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When most people think of dehydration, it is usually getting overheated after a long day of spending time outdoors in the sun, having diarrhea from a stomach bug, or competing in a rigorous athletic event without drinking fluids.
For very mild cases, a bottle of Gatorade may fix the problem. For serious ones, you may need a bag of IV fluids at an urgent care center.
Dehydration in the elderly, however, is not as simple and its repercussions can cause serious damage.
According to the Journal of Health, Nutrition, and Aging, dehydration in the elderly is an actual cause of higher healthcare spending and is associated with an increased risk of dying while hospitalized. (1)
It is also linked with increased admissions to the ICU, readmission to the hospital, and the need to return to the hospital after being discharged. (1)
The elderly should drink a minimum of 1.5 L of water per day. There is no diet that is proven to prevent this problem.
Why are the elderly at a higher risk for dehydration?
The elderly have a higher risk of dehydration as the brain changes with age and isn’t as sensitive to the sensation of thirst anymore.
Also, it becomes more challenging to stay hydrated because of the changes they experience in their golden years. These changes include the following:
- Joint pain may discourage them from making trips to the kitchen.
- Macular degeneration or cataracts can influence a decision between drinking more fluids or risking a trip and fall.
- There may be an unrecognized fear of taking in too much fluid because of prostate problems or urinary incontinence.
- Infections become more frequent, and they are a cause and a result of dehydration (think of the common urinary tract infection).
- The elderly tend to take many medications that can cause dry mouth (Benadryl, pain medications) and excessive urination (diuretics for blood pressure), leading to further dehydration.
- A number of geriatric conditions (including dementia) can affect the physical process of swallowing.
What are the symptoms of dehydration in the elderly?
Patients usually report dizziness, weight loss, weakness, dry mouth, and decreased or smelly urine.
Another interesting sign is called “tenting,” which is a sign of fluid loss. To check for this, simply pinch the forearm skin lightly between the thumb and index fingers.
If the skin remains standing on its own (much like a pup tent), then it indicates not enough fluids in the system.
The doctor may also notice a high heart rate, low blood pressure, cold clammy extremities, and even confusion.
If not treated, these symptoms can progress to shock, kidney failure, falls, and heart failure requiring admission to the hospital.
What causes dehydration and how to deal with it?
Typically, one can recover from dehydration with aggressive fluid intake either by mouth or IV. Addressing the cause is also important and may require medication changes, antibiotics, or lifestyle modifications.
The causes for dehydration in the elderly are many and are not as easy to identify as it is in a healthy 20-year-old.
As always, prevention is key. If your loved one is at risk for dehydration, you may do the following:
- Ask their doctor to review their medications and see if those that worsen or cause dehydration can be reduced or eliminated.
- If they are getting “thickened” fluids because of a problem with swallowing, request a trial off of the thickening powders as they turn fluids into a distasteful honey or pudding consistency.
- If there is a problem with coordinating the movements required to get fluids to the mouth, request that an occupational therapist work with you and your loved one to discover mechanical or swallowing techniques.
- Creating a hydration regimen can also be very helpful and should be viewed in the same way as the non-negotiable pillbox that simplifies when prescriptions should be taken.
- Finally, if you are in the position of transferring the care of your loved one from home to a nursing facility, make sure to inquire what precautions the facility has in place to prevent dehydration. Do they have scheduled “water rounds” or “hydrating carts” at the ready?
Dehydration in the elderly is a real threat. However, it is certainly treatable and can usually be avoided with an ounce of prevention.
Expert Answers (Q&A)
Answered by Dr. Michael Langan, MD
Symptoms of dehydration are not always obvious in the elderly. Mild to severe dehydration can be associated with thirst. However, this is not always the case as the sense of thirst typically decreases with age.
Other symptoms include fatigue, headache, and confusion. Weakness, difficulty getting up out of a chair, and ambulating may occur as the dehydration progresses.
The dehydrated individual may also have dry eyes, mouth, and lips and lack of moisture on the skin, but these are not reliable indicators of dehydration. A lack of moisture under the axilla (underarm), sunken eyes, and decreased capillary refill are more reliable indicators.
Heart rate may increase, and blood pressure may decrease as the volume of intravascular fluid decreases. Moreover, dizziness, lightheadedness, and confusion may be experienced.
If the fluid loss becomes severe enough, loss of consciousness or seizures may occur.
Here are some reasons:
– With age, the overall body water decreases, and the sense of thirst typically diminish, causing decreased fluid intake.
– Age-related kidney problems, such as inadequate functioning of the antidiuretic hormone vasopressin, can lead to decreased water reabsorption from the kidney into the circulation, leading to increased urination.
– Urinary problems such as stress incontinence and enlargement of the prostate may result in intentional fluid restriction out of fear that increased fluids might worsen the symptoms.
– Medications such as laxatives and diuretics prescribed for hypertension are also common causes of fluid loss.
– The elderly are more susceptible to fluid loss in the summer, and dehydration can rapidly occur when the outside temperatures are in the 90-100 °F range and the person is living in a dwelling without air conditioning.
– Acute illnesses causing vomiting or diarrhea, such as viral gastroenteritis, can also lead to a rapid onset of dehydration.
The Institute of Medicine of the National Academies of Science in the United States recommended a daily total fluid intake (water provided from beverages and foods) of 3.7 L (125 ounces) for elderly men and 2.7 L (91 ounces) for elderly women. (2)
In patients with chronic medical conditions such as congestive heart failure, fluid intake needs to be addressed on a case by case basis under the direction of a physician.
In an elderly person with dementia, dehydration can cause delirium, which is an acute state of confusion. This can result in lethargy and somnolence as well as agitation.
The confusion caused by dehydration in someone with dementia should improve with hydration, and it does not worsen underlying dementia.
Yes, severe dehydration can lead to a dramatic loss of electrolytes, which can also lead to delirium and in some cases, hallucinations. Dehydration so severe that it is producing hallucinations is a medical emergency, and the person should be brought to the hospital for treatment.
If the dehydration is mild, the symptoms should improve shortly after drinking sufficient fluids. If the dehydration is severe and IV fluids are administered, they should recover from most symptoms shortly after fluid replacement.
Yes, when the joints are hydrated, they move freely and with ease. However, when the joints are dry and dehydrated, they can become painful. The pain is due to a decrease in the synovial fluid.
The water content in the cartilage is regulated by proteins that become gel-like when they come into contact with water. Dehydration is one of the easiest causes of joint pain to treat.
Encourage older people to drink small amounts of fluids throughout the day rather than drinking large amounts all at once. You can set a benchmark of five 8-ounce glasses of water a day.
It is also important that family members and caregivers recognize the early warning signs of dehydration, such as fatigue, dizziness, dark urine, dry axilla, sunken eyes, and poor capillary refill.
About Dr. Michael Langan, MD: Dr Langan was an instructor in medicine at Harvard Medical School and an assistant professor of medicine at Massachusetts General Hospital for more than 15 years, where he practiced internal medicine and geriatrics.