社区老年人口腔衰弱风险预测模型的构建及验证

doi:10.3761/j.issn.0254-1769.2025.03.003

摘要/Abstract

摘要：

目的分析社区老年人口腔衰弱的影响因素，构建并验证其风险预测模型，为早期识别、预防老年人口腔衰弱提供参考。方法于2024年6月—8月，采用便利抽样方法，选取四川省自贡市4个社区的556名老年人为调查对象，将其随机分为训练集（n=383）和验证集（n=165），采用一般资料调查表、社会衰弱量表、老年抑郁量表和口腔衰弱指数问卷收集资料。采用Logistic回归确定口腔衰弱的影响因素，运用R软件构建口腔衰弱风险预测模型并绘制列线图；采用加强Bootstrap法和验证集进行内部验证，采用受试者操作特征曲线下面积、校准曲线、决策曲线评价模型的预测性能。结果回收有效问卷548份，年龄是否≥80岁、是否佩戴可拆卸义齿、外出频次是否减少、每日刷牙是否<2次、是否经常口干、是否进食硬食物更困难、进食是否有呛咳是社区老年人口腔衰弱的预测因子。训练集受试者操作特征曲线下面积为0.95（95%CI：0.93~0.97），最佳截断值为0.687、准确度为87%、灵敏度为91%、特异度为85%、阳性预测值为0.75、阴性预测值为0.95。Hosmer-Lemeshow拟合检验结果（χ²=3.036，P=0.932）显示模型拟合优度良好。结论口腔衰弱风险预测模型具有良好的区分度、校准度和临床实用性，可为社区老年人口腔衰弱的预防和早期筛查提供参考。

关键词: 口腔衰弱, 老年人, 预测模型, 列线图, 社区护理

Abstract:

Objective This study examines the factors influencing oral frailty in the elderly community，develops a risk prediction model，and validates its efficacy，so as to provide references for identifying and preventing oral weakness in the elderly. Methods 556 elderly individuals from 4 communities were selected by convenience sampling from June to August 2024 in Zigong City Sichuan Province. They were randomly divided into a training group（383 cases）and a validation group（165 cases）. Data were collected by a general information questionnaire，Social Frailty Scale，Geriatric Depression Scale，and the Oral Frailty Index-8 screening tool. Logistic regression was used to determine the influencing factors，and R software was used to establish a nomogram model for predicting the risk of oral frailty. Bootstrap method and the validation group were used for internally validation of the model. Calibration curve was used to evaluate the prediction performance of the model. Results 548 valid questionnaires were collected. The final model variables included whether the age≥80 years，wearing removable dentures，reduced frequency of going out，brushing teeth less than twice a day，frequent dry mouth，increased difficulty in eating hard foods，and choking. The area under the receiver operating characteristic curve of the training group was 0.95（95%CI：0.93~0.97），and the best cutoff value was 0.687. The model achieved an accuracy of 87%，sensitivity of 91%，specificity of 85%，positive predictive value of 0.75，and negative predictive value of 0.95. The Hosmer-Lemeshow fitting test show that χ²=3.036，P=0.932，indicating a good model fit. Conclusion The oral frailty prediction model demonstrated a good discrimination，calibration，and clinical utility，which can provide a scientific basis for the prevention and early screening of oral frailty in the elderly.

Key words: Oral frailty, Aged, Prediction Model, Nomograms, Community Nursing

王敏, 杨文娟, 廖婷, 邹金梅, 廖冬霞, 张翠翠, 邓颖一, 龚喜燕, 廖常菊. 社区老年人口腔衰弱风险预测模型的构建及验证[J]. 中华护理杂志, 2025, 60(3): 274-280.

WANG Min, YANG Wenjuan, LIAO Ting, ZOU Jinmei, LIAO Dongxia, ZHANG Cuicui, DENG Yingyi, GONG Xiyan, LIAO Changju. Construction and validation of a risk prediction model for oral frailty in the elderly community population[J]. Chinese Journal of Nursing, 2025, 60(3): 274-280.

图/表 7

表1 不同特征社区老年人口腔衰弱分布情况比较[例（百分比，%）]

Table 1 Comparison of the distribution of oral frailty among elderly people in communities with different characteristics[case（percentage，%）]

表2 自变量赋值方式

Table 2 Assignment of independent variables

表3 社区老年人口腔衰弱影响因素的Logistic回归分析（n=383）

Table 3 Logistic regression analysis result of influential factors for oral frailty among the community elderly（n=383）

图1 社区老年人口腔衰弱发生风险的列线图

Figure 1 Nomogram for predicting oral frailty among the community elderly

图2 口腔衰弱风险预测模型的受试者操作特征曲线下面积

Figure 2 The receiver operating characteristic curve for oral frailty prediction model

图3 模型内部验证校准图（训练集和验证集）注：A为训练集模型内部验证校准图，B为验证集模型内部验证校准图。

Figure 3 The calibration curve of model internal validation（training set and validation set）

