Chewing Efficiency, Nutritional Status, and Frailty in Geriatric Patients: A Cross- Sectional Study

Abstract Background Chewing function is critical for maintaining health and well-being in older adults. Impaired masticatory function has been linked to systemic conditions such as stroke, respiratory disease, and cognitive decline, as well as increased frailty and its progression. Tooth loss and partial dentition often lead older adults to avoid hard-to-chew, fiber-rich foods, thereby increasing their risk of malnutrition. Despite its importance, chewing function remains under-recognized in geriatric assessments. This study aimed to evaluate chewing efficiency and its association with frailty and nutritional status in geriatric patients. Methods Cross-sectional study of 150 consecutive patients in an acute geriatric clinic in Germany. Participants underwent comprehensive geriatric and dental examinations, including a frailty-assessment using the Clinical Frailty Scale (CFS) and a nutritional screening via the Mini Nutritional Assessment short form (MNA). Chewing efficiency was measured using a two-color chewing gum mixing test. Results Among the 150 patients (mean age 82.3 ± 7.6 years, 63.3% female), 28.7% were edentulous. Malnutrition was present in 44.6% of patients and 47.5% were at risk of malnutrition. Frailty was identified in 81.2% of patients. Chewing efficiency and other oral health parameters declined significantly with increasing frailty. Lower chewing efficiency was associated with poorer nutritional status. Conclusion Chewing efficiency reflects not only oral health but also systemic conditions and frailty. As such, it may serve as an integrative parameter in the evaluation of older adults. Given the high prevalence of oral health deficits in frail older adults, incorporating a brief dental assessment into routine geriatric care is both feasible and warranted. Trial registration: The study received approvel from the Ethics Committee of the Universitätsmedizin Greifswald, and was registered in the German Clinical Trials Register (DRKS) on 17th April 2024 (registration number: DRKS00033778).