Dehydration in the Elderly

The Dangers of Dehydration in the Elderly — A Hidden Problem

Dehydration is a common but frequently overlooked problem that affects millions of seniors across the United States. Part of the reason that it tends to be overlooked is because of common misconceptions about dehydration.

Frequently, people assume that the individuals most likely to be affected by dehydration are endurance athletes or individuals who work in hot conditions.

Most seniors do not fall into either of these categories. And yet, still, seniors regularly experience dehydration — and the effects of this fluid shortage can be even more serious for them than it is for their younger counterparts.

In this article we will discuss:

  • What Is Dehydration and Why Is It Dangerous?
  • Chronic Dehydration in the Elderly Population
  • Dehydration Death in the Elderly
  • Why Do Seniors Frequently Experience Dehydration?
  • Non-Specific Signs of Dehydration
  • Physical Symptoms of Dehydration
  • Diagnosis and Recovery from Dehydration in the Elderly
  • Tips for Preventing and Managing Dehydration in the Elderly
  • Concluding Thoughts
  •  Dehydration  in seniors

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    What Is Dehydration and Why Is It Dangerous?

    Dehydration is an excessive loss of water which causes disruption in the body’s normal functioning. This tends to happen when a person loses more fluid than they consume. There are a number of causes for this, which we will cover later in this post.

    Elderly dehydration is difficult to diagnose because signs of dehydration in younger people, like wrinkling and sagging skin, are not noticeable in seniors.

    Because it can take time to observe dehydration symptoms and get a diagnosis, elderly dehydration is a common cause for hospitalization. In fact, complications of dehydration can cause serious health issues like:

    • Weak, rapid pulse
    • Hypovolemic shock (drop in blood pressure/amount of oxygen)
    • Passing out
    • Kidney and urinary problems, including kidney failure
    • Seizures
    • Blood clots

    Chronic Dehydration in the Elderly Population

    Chronic dehydration is common among older adults. If frequent dehydration has been confirmed, fluid intake should be measured daily and compared to the recommended daily intake for the senior’s age range.

    Why do seniors have a higher risk for dehydration? Because with aging, our body mechanisms don’t work as well as they did when we were younger. Cues like thirst signals aren’t as noticeable, and incontinence can make it difficult to measure output. Risk factors for chronic dehydration include:

    • Dementia or memory issues—Individuals can forget to drink on a regular basis.
    • Trouble swallowing—Swallowing issues hinder fluid intake.
    • Chronic urinary incontinence—Incontinence can cause individuals to avoid drinking to reduce incidents.
    • Residing in nursing facilities—This can result from staff not being attentive to fluid intake/output.
    • Trouble with mobility—Individuals can find it difficult to get up and get a drink.

    Dehydration Death in the Elderly

    It is estimated that (depending on the definition of hydration) between six and thirty percent of people aged 65 years and older who are hospitalized are dehydrated. Furthermore, the fatality rate due to dehydration can be as high as 50%. [i]

    According to Gary Payinda, MD, patients can die from dehydration in less than a week, depending on the level of exertion. Once dehydration occurs, sodium levels rise and begin to affect the brain, causing confusion and lethargy. The individual then enters a sleep-like state and eventually vital systems shut down. [ii]

    It is especially important for seniors living on their own to be monitored by loved ones and caregivers to be sure they are getting adequate fluids, especially if they are on certain medications, suffer from dementia, have been ill with vomiting or diarrhea, or have just returned from a hospital stay.

    Why Do Seniors Frequently Experience Dehydration?

    Given the diversity of the senior population, it is perhaps not surprising to hear that there are many different reasons that older Americans may be vulnerable to experiencing dehydration. [iii]

    Changes in Body Water Composition: As we age, our total body water decreases. This makes older adults more susceptible to becoming dehydrated.

    Mobility Challenges: One common reason for dehydration is mobility challenges. Some seniors may have problems either with walking or sitting and standing from their chairs or couches. Because of these challenges, they may be more reluctant to go to their bathrooms or kitchens to get water — leading to chronic dehydration.

    Decreased Sensitivity to Thirst: Another common reason for dehydration is that as the body ages it is no longer as sensitive to thirst cues. Therefore, a senior may actually overlook the fact that they are thirsty and need water.

    Changes in Kidney Function
    : Many seniors have poorer kidney function than their younger peers. Kidneys that are not functioning at as high of a level may have a lower ability to conserve liquid — and thus, the senior with kidney challenges may need more water than other people simply to maintain baseline functioning.

    Medications: Although the above-mentioned factors are some of the primary causes of dehydration in the senior population, they are not the only ones. For example, the medications that many seniors regularly take may also be responsible for dehydration challenges.

