{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:37:59Z","timestamp":1789155479620,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["001"],"award-info":[{"award-number":["001"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: The objective of this study was to assess clinical-functional vulnerability (CFV) and associated factors in community-dwelling older adults treated in primary care. Methods: A cross-sectional study was conducted with non-institutionalized elderly individuals \u226560 years randomly selected from five Health Units in Jundia\u00ed\/SP, Brazil, in 2023. Sociodemographic data, health behaviors, and data on oral health (number of teeth; chewing: good\/fair\/poor), cognitive function (10-CS), nutritional status (MNA), health literacy (HLS-14), sarcopenia (SARC-F+CC) and frailty (IVCF-20) were collected. Descriptive and bivariate analyses between the outcome (CFV) and the independent variables were performed using the chi-squared test and binary logistic regression models (p &lt; 0.05). Results: A total of 211 older adults participated in this study; 72% were female and the mean age was 70.41 years (\u00b17.45). Regarding CFV, a high risk was identified in 9.5% of the participants (n = 19), a moderate risk in 34.6% (n = 73), and a low risk in 55.9% (n = 118). After adjusting the regression model, the following variables were associated with CFV: lower income (OR = 1.90; 95%CI: 1.02\u20133.55), poor (OR = 5.18; 95%CI: 2.13\u201312.63) and fair (OR = 2.36; 95%CI: 1.10\u20135.05) chewing, risk of malnutrition or malnourished (OR = 2.36; 95%CI: 1.23\u20135.52), and low literacy (OR = 1.86; 95%CI: 1.09\u20133.45). Conclusion: Socioeconomic factors, nutritional status (underweight or malnourished), poor or fair chewing, and low health literacy were associated with CFV among older people. Strengthening primary health care through targeted interventions may help prevent frailty or delay its progression. Understanding the predictors of frailty can guide health professionals, managers, and researchers in designing preventive and health promotion strategies, as well as public policies within Primary Health Care.<\/jats:p>","DOI":"10.3390\/ijerph22101583","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T08:18:54Z","timestamp":1760948334000},"page":"1583","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical-Functional Vulnerability of Older Adults in Primary Care in a Brazilian Municipality: Associated Factors"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6745-4877","authenticated-orcid":false,"given":"Cleomar Ana de Souza","family":"Valentim","sequence":"first","affiliation":[{"name":"Department Community Health, Faculty of Medicine of Jundia\u00ed (FMJ), Jundia\u00ed 13202-550, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9 Silva","family":"Valentim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine of Jundia\u00ed (FMJ), Jundia\u00ed 13202-550, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria da Luz Ros\u00e1rio de","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Collective Health, Pediatric Dentistry and Orthodontics, School of Dentistry of Piracicaba, University of Campinas (FOP\u2013Unicamp), Piracicaba 13414-903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0379-3742","authenticated-orcid":false,"given":"Mar\u00edlia Jesus","family":"Batista","sequence":"additional","affiliation":[{"name":"Department Community Health, Faculty of Medicine of Jundia\u00ed (FMJ), Jundia\u00ed 13202-550, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"ref_1","unstructured":"(2025, October 13). Envelhecimento Saud\u00e1vel\u2014OPAS\/OMS|Organiza\u00e7\u00e3o Pan-Americana da Sa\u00fade [Internet]. Available online: https:\/\/www.paho.org\/pt\/envelhecimento-saudavel."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e00255420","DOI":"10.1590\/0102-311x00255420","article-title":"Fragilidade entre idosos e percep\u00e7\u00e3o de problemas em indicadores de atributos da aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade: Resultados do ELSI-Brasil","volume":"37","author":"Silva","year":"2021","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1056\/NEJMra2301292","article-title":"Frailty in older adults","volume":"391","author":"Kim","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Tan, V., Chen, C., and Merchant, R.A. (2022). Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0277290"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1016\/S2468-2667(19)30226-9","article-title":"Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: A 24-year follow-up of the Whitehall II cohort study","volume":"5","author":"Dugravot","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.gerinurse.2023.11.016","article-title":"Factors associated with poor health literacy in older adults: A systematic review","volume":"55","author":"Lima","year":"2024","journal-title":"Geriatr. Nurs."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S258","DOI":"10.1097\/PHH.0000000000001324","article-title":"Updating health literacy for healthy people 2030: Defining its importance for a new decade in public health","volume":"27","author":"Santana","year":"2021","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yoshida, S., Shiraishi, R., Nakayama, Y., and Taira, Y. (2023). Can nutrition contribute to a reduction in sarcopenia, frailty, and comorbidities in a super-aged society?. Nutrients, 15.","DOI":"10.20944\/preprints202306.2123.v1"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"de Sire, A., Ferrillo, M., Lippi, L., Agostini, F., de Sire, R., Ferrara, P.E., Raguso, G., Riso, S., Roccuzzo, A., and Ronconi, G. (2022). Sarcopenic dysphagia, malnutrition, and oral frailty in elderly: A comprehensive review. Nutrients, 14.","DOI":"10.3390\/nu14050982"},{"key":"ref_10","unstructured":"Oral in, World Health Organization (2025, October 13). Recent Advances in Oral Health: Report of a WHO Expert Committee [Meeting Held in Geneva from 3 to 9 December 1991]. Whoint [Internet]. Available online: http:\/\/apps.who.int\/iris\/handle\/10665\/39644."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"afae052","DOI":"10.1093\/ageing\/afae052","article-title":"The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS)","volume":"53","author":"Kirk","year":"2024","journal-title":"Age Ageing"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e20210257","DOI":"10.1590\/1983-1447.2022.20210257.pt","article-title":"Concord\u00e2ncia entre instrumentos de avalia\u00e7\u00e3o da fragilidade em idosos na aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade","volume":"43","author":"Luchesi","year":"2022","journal-title":"Rev. Ga\u00facha Enferm."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1590\/s1518-8787.2016050006963","article-title":"Clinical-Functional Vulnerability Index-20 (IVCF-20): Rapid recognition of frail older adults","volume":"50","author":"Moraes","year":"2016","journal-title":"Rev. Sa\u00fade P\u00fablica"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"9s","DOI":"10.11606\/s1518-8787.2023057005273","article-title":"Fragilidade e espacializa\u00e7\u00e3o de pessoas idosas no munic\u00edpio de Uberl\u00e2ndia com IVCF-20","volume":"57","author":"Barra","year":"2023","journal-title":"Rev. Saude Publica"},{"key":"ref_15","unstructured":"(2024, June 29). IBGE|Cidades@|S\u00e3o Paulo|Jundia\u00ed|Panorama [Internet], Available online: https:\/\/cidades.ibge.gov.br\/brasil\/sp\/jundiai\/panorama."},{"key":"ref_16","unstructured":"(2025, October 13). Prefeitura de Jundia\u00ed\u00bb Plano Municipal de Sa\u00fade [Internet]. Prefeitura de Jundia\u00ed, Available online: https:\/\/jundiai.sp.gov.br\/saude\/conselho\/plano-municipal-de-saude\/."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/gps.4282","article-title":"Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: The 10-point cognitive screener (10-CS)","volume":"31","author":"Apolinario","year":"2015","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_18","unstructured":"Organiza\u00e7\u00e3o Pan-Americana de Sa\u00fade (2025, October 13). XXXVI Reuni\u00f3n del Comit\u00ea Asesor de Investigaciones em Salud\u2014Encuesta Multic\u00eantrica Salud Beinestar y Envejecimeiento (SABE) en Am\u00e9rica Latina e el Caribe. Informe Preliminar. Available online: https:\/\/iris.paho.org\/handle\/10665.2\/45890."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e230054","DOI":"10.1590\/1981-22562023026.230054.en","article-title":"Body mass index cutoff points and their relationship to chronic non-communicable diseases in older people","volume":"26","author":"Felipe","year":"2023","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_20","unstructured":"World Health Organization (2022). Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030, WHO."},{"key":"ref_21","unstructured":"(2025, October 13). User Guide|MNA [Internet]. Available online: https:\/\/www.mna-elderly.com\/user-guide."