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Nanjing Luhe District People's Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Nanjing Luhe People\u2019s Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenjian","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Luhe District People's Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changke","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Nanjing Luhe People\u2019s Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zexiang","family":"Bao","sequence":"additional","affiliation":[{"name":"School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University","place":["Nanjing, China"]},{"name":"Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref1","first-page":"n2","article-title":"Management of the hypertensive dental patient","volume":"89","author":"Valtellini","year":"2023","journal-title":"J Can Dent Assoc"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1111\/ger.12468","article-title":"Rate of oral frailty and oral hypofunction in rural community-dwelling older Japanese individuals","volume":"37","author":"Kugimiya","year":"2020","journal-title":"Gerodontology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1687651","DOI":"10.3389\/fpubh.2026.1687651","article-title":"Construction and validation of a risk prediction model for oral frailty in rural hypertensive patients","volume":"14","author":"Feng","year":"2026","journal-title":"Front Public Health"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1111\/ger.12347","article-title":"Oral hypofunction in the older population: position paper of the Japanese Society of Gerodontology in 2016","volume":"35","author":"Minakuchi","year":"2018","journal-title":"Gerodontology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1736063","DOI":"10.3389\/fonc.2025.1736063","article-title":"Construction and validation of a risk prediction model for oral frailty in elderly patients with esophageal cancer","volume":"15","author":"Lv","year":"2026","journal-title":"Front Oncol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1093\/gerona\/glx225","article-title":"Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly","volume":"73","author":"Tanaka","year":"2018","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/00012272-199703000-00003","article-title":"The middle-range theory of unpleasant symptoms: an update","volume":"19","author":"Lenz","year":"1997","journal-title":"ANS Adv Nurs Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1177\/01939459231217934","article-title":"The mediating role of psychological well-being in the relationship between self-management and quality of life in patients with hypertension","volume":"46","author":"Lee","year":"2024","journal-title":"West J Nurs Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.gerinurse.2024.08.029","article-title":"Current situation and influencing factors of oral frailty for community-dwelling older adults in the northeastern border areas of China: a cross-sectional study","volume":"60","author":"Wang","year":"2024","journal-title":"Geriatr Nurs"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1111\/prd.12616","article-title":"Periodontal disease: a systemic condition","volume":"96","author":"Villoria","year":"2024","journal-title":"Periodontol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2585","DOI":"10.1007\/s11136-019-02191-z","article-title":"Self-management and psychological resilience moderate the relationships between symptoms and health-related quality of life among patients with hypertension in China","volume":"28","author":"Qiu","year":"2019","journal-title":"Qual Life Res"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1186\/s12877-023-03879-1","article-title":"The development of a self-management evaluation scale for elderly adults with hypertension based on the capability, opportunity, and motivation-behaviour (COM-B) model","volume":"23","author":"Wu","year":"2023","journal-title":"BMC 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after non-surgical periodontal treatment: a systematic review","volume":"57","author":"Chatzopoulos","year":"2022","journal-title":"J Periodontal Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"103092","DOI":"10.5498\/wjp.v15.i4.103092","article-title":"Nutritional status of elderly hypertensive patients and its relation to the occurrence of cognitive impairment","volume":"15","author":"Xu","year":"2025","journal-title":"World J Psychiatry"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"260","DOI":"10.3390\/ijerph18010260","article-title":"Sugary liquids in the baby bottle: risk for child undernutrition and severe tooth decay in rural El Salvador","volume":"18","author":"Achalu","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"3141","DOI":"10.2147\/JMDH.S469086","article-title":"Oral health and its associated factors among the elderly in the emergency department: a latent class analysis","volume":"17","author":"Yang","year":"2024","journal-title":"J Multidiscip Healthc"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/nuf.12576","article-title":"Nutritional status and its determinants among community-dwelling older adults in Jordan","volume":"56","author":"Hweidi","year":"2021","journal-title":"Nurs Forum"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"45606","DOI":"10.1038\/s41598-025-29717-5","article-title":"Impact of malnutrition and anxiety on the health of older population in rural China","volume":"15","author":"Sun","year":"2025","journal-title":"Sci Rep"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"7017","DOI":"10.12998\/wjcc.v11.i29.7017","article-title":"Clinical efficacy and safety of Guipi decoction combined with escitalopram oxalate tablets in patients