Masticatory Performance and its Relationship With Sarcopenia, Frailty and Functional Outcomes in Hospitalized Older Adults: A Prospective Cohort Study

BACKGROUND: Masticatory performance is rarely included in geriatric assessment and its additional value is unclear. OBJECTIVES: To explore the prevalence of low masticatory performance and its association with sarcopenia and frailty, as well as its prospective associations with functional outcomes upon discharge in hospitalized older adults using a pragmatic bedside assessment protocol. METHODS: Patients aged ≥ 70 years admitted to a Swiss geriatric rehabilitation hospital in 2023 were assessed. Masticatory performance was measured using Hue-Check Gum, a colour-mixing test of chewing ability, scored with the Orophys scale; low masticatory performance was defined as Grades 1-2. Structural oral parameters included total number of eruptive teeth, number of supporting zones and maximum occlusal bite force. Sarcopenia (EWGSOP2) and frailty (Clinical Frailty Scale) were evaluated upon admission. Outcomes were impaired functional status (extended Barthel Index < 39) and low physical performance (de Morton Mobility Index < 62) upon discharge. RESULTS: Among 217 patients (mean age 84.0 years; 64.5% female), mean tooth count was 12.8. Low masticatory performance was present in 117 (54.9%), sarcopenia in 38 (19.4%) and frailty in 92 (42.4%). Of those with low masticatory performance, 44.9% were neither frail nor sarcopenic. Masticatory performance and sarcopenia were both independently associated with impaired functional status (OR 2.3, 95% CI 1.1-4.9; OR 2.7, 95% CI 1.1-6.3). Low masticatory performance (OR 1.8, 95% CI 1.0-3.5) and frailty (OR 2.5, 95% CI 1.3-4.8) were independently associated with low physical performance. CONCLUSION: Low masticatory performance was common and often occurred without sarcopenia or frailty. Its independent association with functional outcomes suggests that pragmatic bedside assessment of masticatory performance adds value to routine geriatric assessment in hospitalized older adults.