The polypharmacy-xerostomia-nutrition triad: the clinical framework for older adults.

BACKGROUND: Polypharmacy, the concurrent use of five or more medications, affects the majority of community-dwelling older adults aged 65 and older in the United States. A clinically underrecognized consequence is medication-induced xerostomia and salivary hypofunction, which critically impair oral function, food selection, and nutritional status. OBJECTIVE: This mini-review synthesizes mechanistic and clinical evidence linking polypharmacy-induced xerostomia to nutritional decline in older adults and proposes a clinical framework for integrated dental-medical screening. METHODS: A narrative review of English-language peer-reviewed literature published between 2000 and 2025 was conducted using PubMed/MEDLINE, CINAHL, and Cochrane databases. Studies examining xerogenic medication burden, salivary function, masticatory performance, dietary intake, and nutritional biomarkers in adults aged 60 and older were included. RESULTS: Xerogenic medications, including diuretics, antihypertensives, antidepressants, antihistamines, and anticholinergics, are highly prevalent in older adults and exert dose-dependent suppression of salivary flow via anticholinergic, aquaporin-disrupting, and sympatholytic mechanisms. Salivary hypofunction impairs bolus formation, swallowing efficiency, and gustatory function, driving avoidance of fibrous and nutrient-dense foods. This dietary shift is associated with protein-energy malnutrition, sarcopenia, and micronutrient deficiencies. Socioeconomic and structural disparities amplify nutritional risk among low-income and minority older adults. CONCLUSION: The polypharmacy-xerostomia-nutrition triad represents a tractable but systematically under-addressed pathway to preventable malnutrition and functional decline. Interprofessional screening, patient-centered salivary management strategies, and expanded dental benefit coverage are urgently needed.