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

Hiroshi Kusunoki; Shotaro Tsuji; Kazumi Ekawa; Nozomi Kato; Keita Yamasaki; Fumiki Yoshihara; Hideo Shimizu

doi:10.31662/jmaj.2025-0057

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

JMA J. 2025 Oct 15;8(4):1250-1260. doi: 10.31662/jmaj.2025-0057. Epub 2025 Aug 22.

Authors

Hiroshi Kusunoki^{1

2}, Shotaro Tsuji^{1

3}, Kazumi Ekawa^{1

4}, Nozomi Kato¹, Keita Yamasaki^{1

5}, Fumiki Yoshihara², Hideo Shimizu¹

Affiliations

¹ Department of Internal Medicine, Osaka Dental University, Hirakata, Japan.
² Department of Hypertension and Nephrology, National Cerebral and Cardiovascular Center, Suita, Japan.
³ Tsuji Surgical Rehabilitation Hospital, Osaka, Japan.
⁴ Department of Preventive Medicine, Hyogo Medical University Faculty of Medicine, Nishinomiya, Japan.
⁵ Medical Corporation Shimanami, Nishinomiya, Japan.

Abstract

Introduction: 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.

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: Oral Frailty Five-item Checklist (OF-5); Oral Frailty Index-8 (OFI-8); frailty; oral frailty.