图4 模型决策曲线（训练集和验证集）注：a为训练集模型决策曲线，b为验证集模型决策曲线。

Figure 4 The decision curve of the model（training set and validation set）

参考文献 24

[1]	Parisius KGH, Wartewig E, Schoonmade LJ, et al. Oral frailty dissected and conceptualized:a scoping review[J]. Arch Gerontol Geriatr, 2022, 100:104653.
[2]	Dibello V, Lobbezoo F, Lozupone M, et al. Oral frailty indicators to target major adverse health-related outcomes in older age:a systematic review[J]. Geroscience, 2023, 45(2):663-706.
[3]	Li T, Shen YL, Leng YJ, et al. The prevalence of oral frailty among older adults:a systematic review and meta-analysis[J]. Eur Geriatr Med, 2024, 15(3):645-655.
[4]	Neelamana SK, Janakiram C. Characterizing the literature on validity and assessment tool of oral frailty:a systematic scoping review[J]. J Contemp Dent Pract, 2022, 23(6):659-668. PMID
[5]	Tanaka T, Takahashi K, Hirano H, et al. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly[J]. J Gerontol A Biol Sci Med Sci, 2018, 73(12):1661-1667.
[6]	Choi JH, Kang JH, Koh SB, et al. Development of an Oral and Maxillofacial Frailty Index:a preliminary study[J]. J Oral Rehabil, 2020, 47(2):187-195.
[7]	Kang JH, Park SC, Jung HI, et al. Validation of the Korean Academy of Geriatric Dentistry Screening Questionnaire and Oral Frailty Diagnostic Criteria in Community-Dwelling Older Adults[J]. Epidemiol Health, 2024, 46:e2024008.
[8]	Tanaka T, Hirano H, Ohara Y, et al. Oral Frailty Index-8 in the risk assessment of new-onset oral frailty and functional disability among community-dwelling older adults[J]. Arch Ge-rontol Geriatr, 2021, 94:104340.
[9]	屠杭佳, 张书怡, 方雨慧, 等. 社区老年人口腔衰弱现状及影响因素分析[J]. 中华护理杂志, 2023, 58(11):1351-1356. DOI URL
	Tu HJ, Zhang SY, Fang YH, et al. Current situation and influencing factors of oral frailty in the community elderly[J]. Chin J Nurs, 2023, 58(11):1351-1356. DOI URL
[10]	Hironaka S, Kugimiya Y, Watanabe Y, et al. Association between oral,social,and physical frailty in community-dwelling older adults[J]. Arch Gerontol Geriatr, 2020, 89:104105.
[11]	Park KE, Lee H, Kwon YD, et al. Association between changes in oral health-related quality of life and depressive symptoms in the Korean elderly population[J]. Int J Public Health, 2023, 68:1605403.
[12]	Teo N, Yeo PS, Gao Q, et al. A bio-psycho-social approach for frailty amongst Singaporean Chinese community-dwelling older adults-evidence from the Singapore longitudinal aging study[J]. BMC Geriatr, 2019, 19(1):350.
[13]	张露露, 高静, 吴晨曦, 等. 社会衰弱指数量表的汉化及信效度检验[J]. 护理学杂志, 2023, 38(8):102-105.
	Zhang LL, Gao J, Wu CX, et al. Translation and validation of the Social Frailty Index scale[J]. J Nurs Sci, 2023, 38(8):102-105.
[14]	Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a Geriatric Depression Screening Scale:a preliminary report[J]. J Psychiatr Res, 1982, 17(1):37-49. DOI PMID
[15]	Zhang C, Zhang H, Zhao MH, et al. Assessment of Geriatric Depression Scale’s applicability in longevous persons based on classical test and item response theory[J]. J Affect Disord, 2020, 274:610-616.
[16]	Yamamoto T, Tanaka T, Hirano H, et al. Model to predict oral frailty based on a questionnaire:a cross-sectional study[J]. Int J Environ Res Public Health, 2022, 19(20):13244.
[17]	冯静宜, 张雪芳, 周雪迎, 等. 老年衰弱患者真实体验质性研究的Meta整合[J]. 中华护理杂志, 2023, 58(23):2928-2935. DOI URL
	Feng JY, Zhang XF, Zhou XY, et al. The real experience of frailty in elderly patients:a qualitative Meta-synthesis[J]. Chin J Nurs, 2023, 58(23):2928-2935.
[18]	唐吉, 唐小艳, 曾黎, 等. 贵州省农村地区老年人口腔衰弱的流行现况及影响因素分析[J]. 中国慢性病预防与控制, 2023, 31(5):327-331.
	Tang J, Tang XY, Zeng L, et al. Prevalence and influencing factors of oral frailty in the elderly of rural areas in Guizhou Province[J]. Chin J Prev Contr Chronic Dis, 2023, 31(5):327-331.
[19]	Nomura Y, Ishii Y, Chiba Y, et al. Structure and validity of questionnaire for oral frail screening[J]. Healthcare, 2021, 9(1):45.
[20]	Hu SY, Li X. An analysis of influencing factors of oral frailty in the elderly in the community[J]. BMC Oral Health, 2024, 24(1):260. DOI PMID
[21]	Doi T, Fukui M, Yoshioka M, et al. The relationship between subjective oral frailty and adverse health outcomes or medical and dental expenditures in the latter-stage older adult:a 6-year longitudinal study[J]. Clin Exp Dent Res, 2023, 9(2):349-357.
[22]	Lu TY, Chen JH, Du JK, et al. Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population[J]. BMC Geriatr, 2020, 20(1):521.
[23]	Tanaka T, Hirano H, Ikebe K, et al. Oral Frailty Five-Item Checklist to predict adverse health outcomes in community-dwelling older adults:a Kashiwa cohort study[J]. Geriatr Gerontol Int, 2023, 23(9):651-659.
[24]	许文馨, 黄欢欢, 王俊, 等. 社区居家失能老年人吞咽安全科普作品的设计及制作[J]. 中华护理杂志, 2022, 57(16):1976-1983.
	Xu WX, Huang HH, Wang J, et al. Development of evidence-based popular works of swallowing safety for home-dwelling disabled elderly[J]. Chin J Nurs, 2022, 57(16):1976-1983.