Comparison of Social Frailty and Oral Health Literacy Among Older Adults in Urban and Rural Areas: A Cross-Sectional...

Social frailty and oral health literacy (OHL) may be influenced by the residential environment; however, evidence regarding regional differences among older adults remains limited. This study aimed to examine differences in social frailty and OHL between older adult study populations recruited from urban and rural areas.

This cross-sectional study included 176 community-dwelling older adults (88 participants in the urban study population and 88 participants in the rural study population) enrolled between November 2024 and November 2025. Social frailty was assessed using a five-item assessment, and OHL was evaluated using a 16-item questionnaire. Oral health status was assessed using the Japanese version of the Oral Health Assessment Tool (OHAT-J), and health-related quality of life (QOL) was measured using the Short Form-8 (SF-8). Ordinal logistic regression and multinomial logistic regression analyses were performed to examine the associations of study population (rural vs urban) with social frailty and OHL, respectively, adjusting for demographic and health-related factors.

Compared with the urban study population, the rural study population showed a higher prevalence of social frailty (p = 0.004) and low OHL (p < 0.001). In contrast, mental health-related QOL and oral health status were more favorable in the rural study population (p < 0.001). Multivariable analyses showed that participants in the rural study population had higher levels of social frailty and lower OHL than those in the urban study population.

Participants in the rural study population demonstrated favorable mental health-related QOL and oral health status; however, higher levels of social frailty and lower OHL were also observed. Given the cross-sectional design and differences in participant recruitment settings between the two study populations, these findings should be interpreted as exploratory and hypothesis-generating rather than as definitive evidence of causal relationships. Nevertheless, these findings may inform the development of region-specific, integrated approaches that combine support for social participation with improved access to health-related information.