Preventing Dehydration in the Elderly

With all the available drinks on the market today, one might think staying adequately hydrated is foolproof. But a five-year study by American and French researchers finds that most Americans are not consuming enough liquids every day, and seniors are significantly at risk for dehydration, the condition when a person uses or loses more water and other fluids than their body takes in. The study of more than 15,000 Americans notes 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.

“The sensation of being thirsty fades with age, which is one reason many older adults don’t drink enough fluids,” said Celeste Begley, Community Relations Director Right at Home Boston and North and local Bradford resident. “Cognitive challenges and just plain forgetting to hydrate are also common among seniors. Some elders have mobility restrictions and find it harder to physically secure a drink themselves. Keeping older adults fully hydrated is one of the most crucial health issues our in-home caregivers address every day.”

Common Causes of Dehydration in Seniors

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. 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 seniors 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 function – As people age, their kidney function decreases, and they are less able to conserve fluids.
• Excessive sweating – Losing water through sweating without replacing fluids can cause dehydration. High temperatures and strenuous activity increase sweating and fluid loss.
• Increased urination – Certain 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 Seniors

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.

A Nutrition and Healthy Aging publication of the National Institutes of Health states that “in some individuals, the loss of as little as 2-3 percent of body fluid can cause physical and cognitive impairment.” For some seniors, a slight fluctuation in hydration can send their health spiraling downward.

On the other end of the medical spectrum, overhydration also puts the elderly at increased risk. Fluid overload can occur with health conditions such as congestive heart failure and kidney failure and after a person receives intravenous fluids, a blood transfusion or steroids.

How Caregivers Can Help Prevent Dehydration

“Seniors often need to be coached on the adequate amount of liquids to consume each day,” Begley explains. “Your elder’s doctor can guide you on a proper hydration amount for your aging loved one, but generally, older adults need to drink even when they are not thirsty. It is much easier to keep your senior hydrated than to offset the problems caused by dehydration.”

Begley suggests 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 senior day and night.
• Check regularly that the senior’s urine is light-colored, and output is sufficient.
• Serve a variety of high-water-content foods such as fruits, soups, vegetables and smoothies.
• The senior should not skip meals. Much of a senior’s fluids comes from foods.
• Ensure the senior 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 senior’s daily fluid intake by creating a hydration schedule. It is better for the senior to sip liquids every hour than drink extra at a meal.
• Consult with the doctor about changing medications if the elder is taking laxatives or diuretics.

Watch continually for signs of dehydration. If you suspect your senior 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 elder has had diarrhea for 24 hours or more, cannot keep down fluids, or is disoriented or listless.

“Our mission at Right at Home is to improve the quality of life for those we serve,” Begley added. “Hydration improves one’s quality of life and saves on medical interventions and hospitalizations. In keeping older adults well-hydrated and healthy, perhaps Benjamin Franklin said it best: ‘An ounce of prevention is worth a pound of cure.’”

About Right at Home of Boston and North

Right at Home Boston and North is a locally owned and operated by Rosaleen Doherty, CEO and Jay Kenney COO, serving over fifty towns in the North Shore, Merrimack Valley and Greater Boston area. Right at Home offers in-home companionship and personal care and assistance to seniors and adults with a disability who want to continue to live independently. For more information, contact Right at Home of Boston and North at www.rightathome.net/boston-north, 877-500-CARE (2273) or by email at info@rightathomemass.com. To sign up for Right at Home’s free adult caregiving e-newsletter, Caring Right at Home, visit http://caringnews.com.