Preventing Dehydration in the Elderly

By Beth Lueders

With all the variety of specialty drinks on the market, one might think staying adequately hydrated is fairly foolproof. But most people are not consuming enough liquids every day, and elders are significantly at risk for dehydration, the condition when a person uses or loses more water and other fluids than their body takes in. Dehydration research presented at a Royal Society of Medicine conference showed that one in five older adults living in a care home does not drink enough water and a quarter of elders living at home without a carer do not drink enough fluid. A five-year international study on hydration among older adults noted that among older adults age 71 and above, 95 percent of elder men and 83 percent of elder women do not drink enough water.

Not drinking enough water and other fluids throughout the day can lead to the body failing to carry out normal functions such as digestion and temperature regulation. Drinking more fluids can reverse mild to moderate dehydration, but severe dehydration requires immediate medical treatment.

Common Causes of Dehydration in Elders

Dehydration can occur at any age, especially during hot weather or with vigorous exercise or when a person cannot access safe drinking water, for example, while traveling or enjoying outdoor recreation. As people age, the sensation of being thirsty fades. Some elders have cognitive or mobility challenges that limit their ability to secure liquids themselves. Other common reasons for dehydration in older adults include:

  • Vomiting and diarrhea – Severe, acute vomiting or diarrhea quickly depletes the body’s fluids and minerals.
  • Infections and illnesses Even minor illnesses, such as those that affect the lungs or bladder, can stress the body’s fluid levels.
  • Fever Just a slight increase in body temperature requires more water for breathing and metabolic stability. The higher the fever, the greater the chance of becoming dehydrated.
  • Medications Many elders take a number of medications, and some of these can be diuretics (increasing the passing of urine) and others may cause a person to sweat more.
  • Decreased kidney functionAs people age, their kidney function decreases and they are less able to conserve fluids.
  • Excessive sweatingLosing water through sweating without replacing fluids can cause dehydration. High temperatures and strenuous activity increase sweating and fluid loss.
  • Increased urinationCertain medical conditions such as undiagnosed or uncontrolled diabetes, or bladder problems can cause an individual to urinate more frequently.

Symptoms of Elderly Dehydration

Initially, dehydration creates subtle signs that may be hard to detect but can escalate quickly. Warning signs of dehydration include fatigue, thirst, dizziness, dark urine, headaches, dry mouth/nose/skin and muscle cramping. Other symptoms of elderly dehydration may include:

  • Confusion
  • Difficulty walking
  • Rapid heart rate
  • Low blood pressure
  • Low urine output
  • Constipation
  • Inability to sweat or produce tears
  • Sunken eyes

Complications of Dehydration in Older Adults

Inadequate fluid levels in older adults can lead to serious or life-threatening health conditions. These complications include:

  • Urinary and kidney problems
  • Heat injury (ranging from mild heat cramps to heat exhaustion to heatstroke)
  • Seizures
  • Low blood volume shock (hypovolemic shock)

Excess fluid loss or inadequate fluid intake can lead to an imbalance of sodium and other electrolytes in the body. Electrolytes help transfer electrical messages between cells, and without a proper balance of electrolytes, muscles can involuntarily contract or the person may lose consciousness. If not treated promptly, this dehydration and imbalance can cause significant problems and even death.

How Caregivers Can Help Prevent Dehydration

Elders often need to be coached on the adequate amount of liquids to consume each day, and their doctor can help determine a consumption amount. Here are a number of steps caregivers and family members can take to make sure older loved ones are properly hydrated throughout the day:

  • Keep fluids in a water bottle or lidded cup with a straw near the elder day and night.
  • Check regularly that the elder’s urine is light-colored and output is sufficient.
  • Serve a variety of high-water-content foods such as fruits, soups, broths, vegetables and smoothies.
  • The older adult should not skip meals. Much of a person’s fluids come from foods.
  • Ensure the elderly loved one avoids the consumption of caffeine and alcohol, which can dehydrate the body.
  • In warmer weather, schedule outdoor activities for the cooler part of the day.
  • Monitor the elder’s daily fluid intake by creating a hydration schedule. It is better for the older adult to sip liquids every hour than drink extra at a meal.
  • Consult with the elder’s doctor about changing medications if the person is taking laxatives or diuretics.

Watch continually for signs of dehydration. If you suspect your elder may be dehydrated, you can do a simple test by gently pulling up skin on the back of the hand for a few seconds. If the skin does not return almost instantly to its normal position, the elder is dehydrated. Seek medical help if the older adult has had diarrhea for 24 hours or more, cannot keep down fluids, or is disoriented or listless. In keeping older adults well-hydrated and healthy, upfront prevention is always the best practice.