Rethinking Long-Term Follow-Up of CPAP Therapy in Obstructive Sleep Apnea: Toward Personalized and Integrated Care.

The global population of adults aged 65 and older is projected to reach 1.6 billion by 2050, accompanied by an increasing burden of multimorbidity requiring complex pharmacological management (). In the United States, polypharmacy, defined as concurrent use of five or more medications, affects an estimated 36%–42% of community-dwelling older adults, rising to over 65% among those with multiple chronic conditions (, ). While the risks of polypharmacy are well-documented across several domains, including falls, drug-drug interactions, and cognitive impairment, one adverse effect remains systematically overlooked in both clinical practice and health policy: the oral consequences of xerogenic medication burden and their downstream effects on nutritional status. Xerostomia, the subjective sensation of oral dryness, and salivary hypofunction, the objective reduction in salivary flow rate, affect an estimated 25%–35% of community-dwelling older adults and up to 60% of those in long-term care (, ). Medications are the leading etiologic factor, implicated in more than 400 commonly prescribed drug classes (). Despite the centrality of saliva to food intake, digestion, oral comfort, and mucosal protection, xerostomia is routinely dismissed as a mere nuisance rather than recognized as a gateway to nutritional compromise. This mini-review addresses this gap by presenting a mechanistic and clinical synthesis of the triad linking polypharmacy, xerostomia, and nutritional decline in older adults. We draw on evidence from salivary biology, nutritional epidemiology, and geriatric medicine to construct a pathophysiological framework and to propose targeted interprofessional and policy interventions. This work builds on and extends prior analyses of oral health disparities in aging Americans (), with emphasis on the nutritional sequelae that disproportionately burden underserved populations.