Psychometric evaluation of the Persian PRISMA-7 for disability screening among older adults in Iran

Rapid population aging has increased the need for brief, valid tools to identify older adults at risk of disability. The PRISMA-7 is a widely used screening instrument; however, no validated Persian version exists for use in Iran. This study aimed to cross-culturally adapt the Persian PRISMA-7 and evaluate its psychometric properties in community-dwelling older adults. This cross-sectional methodological study was conducted between October 2025 and January 2026 in Sari, Iran. A total of 165 adults aged ≥ 60 years (mean age 70.3 ± 8.9; 58.8% female) were recruited via two-stage random sampling from five healthcare centers. Translation and cultural adaptation followed Beaton’s guidelines. Face and content validity (CVR, CVI), construct validity (confirmatory factor analysis), concurrent validity (correlations with Barthel Index, Katz ADL, Lawton IADL, and Abbreviated Mental Test score), internal consistency (Cronbach’s alpha), test–retest reliability (intraclass correlation coefficient), and diagnostic accuracy (ROC analysis using Barthel Index ≤ 90) were assessed. The Persian PRISMA-7 demonstrated strong validity (S-CVI = 0.94; CVR: 0.60–1.00). Confirmatory factor analysis supported a single-factor structure with good fit (χ²/df = 1.43; RMSEA = 0.051; CFI = 0.94; TLI = 0.92; SRMR = 0.047). It showed moderate to strong negative correlations with the Barthel Index ( r = − 0.62), Katz ADL ( r = − 0.59), Lawton IADL ( r = − 0.54), and AMTs ( r = − 0.48) (all p < 0.001). Internal consistency was good (α = 0.81), and test-retest reliability was excellent (ICC = 0.89). Diagnostic accuracy was high (AUC = 0.89), with an optimal cut-off ≥ 3 yielding 84.4% sensitivity and 81.2% specificity. The Persian PRISMA-7 is a valid, reliable, and accurate tool for screening disability risk among Iranian older adults. Its brevity and robust psychometric performance support its use in clinical and community settings. Not applicable.