with depression","volume":"11","author":"Yu","year":"2023","journal-title":"World J Clin Cases"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"982","DOI":"10.1097\/HJH.0000000000002453","article-title":"2020 International Society of Hypertension global hypertension practice guidelines","volume":"38","author":"Unger","year":"2020","journal-title":"J Hypertens"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1186\/s12889-024-21158-5","article-title":"The association between cognitive impairment and oral health or oral hygiene behaviors among multiethnic older adults in Western China: a cross-sectional multicenter study","volume":"25","author":"Xie","year":"2025","journal-title":"BMC Public Health"},{"key":"ref25","first-page":"14","article-title":"Sample size calculation in medical studies","volume":"6","author":"Pourhoseingholi","year":"2013","journal-title":"Gastroenterol Hepatol Bed Bench"},{"key":"ref26","first-page":"947","article-title":"Prevalence and influencing factors of oral frailty in elderly residents of nursing 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Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"M366","DOI":"10.1093\/gerona\/56.6.M366","article-title":"Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF)","volume":"56","author":"Rubenstein","year":"2001","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"113078","DOI":"10.1016\/j.exger.2026.113078","article-title":"Construction of a risk prediction model for oral frailty in hospitalized elderly patients with chronic diseases","volume":"216","author":"Huang","year":"2026","journal-title":"Exp Gerontol"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"104340","DOI":"10.1016\/j.archger.2021.104340","article-title":"Oral frailty index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults","volume":"94","author":"Tanaka","year":"2021","journal-title":"Arch Gerontol Geriatr"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1186\/s12903-025-06297-4","article-title":"The relationship between eHealth literacy and oral frailty among older adults: the serial mediating effects of self-efficacy and oral health","volume":"25","author":"Wu","year":"2025","journal-title":"BMC Oral Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"584707","DOI":"10.2147\/PPA.S584707","article-title":"Self-disclosure and fear of progression in younger and middle-aged adults with diabetes: chain-mediating roles of social support and illness perception","volume":"20","author":"Qin","year":"2026","journal-title":"Patient Prefer Adherence"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav Res Methods"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1177\/096228029500400302","article-title":"Generalized additive models for medical research","volume":"4","author":"Hastie","year":"1995","journal-title":"Stat Methods Med Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"2023 ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension endorsed by the International Society of Hypertension (ISH) and the European renal association (ERA)","volume":"41","author":"Mancia","year":"2023","journal-title":"J Hypertens"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1007\/s11906-014-0486-0","article-title":"Anxiety in the \"age of hypertension\"","volume":"16","author":"Byrd","year":"2014","journal-title":"Curr Hypertens Rep"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/jcpe.13189","article-title":"Periodontitis and cardiovascular diseases: consensus report","volume":"47","author":"Sanz","year":"2020","journal-title":"J Clin Periodontol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1038\/s41366-023-01315-3","article-title":"Relationship of perceived depression, stress, anxiety levels and hedonic hunger","volume":"47","author":"Yal\u00e7\u0131n","year":"2023","journal-title":"Int J Obes"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1080\/13548506.2025.2458255","article-title":"Effectiveness of relaxation techniques for stress management and quality of life improvement in cardiovascular disease and hypertensive patients: a systematic review","volume":"30","author":"Calderone","year":"2025","journal-title":"Psychol Health Med"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1002\/agm2.12226","article-title":"Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)","volume":"5","author":"Mao","year":"2022","journal-title":"Aging Med (Milton)"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1056\/NEJM199704173361601","article-title":"A clinical trial of the effects of dietary patterns on blood pressure","volume":"336","author":"Appel","year":"1997","journal-title":"N Engl J Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1093\/nutrit\/nuaa025","article-title":"Nutrition and behavioral health disorders: depression and anxiety","volume":"79","author":"Kris-Etherton","year":"2021","journal-title":"Nutr Rev"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1007\/s12603-020-1511-4","article-title":"Association between oral frailty and nutritional status among community-dwelling older adults: the Takashimadaira study","volume":"24","author":"Iwasaki","year":"2020","journal-title":"J Nutr Health Aging"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1191\/096120300678828299","article-title":"Normal endothelial cell function","volume":"9","author":"Pearson","year":"2000","journal-title":"Lupus"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1717485","DOI":"10.3389\/fpubh.2026.1717485","article-title":"Development and internal validation of a risk prediction model for oral frailty in hospitalized older adults with chronic diseases","volume":"14","author":"Liu","year":"2026","journal-title":"Front Public 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