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2847","DOI":"10.1590\/1413-81232020257.22282018","article-title":"Translation, cross-cultural adaptation and psychometric evaluation of Brazilian Portuguese version of the 14-item Health Literacy Scale","volume":"25","author":"Batista","year":"2020","journal-title":"Cien Saude Colet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.jamda.2016.08.004","article-title":"Enhancing SARC-F: Improving sarcopenia screening in the clinical practice","volume":"17","author":"Menezes","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/ageing\/afaa219","article-title":"Prevalence of frailty in 62 countries across the world: A systematic review and meta-analysis of population-level studies","volume":"50","author":"Sezgin","year":"2021","journal-title":"Age Ageing"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102082","DOI":"10.1016\/j.arr.2023.102082","article-title":"Recent developments in frailty identification, management, risk factors and prevention: A narrative review of leading journals in geriatrics and gerontology","volume":"91","author":"Dent","year":"2023","journal-title":"Ageing Res. Rev."},{"key":"ref_26","first-page":"250025","article-title":"Associa\u00e7\u00e3o do estado nutricional e sa\u00fade bucal na fragilidade em pessoas idosas da comunidade. Association of nutritional status and oral health with frailty in community-dwelling older adults. Se\u00e7\u00e3o Tem\u00e1tica: Sa\u00fade buccal e Envelhecimento","volume":"28","author":"Valentim","year":"2025","journal-title":"Rev. Bras. Geriatr. Gerontol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Woo, J., Tong, C., and Yu, R. (2018). Chewing difficulty should be included as a geriatric syndrome. Nutrients, 10.","DOI":"10.3390\/nu10121997"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/ger.12406","article-title":"Association between oral health and frailty: A systematic review of longitudinal studies","volume":"36","author":"Hakeem","year":"2019","journal-title":"Gerodontology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"75","DOI":"10.11606\/s1518-8787.2021055002853","article-title":"Mortality, sarcopenic obesity, and sarcopenia: Frailty in Brazilian Older People Study\u2014FIBRA\u2014RJ","volume":"55","author":"Campos","year":"2021","journal-title":"Rev. Saude Publica"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"6086","DOI":"10.56083\/RCV3N6-073","article-title":"Determinantes sociais em sa\u00fade e suas implica\u00e7\u00f5es no processo sa\u00fade doen\u00e7a da popula\u00e7\u00e3o","volume":"3","author":"Machado","year":"2023","journal-title":"Rev. Contemp."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Besora-Moreno, M., Llaurad\u00f3, E., Tarro, L., and Sol\u00e0, R. (2020). Social and economic factors and malnutrition or the risk of malnutrition in the elderly: A systematic review and meta-analysis of observational studies. Nutrients, 12.","DOI":"10.3390\/nu12030737"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1590\/1980-5497201700040004","article-title":"Factors associated with risk of malnutrition in the elderly in south-eastern Brazil","volume":"20","author":"Santos","year":"2017","journal-title":"Rev. Bras. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2036","DOI":"10.1016\/S0140-6736(18)30482-3","article-title":"Tackling socioeconomic inequalities and non-communicable diseases in low-income and middle-income countries under the Sustainable Development agenda","volume":"391","author":"Niessen","year":"2018","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"116","DOI":"10.11606\/s1518-8787.2021055003506","article-title":"The role of health literacy as a factor associated with tooth loss","volume":"55","author":"Tenani","year":"2021","journal-title":"Rev. Saude Publica"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Eyemienbai, E.J., Logue, D., McMonagle, G., Doherty, R., Ryan, L., and Keaver, L. (2025). Enhancing Nutrition Care in Primary Healthcare: Exploring Practices, Barriers, and Multidisciplinary Solutions in Ireland. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22050771"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"832","DOI":"10.6026\/973206300210832","article-title":"Oral health disparities in the elderly: A study on access to dental care and its implications","volume":"21","author":"Sinha","year":"2025","journal-title":"Bioinformation"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/10\/1583\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T08:28:24Z","timestamp":1760948904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/10\/1583"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,18]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["ijerph22101583"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22101583","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,18]]}}}