Background <p>Oral frailty (OF), a multidimensional decline in oral function, significantly impacts nutrition, quality of life, and overall health, posing heightened risks for older adults recovering from stroke due to neurological impairments and potential dysphagia. Understanding its long-term progression post-stroke remains limited. This longitudinal study aimed to identify distinct oral frailty trajectories and their influencing factors during the critical six-month recovery phase after hospital discharge.</p> Objective <p>To investigate the longitudinal trajectory of oral frailty and its influencing factors in older adults with stroke.</p> Methods <p>Using convenience sampling, 272 older adults with stroke were recruited from the Department of Neurology between May 2024 and May 2025. The General Information Questionnaire, Oral Frailty Index-8, Oral Health Assessment Scale, Geriatric Oral Health Related Self-Efficacy Scale and Perceived Social Support Scale were used to assess patients within 24&#xa0;h of admission and at 1, 3, and 6 months after hospital discharge. Oral frailty levels were tracked. Trajectories of change were analyzed using latent variable growth mixed models and influencing factors with logistic regression.</p> Results <p>The trajectory of change in oral frailty among older adults with stroke could be categorized into a low-level un-frailty group (35.3%), a medium-level fluctuating group (8.1%), and a high-level persistent frailty group (56.6%); age, number of dentures, history of stroke, dry mouth, subjective masticatory difficulty, level of geriatric oral health-related self-efficacy, and level of comprehended social support were factors influencing the trajectory of change in oral frailty in patients.</p> Conclusion <p>Three distinct oral frailty trajectories exist in older stroke adults, showing significant group heterogeneity. Clinical teams should provide trajectory-specific assessments and interventions.</p> Clinical trial number <p>Not applicable.</p>