    Some of the most frequent culprits are blood pressure pills and anti-depressant medications. Many seniors have been prescribed these classes of drugs, and they cannot stop taking the medication. However, it is important to know that dehydration may be a symptom of this medication use.

    Physical Illness: Severe illnesses, especially those that involve vomiting, diarrhea, and/or fever, as well as bladder infections and bronchitis, can lead to a significant loss of water.

    Sweating Profusely: Sweating excessively due to vigorous exercise or prolonged exposure to humid, hot conditions can quickly cause dehydration.

    Chronic Medical Issues: Diabetes, kidney disease, dementia, and other physical conditions can lead to dehydration.

    Given the vast number of different causes of dehydration, it is perhaps not surprising that in most cases doctors and medical providers are unable to pinpoint the exact cause of dehydration.

    What Are Signs and Symptoms of Dehydration in Seniors?

    Since dehydration may have serious consequences for seniors, it is important that seniors — as well as family, friends, and caregivers — are equipped with the information and tools to recognize dehydration in this population and take necessary steps to combat it. So, what are common signs and symptoms of dehydration?

    Non-Specific Signs of Dehydration

    There are numerous signs and symptoms of dehydration. Unfortunately, many of these symptoms are non-specific — in other words, they may point to dehydration, but they could also point to a wide range of other more serious health problems too.

    Non-specific symptoms of dehydration may include:

    Low Blood Pressure

    Another significant symptom of dehydration is low blood pressure. When a person is dehydrated, they may experience a significant drop in their blood pressure (which in turn can lead to a wide range of other troubling symptoms, such as dizziness).

    While the blood pressure is dropping, the person’s heart rate may also increase, and the pulse will be rapid and thread-y. The only problem with using these symptoms to diagnose dehydration is that not everyone has a blood pressure monitor at home — and even people who do may not regularly check their blood pressure. Thus, they will not necessarily know if their rate has dropped.

    Skin Tenting

    The second symptom is perhaps significantly easier to recognize — it is commonly referred to as skin tenting.

    In a well-hydrated person, if you pinch the skin on the back of their hand, it will quickly return to normal. For a dehydrated person, this does not happen. The skin will remain tented up — in other words, there is a lack of elasticity.

    In addition to these physical symptoms of dehydration in the elderly, there may also be physical changes in a dehydrated person’s appearance.

    Physical Symptoms of Dehydration

    You may be able to observe physical symptoms of dehydration, including:

    • Rapid heart beat (over 100 beats p/m)
    • Constipation
    • Difficulty urinating
    • Confusion or disorientation
    • Dark/Bloody stools
    • Dizziness
    • Headaches
    • Trouble walking / more frequent falls
    • Exhaustion
    • Changes in mood
    • No tears
    • Dry and cracked skin, particularly around the lips
    • Inability to sweat
    • Dry mouth
    • Dry skin in the armpit
    • Delirium (more pronounced than usual or new confusion)
    • Sunken eyes
    • Weakness

    A dehydrated person may not be able to sweat — even in very hot weather conditions. The person may also not be able to produce tears, and their skin (particularly around the lips and mouth) may become extremely dry and cracked.

    These are only the tip of the iceberg for symptoms that seniors may experience. And given the dramatic range in health conditions for seniors, these symptoms may look very different in different individuals.

    Diagnosis and Recovery from Dehydration in the Elderly

    The best way to diagnose dehydration in older adults is through lab testing. Blood samples can show abnormal results like the following: [iv]

    • Urine sodium concentration is low (not the case when the individual is on diuretics)
    • Electrolyte imbalances are present (especially abnormal blood sodium levels)
    • Creatinine and blood urea nitrogen levels are elevated (related to kidney function)
    • Plasma serum osmolality is elevated (pertaining to particle concentrations in blood plasma)

    Once dehydration has been diagnosed, the protocol for recovery will depend on its severity, the type of electrolyte imbalance detected, and the cause of dehydration.

    Treatment for Mild Dehydration

    This can typically be treated with increased oral fluid intake. Preferably, the elderly individual should take in fluids containing electrolytes like Gatorade (or other sports drinks), juices, or bullion. Of course, water is also helpful.

    Moderate Dehydration Treatment

    Seniors with moderate dehydration are often treated with hydration through an IV in a facility (ER, urgent care center, or hospital).

    Treatment can also be administered in a nursing home via hypodermoclysis (fluid through a small IV needle in the skin of the thigh or belly). This subcutaneous infusion is considered more comfortable and safer for elderly patients than traditional IV.

    Treating Severe Dehydration

    In addition to the treatments above, if an elderly person is suffering from severe dehydration, he or she may need additional support for the kidneys, including short-term dialysis.

