Nutrition, Oral Health, and Functional Decline in Older Adults: An Integrated Review Toward the Development of Evidence-Based Geriatric Nutrition Strategies
Yudhasmara Sandiaz, Judarwanto Widodo
Abstract
Aging is accompanied by progressive physiological, metabolic, and functional changes that elevate the risk of malnutrition, oral dysfunction, chronic disease, and functional decline. Recent literature highlights that inadequate dietary intake, impaired dentition, multimorbidity, frailty, and psychosocial barriers interact bidirectionally to worsen nutritional status in the elderly. This review synthesizes evidence from nutritional science, oral health research, and comprehensive geriatric assessment (CGA) to present a unified framework for effective geriatric nutrition interventions. Key themes include age-related anorexia, micronutrient deficiencies, sarcopenia, the oral health–nutrition nexus, and the role of CGA-based personalized nutrition therapy. The review also discusses challenges in developing geriatric foods tailored to sensory, swallowing, metabolic, and functional needs. Findings suggest that early screening, individualized dietary planning, oral health rehabilitation, and caregiver-supported care models significantly improve outcomes. Future research should emphasize functional nutrition, biogerontology-based dietary strategies, and large-scale evaluation of CGA-guided interventions.
Keywords: aging, malnutrition, oral health, sarcopenia, geriatric nutrition, comprehensive geriatric assessment, geriatric foods
1. Introduction
The global population of older adults is increasing rapidly, making malnutrition, oral dysfunction, and frailty prominent public health concerns. Aging is characterized by biological heterogeneity and cumulative cellular damage leading to functional decline, chronic inflammation, and anorexia of aging. Nutritional status profoundly influences physical, cognitive, and social wellbeing, making targeted interventions essential for healthy aging. Recent evidence indicates that malnutrition results not only from physiological factors but also from oral health impairments, multimorbidity, medication burden, disability, and socioeconomic limitations. This review integrates findings from geriatric nutrition, oral health, and CGA literature to propose a comprehensive model for optimizing nutrition in older adults.
2. Methods
This narrative review draws on peer-reviewed studies from PubMed, focusing on:
(1) nutritional deficiencies in older adults,
(2) oral health and nutrition,
(3) CGA-guided interventions,
(4) development of geriatric foods,
(5) longitudinal outcomes of malnutrition.
Authoritative reviews (2019–2025), classical references (2001), and recent clinical cases are included.
3. Physiological and Metabolic Changes in Aging Relevant to Nutrition
Aging is associated with reduced basal metabolic rate, altered taste and smell, slower gastric emptying, hormonal dysregulation of appetite (ghrelin, leptin), and reduced functional capacity. These factors promote anorexia of aging and reduced dietary intake. Declines in muscle mass and mitochondrial function lead to sarcopenia, impairing mobility and increasing dependence. Micronutrient deficiencies (vitamin D, B12, folate, calcium, protein) contribute to osteoporosis, cognitive decline, immune dysfunction, and poor wound healing.
4. Malnutrition in Older Adults
Malnutrition is more prevalent in older adults than in younger populations. It is driven by chronic illness, polypharmacy, depression, social isolation, functional limitations, dysphagia, and poor oral health. Malnutrition increases morbidity, mortality, hospitalization, and frailty. Screening tools such as BMI, weight loss history, Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), mid-arm and calf circumference are validated for older adults.
5. Oral Health, Mastication, and Nutritional Intake
Oral diseases—including dental caries, periodontal disease, tooth wear, and oral cancer—are closely linked to diet and nutrition. Poor dentition reduces masticatory efficiency and limits consumption of fibrous foods, fruits, and proteins, increasing the risk of malnutrition. Conversely, malnutrition weakens immunity, exacerbating periodontal infections. Pain, xerostomia, ill-fitting dentures, and dysphagia further restrict food choice and intake. Integrating oral health services into geriatric nutrition programs is essential.
6. Geriatric Foods: Sensory, Functional, and Safety Considerations
The development of geriatric foods must account for sensory limitations (reduced taste and smell), mastication difficulty, swallowing impairments, gastrointestinal intolerance, metabolism, and micronutrient requirements. Ideal geriatric foods should be:
- texture-modified while nutrient-dense,
- high in protein and essential micronutrients,
- low in sodium and refined sugars,
- fortified to prevent deficiencies,
- easy to digest and culturally acceptable.
Emerging directions include functional foods targeting sarcopenia, cognitive decline, and immune modulation.
7. Comprehensive Geriatric Assessment (CGA) as a Framework for Nutrition Care
CGA provides a multidimensional evaluation of medical, psychological, functional, and social domains. Studies show CGA correlations with nutritional status—lower BMI, mid-arm circumference, calf circumference, and poor ADL/IADL scores indicate undernutrition. CGA improves early detection of malnutrition, sarcopenia, dysphagia, and cachexia, guiding personalized nutrition interventions. CGA-based nutrition therapy reduces complications, hospitalization length, and mortality.
8. Individualized Nutrition Interventions
Effective interventions include:
- Energy and Protein Optimization: gradual refeeding if at risk of refeeding syndrome.
- Oral Nutrition Supplements: high-protein, vitamin-D fortified formulas.
- Texture Modification & Dysphagia Diets: IDDSI-guided consistency levels.
- Enteral Nutrition (EN) for severe anorexia or dysphagia.
