Oral Frailty Assessments for Older Adults: A Systematic Review and Methodological Evaluation

Oral frailty (OF) is increasingly recognized as a critical component of healthy aging, yet the lack of standardized assessment instruments hinders clinical implementation and comparative research. This systematic review summarizes existing oral frailty instruments and provides evidence-based recommendations for their clinical application.

A systematic search of MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library was conducted from inception through July 24, 2025. Studies developing or validating oral frailty assessment instruments in older adults were included. Clinical measures were summarized descriptively. Patient-reported outcome measures (PROMs) were evaluated according to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) 2.0 guidelines for methodological quality, measurement properties, and evidence levels.

From 6,208 records, 15 studies with 15 distinct instruments were included. Among them, 9 instruments (60.0%) were exclusively PROMs, 5 (33.3%) combined PROMs with clinical measures, and only 1 (OF signs) relied solely on clinical examination. Among clinical measures, Oral Frailty Index-6 (OF-6) was the most suitable reference standard for hospital-based objective assessment. Among PROMs, the Screening for Oral Frailty Tool (SOFT) showed the most comprehensive development and validation, with favorable measurement properties across multiple domains. However, most PROMs lacked sufficient evidence for responsiveness and longitudinal validity, and none reached the highest COSMIN recommendation category.

This first COSMIN-based systematic review of oral frailty instruments demonstrates that none of the available PROMs satisfy the most rigorous psychometric criteria. Our analysis suggests stratified recommendations: SOFT appears most suitable for community nurses conducting broad screening, Oral Frailty 5-Item Questionnaire (OF-5) and OF signs may be preferable for general practitioners in primary care, and the OF-6 is currently the most appropriate reference standard for hospital dental specialists. Future research should focus on hospital-based validation, responsiveness assessment, and cross-cultural refinement of oral frailty instruments to improve generalizability and support a unified core outcome set.Knowledge Transfer Statement:By profiling the measurement properties, completion time, and population skew of existing oral frailty instruments, this study supports evidence-based selection by both clinicians and researchers.