    Tips for Preventing and Managing Dehydration in the Elderly

    Given the severity of dehydration symptoms — as well as the range of other health problems that dehydration can result in — it is important for both seniors and their family members, loved ones, and caregivers to know the necessary steps to take to prevent dehydration.

    It is far easier to prevent dehydration from occurring than it is to treat it once it is a real problem.

    1. Tackle Mobility Barriers to Make Water Easily Accessible

    Encourage Fluids Often

    The best way to prevent dehydration is simple — encourage the seniors in your life to drink, even when they are not feeling thirsty. Water is always best.

    However, if the senior has been vomiting or having diarrhea or is experiencing challenges with their blood pressure or heart rate, it may be beneficial to encourage them to drink Gatorade to restore necessary electrolytes to the body.

    Focus on sipping throughout the day rather than encouraging large quantities of fluid at once.

    Keep Fluids Handy

    Place water bottles near the senior’s couch, chair, or on a bedside table. With water in easy reach, they will not have to get up to get a drink. Provide straws when appropriate to make drinking easier.
    Use an Alarm as a Reminder

    Set an alarm or timer. When this alarm goes off, the person should be encouraged to drink some water, allowing them to stay ahead of the dehydration curve.

    2. Education Is Another Key

    If the senior in your life is being cared for in a professional nursing facility or medical center, it is important to proactively check with them and make sure that they have policies in place to prevent dehydration.

    One of the best ways to do that in a clinical setting is to make sure that the senior is weighed every morning at the same time before breakfast. Dehydration will usually result in a significant (1-2 pounds) weight loss. By recognizing this weight loss early, proactive steps can be taken.

    3. Be Proactive

    Additionally, proactive steps should be taken in case the senior has experienced vomiting or diarrhea. These conditions can quickly transform relatively mild dehydration into a life-threatening condition that needs immediate medical intervention.

    4. Be Flexible and Offer Variety

    Let’s face it. The thought of sipping water all day is probably less than appealing to many of us, and that is no different for seniors. Here are some ideas for helping the older adult in your life get (and enjoy) more fluids throughout the day:

    Offer a Variety of Drinks

    Talk to the senior in your life about their favorite drinks. Stock them up with their favorites, including low-sugar fruit and low-sodium vegetable juices, flavored water, decaf tea, and other non-caffeinated/non-carbonated items, and keep them handy.

    Regarding caffeinated beverages like tea or coffee, there is debate as to whether the weak diuretic properties lead to much water loss (unless the person has an overactive bladder). Many experts say that caffeine in moderation is fine when combined with other drinks throughout the day.
    Get Creative

    How about jazzing up that water by infusing it with fruit or, if blood sugar levels are an issue, a natural flavoring. There are several products on the market with natural flavors/sweeteners that are healthy and don’t affect blood sugar levels.

    In the warmer months, freeze some of their preferred drinks in popsicle holders for a cool, refreshing way to help keep them hydrated.

    Choose Foods with High Water Content

    Step outside the box and look for preferred foods, like soups, fruits, vegetables, and yogurts that have a high water content.

    5. Measure Intake/Output

    If you are concerned about an elderly individual under your care becoming dehydrated, measure and keep a log of what/how much they are drinking throughout the day.

    Additionally, keep an eye on output. It may be beneficial to set up a timed toileting schedule, which will help the individual get to the bathroom regularly, curb incontinence, and measure output.

    In other words, the key ways to prevent and address dehydration in the senior demographic are:

      1. Be proactive.
      2. Improve accessibility to fluids.
      3. Educate people about the dangers of dehydration and important warning signs to look for.
      4. Be flexible and creative to encourage higher fluid intake.
      5. Monitor intake/output.
      6. When dehydration is noted, take immediate steps — either rehydrating the person where they are or transporting them to a hospital if they need more active interventions, such as IV fluids.

    Remembering these six steps will help keep seniors happy, healthy and well-hydrated.

    Concluding Thoughts

    Unfortunately, many people mistakenly assume that dehydration is a problem that primarily affects young people — from endurance athletes to those who work outside under the blazing sun. However, the reality of dehydration is far different than this.

    One of the primary demographic groups that is impacted by dehydration is seniors. Seniors may experience dehydration for many reasons, such as decreased mobility, medications that dehydrate the body, and kidney disease and dysfunction.

    This dehydration then results in a wide range of symptoms. However, many of these symptoms — such as confusion and dizziness—are non-specific, and they may not immediately lead to a diagnosis of dehydration.

    But, with better information and education, seniors and the people in their lives will be able to recognize these symptoms and move forward with appropriate treatment, and ideally, in the long-term, they will be better equipped to prevent dehydration from occurring.