Malnutrition and inadequate protein intake were very common and associated with dentition among older people with multiple disabilities in assisted living facilities. Assessment of dental status should be part of good nutritional care in long-term care.

Objectives: To explore how oral problems: chewing problems, dry mouth, and swallowing difficulties cluster and whether their burden is associated with nutritional status, eating habits, gastrointestinal symptoms, psychological well-being, and mortality among institutionalized residents. Design: Cross-sectional study with 1-year mortality. Setting and participants: 3123 residents living in assisted facilities and nursing homes in Helsinki, Finland. Measures: Trained nurses assessed residents in all nursing homes and assisted living facilities in Helsinki in 2011. A personal interview, the Mini Nutritional Assessment (MNA), oral symptoms, questions about eating habits, and psychological well-being were used to assess each resident. We divided the subjects first according to the number of oral symptoms into four groups: No oral symptoms (G0), one oral symptom (G1), two oral symptoms (G2), and all three symptoms (G3) and second according to the symptoms: dry mouth, chewing problems and swallowing difficulties. The diagnoses and medications were retrieved from medical records and mortality data were obtained from central registers. Results: In all, 26% of the subjects had one oral problem (G1), 11% had two oral problems (G2), and 4% had all three oral problems (G3), whereas 60% (n=1870) had no oral symptoms. Thus, the oral symptoms moderately overlapped. The burden of oral symptoms was linearly associated with malnutrition, higher numbers of comorbidities, dependency in physical functioning, gastrointestinal symptoms, eating less and more often alone. The higher the burden of oral symptoms, the lower the self-*Manuscript Click here to view linked References 2 rated health and psychological well-being. Mortality increased along with the higher oral symptoms burden. Of residents, having one or more symptoms 26% had chewing problems, 18% swallowing difficulties and 15% dry mouth. Conclusions/Implications: The burden of oral health problems was associated in a stepwise fashion with poor health and psychological well-being, malnutrition, and mortality. Clinicians should routinely assess older institutionalized residents' oral health status to improve residents' well-being.

SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.