The mouth is the one part of the examination that gets skipped in almost every acute admission of an older person, and it carries more actionable findings per second spent than most of what replaces it.
Look for four things. Dentures - whether they are in, whether they fit, and whether they went home in a tissue on the day of admission, which is how most of them are lost. Oral candidiasis, common after antibiotics or inhaled steroids and a straightforward cause of reduced intake. Dry mucosa, which points at both dehydration and the anticholinergic load on the drug chart. And frank dental decay or gum disease, which in a patient with aspiration risk is a reservoir.
Then write what you found. A line saying 'edentulous, dentures at home, mucosa dry' does more for the patient's nutrition over the next week than another electrolyte panel, because it generates actions - dentures brought in, a soft diet reviewed, mouth care prescribed rather than assumed.
- Look in the mouth on the post-take round: dentures, candidiasis, dry mucosa, decay
- Ask explicitly where the dentures are and record the answer - most are lost on day one
- Treat dry mucosa as a prompt to review the anticholinergic burden, not only fluid balance
- Prescribe mouth care rather than assuming it happens; documented care is the only care that reliably occurs
- Record the findings in the notes so that nutrition and swallowing decisions have something to rest on
Why it matters
The examination most likely to be skipped is the one that most often explains why an older patient is not eating.
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