An international collaboration of researchers from Weill Cornell Medicine, Michigan State University, the University of Iowa, New York University, the University of Wisconsin-Madison, and multiple institutions in Japan including the University of Tokyo have successfully adapted a Japanese oral health screening tool for use among English-speaking older adults in the United States, potentially enabling earlier detection of oral frailty—an age-related decline in oral and pharyngeal function associated with physical frailty, malnutrition, and increased mortality risk.
The study , which was published in the January 2026 issue Otolaryngology–Head and Neck Surgery, describes the rigorous cross-cultural adaptation of the Oral Frailty Index-8 (OFI-8), an eight-item patient-reported questionnaire originally developed in Japan to screen community-dwelling older adults for oral frailty risk.
The OFI-8 addresses eight key areas: difficulty eating hard foods, coughing when drinking liquids, denture use, dry mouth, reduced social outings, ability to chew hard foods, tooth brushing frequency, and dental visit frequency. A score of four or more points indicates high risk of oral frailty and warrants further professional evaluation.
Previous research has shown that oral frailty, as measured by the original Japanese OFI-8, is associated with a 2.4-fold increased risk of physical frailty, 2.2-fold increased risk of sarcopenia, 2.3-fold increased risk of disability, and 2.2-fold increased risk of mortality.
The researchers note that while the adapted U.S.-English OFI-8 demonstrated strong comprehension and cultural appropriateness in this study, further validation research is needed to establish its reliability, validity, and appropriate cutoff scores for U.S. populations.
According to senior author Anaïs Rameau, MD, MSc, MPhil, MS, who is also currently on a Fulbright Scholar Award at the University of Tokyo and Fujita Health University, “This international collaboration has launched a long-term relationship in geriatric dysphagia among institutions.”
Dr. Rameau is also Chief of Dysphagia at the Sean Parker Institute for the Voice and Associate Professor and the Director of New Technologies in the Department of Otolaryngology - Head and Neck Surgery at Weill Cornell Medical College.
About Oral Frailty
Oral frailty is defined as age-related decline in oral and pharyngeal function, encompassing reduced number of teeth, decreased tongue pressure, impaired chewing and swallowing ability, and reduced oral health-related social participation. Research has shown that poor oral function leads to decreased dietary protein intake, loss of appetite, weight loss, and ultimately physical frailty—creating a vicious cycle in which oral and general frailty exacerbate each other.
Study Citation: Castillo-Allendes, A., Khoury, C.J., Curtis, J.A., Mocchetti, V., Kuroda, J., Kuroda, K., Ikeuchi, T., Saitoh, E., Inamoto, Y., Ueha, R., Matsuo, K., Rogus-Pulia, N., Molfenter, S., Tanaka, T., Iijima, K. and Rameau, A. (2026), Cross-Cultural Adaptation of the Oral Frailty Index-8 for United States English-Speakers. Otolaryngol Head Neck Surg , 174: 128-136. https://doi.org/10.1002/ohn.70047
Otolaryngology–Head and Neck Surgery
Otolaryngology–Head and Neck Surgery (OTO Journal) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. Our mission is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
About the AAO-HNS/F
The AAO-HNS/F is one of the world’s largest organizations representing specialists who treat the ears, nose, throat, and related structures of the head and neck. Otolaryngologist-head and neck surgeons diagnose and treat medical disorders that are among the most common affecting patients of all ages in the United States and around the world. Those medical conditions include chronic ear disease, hearing and balance disorders, hearing loss, sinusitis, snoring and sleep apnea, allergies, swallowing disorders, nosebleeds, hoarseness, dizziness, and tumors of the head and neck as well as aesthetic and reconstructive surgery and intricate micro-surgical procedures of the head and neck. The Academy has approximately 13,000 members. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology-head and neck surgery through education, research, and quality measurement.
Otolaryngology
Cross-Cultural Adaptation of the Oral Frailty Index-8 for United States English-Speakers
14-Oct-2025