Multidimensional oral frailty scale developed through an international e-Delphi approach

Oral frailty is a distinct frailty phenotype encompassing multiple dimensions of oral functional decline. This study aimed to develop a patient-reported, multidimensional oral frailty scale using an e-Delphi approach with international experts.

Informed by a recently established operational definition of oral frailty, the scale was designed to assess eight components across four domains: mastication, swallowing, oral motor skills, and salivation. A systematic literature search identified candidate items, which formed the initial pool for evaluation by 25 international experts in geriatric dentistry, prosthodontics/oral rehabilitation, geriatric medicine/rehabilitation, and population oral health. Through a three-round e-Delphi, experts rated item relevance, proposed new items, selected top three items in each component and ranked them by importance, and provided inputs for response options, recall period, food and phonatory examples, and item wording.

A total of 185 potential items were identified from the literature, of which 34 unique items fell under the eight components and were subjected to the e-Delphi process. Four items were eliminated in Round-1 due to low relevance, and 45 items (30 retained and 15 newly suggested) were reviewed in Round-2. Five items were further eliminated based on relevance in Round 2, and 24 items (3 per component) were selected based on importance ranking. These items were refined for clarity and consistency in Round-3, incorporating expert inputs on phrasing and format.

A patient-reported multidimensional scale, named 24-Item Oral Frailty Scale (OF-24), has been developed for detecting oral frailty in clinical and community settings. Further evaluation of this scale across diverse populations and languages is recommended before its wide adoption.

This e-Delphi study derived a patient-reported scale to capture all dimensions of oral frailty delineated in the recent operational definition. This scale offers a practical tool for diagnosis, risk stratification and early intervention.