A systematic review and meta-analysis of the prevalence and risk factors of oral frailty among older adults

OBJECTIVES: To systematically review the prevalence of oral frailty among older adults and its associated risk factors. METHOD: This systematic review and meta-analysis was prospectively registered with PROSPERO (CRD420261288065) and conducted in accordance with PRISMA guidelines. We developed a search strategy and systematically searched PubMed, Embase, Web of Science, MEDLINE, the Cochrane Library, and CINAHL from inception to August 1, 2025. Studies investigating the prevalence of oral frailty or its risk factors among older adults were included. Two reviewers independently performed study screening, data extraction, and quality assessment, and data were analyzed using RevMan 5.4 and Stata 14.0. This study was registered in PROSPERO. RESULTS: A total of 16 studies involving 13,030 participants were included. The pooled prevalence of oral frailty was 32% (95% CI: 25%-41%), with substantial heterogeneity (I² = 98.85%). Subgroup analyses showed that prevalence varied by country, study design, assessment instrument, and publication year (all p < 0.05). Univariable meta-regression indicated that the assessment instrument was the primary source of heterogeneity (R² = 56.1%, p < 0.001). Pooled analyses of risk factors showed that physical frailty (95% CI: 1.41-4.62), age (95% CI: 1.08-1.11), having fewer than 20 remaining teeth (95% CI: 2.27-21.00) and female sex (95% CI: 1.22-1.91) were associated with an increased risk of oral frailty (all p < 0.05). CONCLUSIONS: Oral frailty is prevalent among older adults and is associated with demographic characteristics, overall frailty status, and underlying oral structural conditions. Clinical and community settings should focus on older adults at high risk of oral frailty, particularly those with fewer than 20 remaining teeth, physical frailty, advanced age, or female sex. Early identification should be prioritized, and multidimensional interventions-including oral function and dentition assessment, nutritional support, frailty management, and targeted oral health education-should be implemented through multidisciplinary collaboration to reduce risk and improve quality of life.