- Caregiver Education: critical for adherence and safe feeding.
- Post-Discharge Monitoring: prevents relapse of malnutrition.
9. Discussion
Nutrition, oral health, and functional decline are tightly interconnected in older adults, forming a reinforcing cycle that accelerates biological aging and vulnerability. Research shows that up to 50% of community-dwelling older adults and over 60% of hospitalized elderly experience some degree of malnutrition or risk thereof, which markedly increases frailty, sarcopenia, and disability. Malnutrition impairs muscle strength, immune function, and wound healing, leading to poorer clinical outcomes and decreased independence. Conversely, frailty itself reduces appetite, physical activity, and the ability to prepare or consume meals, creating a self-perpetuating decline in nutritional status. This bidirectional relationship underscores the need for early identification and integrated intervention.
Oral health plays a central role in this cycle. Studies reveal that nearly 70% of adults aged ≥70 years have chewing or swallowing problems due to tooth loss, xerostomia, ill-fitting dentures, periodontal disease, or reduced salivary flow often caused by polypharmacy. Oral dysfunction leads to avoidance of nutrient-dense foods such as meats, fruits, and vegetables, contributing to deficiencies in protein, fiber, vitamins, and antioxidants. Evidence indicates that older adults with poor oral health have a 2–3 times higher risk of malnutrition and a significantly faster functional decline. Additionally, oral pain and dysphagia are strongly associated with reduced social interaction, depression, and lower quality-of-life scores.
Comprehensive Geriatric Assessment (CGA) provides a multidimensional framework to address nutrition, oral health, cognition, mood, mobility, and comorbidities simultaneously. Randomized trials show that CGA-guided interventions reduce hospitalization rates by 25–35%, improve functional trajectories, and increase survival in frail older adults. When CGA is applied specifically to nutrition care, outcomes include improved protein-energy intake, reduced sarcopenia progression, and better oral function through coordinated dental, nutritional, and rehabilitative therapy. However, successful implementation requires close collaboration among geriatricians, dentists, dietitians, speech therapists, and caregivers—an area where many healthcare systems still face structural and logistical gaps.
The development of specialized geriatric foods represents a promising innovation for bridging these gaps. Emerging research on texture-modified, high-protein, micronutrient-fortified geriatric foods demonstrates improved adherence and nutritional adequacy, particularly in individuals with dysphagia or dental problems. Studies in Japan, Korea, and Europe show that IDDSI-standardized foods increase intake by 15–30%, reduce aspiration events, and enhance patient satisfaction. Moreover, incorporating culturally familiar flavors and easy-to-chew formulations improves acceptance and long-term compliance. As the aging population grows, the integration of geriatric foods into CGA-based nutrition therapy may offer a scalable strategy to maintain functional independence, reduce malnutrition, and enhance the overall quality of life in older adults.
10. Conclusion
Malnutrition in older adults is a multifactorial problem driven by physiological aging, oral health impairment, chronic diseases, and functional decline. Evidence strongly supports integrating geriatric nutrition practices with oral health management and comprehensive geriatric assessment. Multidimensional, personalized nutrition interventions significantly improve functional outcomes, reduce hospitalizations, and enhance quality of life. Future research should focus on functional nutrition frameworks, large-scale CGA-based trials, and standardized development of nutrient-dense geriatric foods.
11. Recommendations
- Routine Nutrition Screening using MNA, SGA, BMI, and anthropometric measures for all older adults.
- Integrate Oral Health into Geriatric Care, including dental rehabilitation, periodontal management, and prosthetic optimization.
- Adopt CGA-Based Personalized Nutrition Plans in hospitals, primary care, and long-term care settings.
- Promote High-Protein, Micronutrient-Rich Diets to prevent sarcopenia and fractures.
- Develop Standardized Geriatric Foods tailored to sensory, metabolic, and swallowing needs.
- Strengthen Caregiver Training Programs to ensure safe feeding, EN competence, and adherence.
- Prioritize Post-Discharge Monitoring to prevent unrecognized deterioration.
- Encourage Interdisciplinary Collaboration among geriatricians, dietitians, dentists, speech therapists, and caregivers.
- Support Research on Functional Nutrition targeting longevity, cognition, and muscle preservation.
- Promote Public Health Policies supporting access to nutrition services, oral health care, and community-based geriatric support.
References
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- Chan AKY, Tsang YC, Jiang CM, et al. Diet, Nutrition, and Oral Health in Older Adults: A Review of the Literature. Dent J (Basel). 2023;11(9):222. doi:10.3390/dj11090222
- Pirlich M, Lochs H. Nutrition in the Elderly. Best Pract Res Clin Gastroenterol. 2001;15(6):869-884. doi:10.1053/bega.2001.0246
- Park D, Shin AR, Park Y. Nutrition Intervention for Older Patients Based on Comprehensive Geriatric Assessment: A Case Report. Clin Nutr Res. 2025;14(2):91-99. doi:10.7762/cnr.2025.14.2.91
- Grande de França N, Valentini Neto J. Nutrition for Healthy Longevity. J Nutr Health Aging. 2025;29(10):100691. doi:10.1016/j.jnha.2025.100691
- Ju et al., Cross-sectional analysis of CGA parameters and nutritional status. (Details as cited in Park et al., 2025)
- Japanese CGA practice survey on sarcopenia and nutrition. (Details as cited in Park et al., 2025)
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