Xerostomia, lack of salivation, affects more than 70% of the elderly. Also, denture wearers chew less efficiently than those with natural teeth. Other organ changes may occur. Insulin secretion is decreased, which can lead to carbohydrate intolerance, and renal function deteriorates in the 40s for some people. Calorie requirements decrease with age, although individuals vary greatly depending on their activity level and health status. Diets that fall below 1,800 calories a day may be low in protein, calcium, iron, and vitamins, so should feature nutrient-dense foods. Dehydration is the most common cause of fluid and electrolyte disturbances in older adults. Reduced thirst sensation and fluid intake, medications such as diuretics and laxatives, and increased fluid needs during illness contribute to dehydration. Skin breakdown is a major problem, particularly in bedridden or immunologically impaired people. The most common skin breakdown is the pressure ulcer, which occurs in hospitalized patients and residents of skilled-care nursing homes. Pressure ulcers are graded to classify the degree of tissue damage. In case of malnutrition most elderly people maintain adequate nutritional status, and hospitalized older adults are at higher risk for malnutrition than individuals who are living independently. Cancer cachexia, the weak, emaciated condition resulting from cancer, accounts for about half of malnutrition cases in institutionalized adults. Two common forms of malnutrition are protein-calorie malnutrition and protein malnutrition. In case of protein-calorie malnutrition, the person appears ill-nourished. In protein malnutrition, an overweight person may have depleted protein stores. Nutrition support may involve higher protein and calorie amounts, nutritional supplements like enteral tube feedings that provide nutrient solutions into the GI tract.
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