# Comparative Analysis of the Oral Frailty Five-item Checklist and Oral Frailty Index-8 Tools in Assessing Oral Frailty and Their Association with Systemic Health Indicators

## TL;DR

This study compares two tools for assessing oral frailty and finds they are closely related, with notable differences in how they affect men and women.

## Contribution

The study provides a comparative analysis of two oral frailty assessment tools and their associations with systemic health indicators in older adults.

## Key findings

- Oral frailty was observed in 40.7% of participants, with higher prevalence in women.
- Both tools showed strong agreement, with over 80% concordance in classifying oral frailty.
- Sex-specific differences were found in physical and biological markers related to oral frailty.

## Abstract

Oral frailty, defined as an age-related decline in oral function, represents a significant risk factor for adverse health outcomes, though it can be mitigated through early intervention. The Oral Frailty Five-item Checklist (OF-5), introduced in 2023, assesses oral frailty using 5 indicators: reduced number of teeth, difficulty chewing, difficulty swallowing, dry mouth, and low articulatory oral motor skills. Designed for use beyond dental clinics, the OF-5 has demonstrated predictive validity for physical frailty and mortality. Similarly, the Oral Frailty Index-8 (OFI-8) comprises 8 items evaluating oral health, social participation, and dental habits.

This study compared the OF-5 and OFI-8 tools and investigated their associations with physical and biological markers. A cross-sectional analysis was conducted on 270 Japanese participants aged ≥65 years (median age: 78 years). The assessments included blood tests, physical measurements, and grip strength evaluation. Participants were categorized by sex and oral frailty risk based on OF-5 scores (non-frailty: ≤1; frailty: ≥2).

Oral frailty, defined as an OF-5 score ≥2, was observed in 40.7% of the participants (33.8% in men and 47.4% in women). Both the OF-5 and OFI-8 scores were higher in women than in men. Sex-specific differences in physical and biological markers were evident; men exhibited higher grip strength, whereas women had a higher prevalence of anemia and osteoporosis. Women were also more likely to report reduced masticatory ability and lower levels of social participation. A high concordance rate of over 80% was observed between oral frailty (OF-5 score ≥2) and high-risk oral frailty (OFI-8 score ≥4).

These findings highlight the utility of subjective questionnaires in assessing oral frailty and emphasize the need for longitudinal studies to evaluate their predictive accuracy for physical frailty.