Developing and Validating a Nursing-Applied Oral Health Risk Assessment Tool for Care-Dependent Older German Adults:...

Implementation of oral health assessment tools in residential care for older adults remains challenging. We aimed to establish the content validity and practice relevance of the Mouth-related Risk Assessment for Professional Nursing (Mu-RAP), a nursing-applied instrument designed to identify oral health risks in care-dependent older adults.

This sequential, two-panel Delphi study (with two rounds per panel) was conducted between May 2025 and February 2026. In Phase 1, a dentist panel of gerodontology experts (Round 1: n = 26; Round 2: n = 27) evaluated conceptual completeness and item relevance (numeric rating scales, qualitative feedback). In Phase 2, a heterogeneous nursing panel (Round 1: n = 66; Round 2: n = 35) assessed item relevance, clarity and feasibility for routine care (Likert-type scales, structured comments). Consensus thresholds were predefined (dentist panel ≥ 60% agreement; nursing panel ≥ 75%).

Agreement for the refined 13-item instrument was high across both panels. In the first nursing round, 12 of 13 items reached the predefined relevance threshold. Two items were rephrased and achieved strong agreement in Round 2 (91.4% and 85.7%). Feasibility was rated as high (median usability rating 9/10) and 93.9% of participants would integrate Mu-RAP into routine care.

The Mu-RAP achieved strong interprofessional consensus on its content validity, clarity and practical applicability. It may provide a framework for early identification of oral health risks in care-dependent older adults.