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Dehydration in The Elderly

Dehydration

Older people are at increased risk of dehydration for a variety of reasons. Unfortunately, however, it can be especially difficult to spot the signs of dehydration in the elderly.

Click here for the dehydration Care Plan.

Symptoms of dehydration may overlap with those of other conditions or be shrugged off simply as old age, leading to late diagnosis and risk of serious complications.

Our bodies are made up of about 70% water and this fluid is essential for controlling body temperature, flushing out toxins, and keeping the blood flowing freely.

Without adequate water people are at a higher risk of urinary tract infections, heart problems due to increased blood viscosity, heat stroke, and even joint aches and pains caused by toxic build-up and increased inflammation.

As many older people are already living with heart disease, bladder problems, and weakened immune systems, the risks posed by dehydration are even greater.

A significant loss of total body water content can prove fatal but it may be hard to spot the signs of dehydration in the elderly, requiring careful monitoring and effective communication.

There is no single, declarative sign of dehydration, especially in the elderly, because a loss of total body water content affects a great many organs and systems.

It appears that older adults are more sensitive to the effects of stress on fluid homeostasis, particularly because of poorer function of the renal system, gastrointestinal function and so forth.

Elderly also suffer more severe effects of dehydration in many cases because of existing age-related weaknesses in certain systems.

Signs of Dehydration

One of the first things to look out for that might suggest dehydration is discoloration of the urine.

Some medications can affect urine colour but for most people it should be clear or pale yellow.

Dark urine can be a sign of urinary tract infection and/or dehydration causing waste products to become concentrated in urine.

Decreased urine output is also a sign of dehydration and so nursing staff, relatives, friends, or the patient themselves should monitor catheter output or record the frequency of bathroom visits as well as fluid intake.

One major sign of dehydration is a dry mouth with reduced saliva production and subsequent problems swallowing tablets or food.

The elderly may also develop a dry cough or tickly throat, with visibly parched lips.

Elderly who are dehydrated may become more demanding and any urgent and uncharacteristic demands for specific foods or beverages should be carefully assessed as this may be a sign that the body is making every attempt to increase fluid intake.

Elderly people may also become confused, fatigued, and sluggish when dehydrated, which can be mistaken for symptoms of dementia or general old age.

Because dehydration means that the heart has to work harder to pump a reduced volume of thicker blood around, they may become out of breath and tired more quickly than usual.

A reduced volume of blood also means that blood is directed towards essential organs and away from the skin and muscles.

This can cause confusion, a bluish discoloration to the skin, increased body temperature as sweating is reduced and the body is unable to cool down, and even muscle cramps and joint pain as joint lubrication is reduced.  

Headaches are another symptom of dehydration in the elderly, caused by an inability to cope with high temperatures, as well as by reduced ability to flush out toxic metabolites and to deliver adequate oxygen and nutrients to the brain.

Simple decisions may become difficult, which can lead to the person taking risks and having accidents.

There may be short-term memory loss, confusion, mental fogginess, and even mood disturbances.

Preventing Dehydration

The traditional recommendations are to drink the equivalent of eight or more large glasses of water every day to stay adequately hydrated. 

Thirst is usually the best way to determine necessary fluid intake, but extremely hot temperatures, diuretic medications, and certain medical conditions may increase a person’s need for water, and some people may not be able to address their thirst.

Tea and coffee are now considered as effective at maintaining hydration as water itself, but the majority of water intake still comes from the food we eat. 

As such, dehydration is more of an issue for older people who take in fewer calories and, therefore, less fluid through their diet. 
Water found in food is usually accompanied by beneficial nutrients, including electrolytes, which are essential for the maintenance of proper water balance and cellular signalling. 
Simply drinking a lot of water may not be sufficient to correct dehydration, especially if potassium, magnesium, and sodium have been lost through sweat and/or urine.

The elderly should have easy access to water throughout the day and carers should encourage hydration through recording fluid intake.

Meals should not be rushed, to give the elderly time to drink water at leisure and eat at their own pace. 

Treating Dehydration

Elderly who are dehydrated require lost fluids to be replaced.

It is important that with all elderly there is an assessment of their fluid and dietary intake, but it is absolutely vital that all elderly with dementia have an assessment for fluid and dietary intake.
All risks for dehydration should be considered and addressed where possible and a monthly review of risk should be carried out.
Dehydration can be rectified very easily and in a care setting either Care Home or Hospital setting dehydration should be prevented by good nursing care.
Too many elderly people are having to experience the upset of a preventable hospital admission. 
For an elderly person with dementia the experience can be really frightening.
We have recently developed a dehydration risk assessment tool to ensure carers and nurses address the issue in an evidence based professional manner.

Click here for the dehydration Risk Assessment.