Development and Validation of An Oral Frailty Assessment Tool for Older Adults Based on the COSMIN Risk of Bias Checklist: A Cross-Sectional Study

Background: Oral frailty is a key determinant of older adults’ health, functional independence, and quality of life. However, its core elements and interrelationships lack clear systematic conceptualization, and existing domestic and international assessment tools suffer from generalized scoring, unclear reliability and validity, and insufficient cross-cultural applicability—failing to accurately reflect the oral frailty status of Chinese older adults. Thus, this study aimed to develop and validate an oral frailty assessment tool for Chinese older adults based on a conceptual framework that we previously constructed. Methods: The COSMIN risk of bias checklist was employed to standardize the methodological quality. First, the scale dimensions and items were refined and revised through the Delphi expert consultation method. A cross-sectional survey of older adults was subsequently conducted via convenience sampling in three stages. First, item analysis and screening were conducted. Second, reliability and validity were calculated. Finally, the area under the curve, sensitivity, and specificity were calculated with the FRAIL scale as the standard, and the cutoff value for the scale was determined. Results : This study developed the Chinese geriatrics oral frailty assessment scale scored on a 5-point Likert scale, comprising dimensions of masticatory function, swallowing function, dry mouth status, and psychosocial status. The Cronbach's α coefficient of the scale was 0.832. The cumulative variance contribution of 79.307%; confirmatory factor model fit indices χ²/ df = 2.394, RMSEA = 0.081, GFI = 0.943, AGFI = 0.889, NFI = 0.940, IFI = 0.964, CFI = 0.964, RFI = 0.904, TLI = 0.942; all AVE > 0.5, all CR > 0.7, and the square root of AVE is greater than the correlation coefficient between the factors; all I-CVI > 0.78, S-CVI = 0.96. The area under the curve was 0.837 (95% CI: 0.723–0.951). The cutoff value for the scale was 16.5, indicating that a score of ≥ 17 indicated oral frailty. Conclusion: The assessment scale for oral frailty in older adults developed in this study is simple to use, has good reliability and validity, and is expected to be a significant tool for assessing oral frailty in older adults in China. Trial Registration : Not applicable.