Relationship between cognitive function, oral health, and activities of daily living among older adults in the context of rural China: a network analysis approach

OBJECTIVES: Using symptom network analysis, this study explores gender differences in the network structure of activities of daily living (ADL) among rural Chinese older adults, examines structural associations between oral health, cognitive function, and ADL, and thereby identifies bridge symptoms within these associations. METHODS: In this study, 1,276 older adults from rural areas of various cities in Anhui Province, China, were enrolled between July and August 2024. Data were collected using a general demographic questionnaire, the Activities of Daily Living (ADL) Scale, Geriatric Oral Health Assessment Index (GOHAI), and Mini-Mental State Examination (MMSE). Gender-stratified network analyses were performed to construct separate ADL networks and combined networks of ADL, oral health, and cognitive function. RESULTS: Network Comparison Test (NCT) revealed no significant gender differences in network structure for either the ADL or cross-domain combined networks (all P > 0.05). However, centrality analysis identified gender-specific core symptoms within the ADL network: "washing clothes" in men (strength = 6.660) and "cooking" in women (strength = 6.669). Furthermore, pathways through which oral health and cognitive function connect to ADL differ between the two subsamples, while "time orientation" serves as the cross-domain bridge symptom (men: 4.520; women: 5.786). CONCLUSION: These findings elucidate gender-specific functional cores within ADL networks and uncover the inter-domain connection pathways of the cross-domain network, providing a strategic basis for simultaneously improving daily functional limitations, oral health deterioration, and cognitive decline among rural older adults.