Associations Between Oral Frailty Patterns and Depressive Symptoms in Older Adults: A Multicenter Cross‐Sectional Latent Class and Association Analysis

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Abstract
Background: Oral frailty is a comprehensive indicator of age‐related oral decline, yet its heterogeneity and association to depression are poorly understood. We aimed to identify latent classes of oral frailty and evaluate the association between dietary diversity and depressive symptoms in older adults with oral frailty. Methods: We conducted a cross‐sectional study enrolling adults aged 60 years or older from urban communities in Beijing and Hebei, China. Latent class analysis was used to identify oral frailty subgroups based on the Oral Frailty Assessment Tool. We used multivariate logistic regression to analyse associations with depressive symptoms (assessed via the Patient Health Questionnaire‐9) and structural equation modelling to assess the indirect association effect of dietary diversity. Results: Between August 2024 and October 2025, 525 participants were enrolled. We identified three oral frailty classes: Multiple Problems‐High Risk ( n = 92; 18%), Structural Deficit‐Functional Compensation ( n = 289; 55%), and Oral Health Advantage ( n = 144; 27%). Compared with the Oral Health Advantage group, the risk of depressive symptoms was significantly higher in the Structural Deficit‐Functional Compensation (OR: 1.736, 95% CI: 1.129–2.669) and Multiple Problems‐High Risk groups (OR: 3.039, 95% CI: 1.695–5.450). Dietary diversity partially mediated these relationships, accounting for 21.89% and 23.40% of the total effects, respectively. Conclusions: Oral frailty in Chinese older adults presents as distinct phenotypes that are associated with depression. Strategies enhancing dietary diversity might serve as a method to improve depression risk in those with oral frailty.

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