An international team of researchers has adapted a Japanese oral health screening tool for use among English-speaking older adults in the United States, a step that could help identify oral frailty earlier and improve health outcomes.
The study, published in the January 2026 issue of Otolaryngology–Head and Neck Surgery, describes the U.S.-English adaptation of the Oral Frailty Index-8 (OFI-8). The original questionnaire was developed in Japan to screen community-dwelling older adults for age-related declines in oral and throat function.
Oral frailty is linked to physical frailty, malnutrition, disability, and higher mortality risk. The OFI-8 is an eight-item, patient-reported tool that asks about difficulty eating hard foods, coughing when drinking liquids, denture use, dry mouth, reduced social activity, chewing ability, tooth-brushing habits, and frequency of dental visits. A score of four or higher suggests a high risk of oral frailty and signals the need for further clinical evaluation.
Previous studies using the Japanese version of the OFI-8 have shown strong associations between oral frailty and adverse outcomes, including more than double the risk of physical frailty, sarcopenia, disability, and death.
The adaptation was led by researchers from Weill Cornell Medicine, Michigan State University, the University of Iowa, New York University, the University of Wisconsin–Madison, and several Japanese institutions, including the University of Tokyo. The team used a rigorous cross-cultural process to ensure the questionnaire was clear, culturally appropriate, and easily understood by U.S. older adults.
While the adapted OFI-8 showed strong comprehension in this initial study, the authors emphasize that further research is needed to validate its reliability, clinical accuracy, and optimal cutoff scores for U.S. populations.
Senior author Anaïs Rameau, MD, MSc, MPhil, MS, said the project marks the beginning of a long-term international collaboration in geriatric dysphagia research. Dr. Rameau is Chief of Dysphagia at the Sean Parker Institute for the Voice and an associate professor at Weill Cornell Medical College, and is currently a Fulbright Scholar at the University of Tokyo and Fujita Health University.