Dehydration in Elderly

By Dr. Vik, MBBS, MRCP(GB), PhD
Dehydration in elderly

The human body is composed largely of water. Recently there has a greater focus by the medical community on dehydration in the elderly. 

Changes in fluid homoeostasis in elderly patients are associated with a number of different illnesses and a higher mortality rate (Lavizzo-Mourey R, 1988).

Therefore, it is important that dehydration be addressed early on so that treatment options can be explored and  the appropriate steps taken for re-hydration.

The Effects of

Dehydration

on the Elderly

Dehydration combined with other health issues account for the majority of hospital admissions of elderly patients.

Clinical research has shown that as we get older, there are changes in:

• The body’s water composition
  
  
• Kidney function
  
  
• The person’s perception of how thirsty they are (DAVIES, 1995)

Dehydration has an impact on both the kidneys and mental function. Dehydration is a risk factor in the development of:

• Infections
  
  
• Blood clots
  
  
• Kidney stones
  

Causes of Dehydration in the Elderly

Dehydration in the elderly can occur due to:

• A reduced consumption of fluid 
  
  
• An increased loss of fluid from the body
  
  
• An inability to feed or take care of yourself
  
  
• The presence of long-standing chronic diseases
  
  
• Poor mobility
  
  
• Poor memory
  
  
• Not realizing the importance of staying hydrated
  
  
• Family members or caregivers may not be aware that the person is dehydrated

Over time, it is not uncommon for dehydration to start affecting vital systems of the body, mental function and quality of life.

Loss of body fluid many times results in the loss of important electrolytes, including sodium, potassium, magnesium and calcium, worsening the person’s condition.

Clinical Signs and Symptoms

Identifying the clinical signs and symptoms that suggest dehydration in the elderly is the most important step in commencing treatment.

This can be rather difficult task particularly because changes in the skin and muscle tone can sometimes be purely due to advancing age rather than dehydration.

For example, as we get older, the skin appears a lot drier and thicker, which could be due to age and not necessarily a result of dehydration (Berardesca E, 1990).

In a study that assessed complaints made by elderly patients who were dehydrated, the following symptoms were noted:

• A fever was the most common symptom
  
  
• A dry mouth
  
  
• Reduced skin elasticity 
  
  
• Decreased saliva production
  
  
• Reduced urine output 
  
  
• Dry skin in the armpit (Shimizu, 2011)
  
  
• A drop in the blood pressure upon standing from a sitting posture (called orthostatic hypotension)
  
  
• Acute onset of confusion, often warranting admission to a hospital
  
  
• Difficulty in recognizing family members
  
  
• An unawareness of where they are
  
  
• Drowsiness

While these symptoms were rather specific to dehydration, having these symptoms does not actually confirm that the individual is dehydrated (Dorrington, 1981).

Other Markers of Dehydration

Dehydration is not always about a deficit of total body water.

It is also measured in these ways:

• By comparing the proper percentage of body fluid with essential electrolytes, including sodium, potassium, magnesium and calcium. A low level of electrolytes is a form of dehydration.
  
  
• Alterations in kidney function, including blood urea nitrogen and creatinine levels, are markers of dehydration.

These useful markers help to indicate the degree of dehydration, and can serve as a guide for the management of the elderly patient.

Treatment of Dehydration

in the Elderly

Difficulties of treatment

Managing dehydration in the elderly can be rather difficult. Many times, relying on the observation and input of the patient is ineffective.

• An elderly patient may be unaware of thirst.
  
  
• They may find it difficult to keep track of how much water they consume in a day.
  
  
• Cognitive impairment often accompanies advancing age. The patient may not be able to remember when they last had a drink of water.

Rehydrating an elderly person

• Due to the difficulties of treatment, the role of family members and nursing staff (if a patient is in a care home) is crucial (Simmons SF, 2001).
  
  
• Fluid and electrolyte replacement must be done in a gentle fashion over a period of days, not hours.
  
  
• A chart should be kept to ensure that 8 to 12 glasses of water or other fluids are ingested each day. Click here for some re-hydration methods. 
  
  
• If electrolyte levels are low, they must also be replaced. Sea mineral electrolytes is a good, all around electrolyte replacement product, as it contains a good balance of electrolyte minerals. A quarter to a half a teaspoon a day may be sufficient.

In cases of severe dehydration, patients may require hospital admission and intravenous fluids containing needed electrolytes.

Conclusion, dehydration in elderly

Dehydration in the elderly is a rising problem that requires aggressive management.

There are numerous risk factors that may lead to dehydration. Targeting each of them can be helpful in preventing dehydration. Rehydration strategies are numerous and must be done in a controlled manner.

In most cases, electrolytes need to be added to drinking water to replace electrolytes that have been lost, especially through diarrhea or vomiting.

Works Cited

Berardesca E, M. H. (1990). Transepidermal water loss and skin surface hydration in the non-invasive assessment of stratum corneum function. Derm Beruf Umwelt, 50 - 53.

DAVIES, I. P. (1995). Age-associated alterations in thirst and arginine vasopressin in response to a water or sodium load. Age and ageing, 151 - 159.

Dorrington, K. (1981). Skin turgor: do we understand the clinical sign? Lancet, 264 - 266.

Lavizzo-Mourey R, J. J. (1988). Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc, 213 - 218.

Shimizu, M. K. (2011). Physical signs of dehydration in the elderly. Internal medicine, 1207 - 1210.

Simmons SF, A. C. (2001). An intervention to increase fluid intake in nursing home residents: prompting and preference compliance. J Am Geriatric Soc, 926 - 933.

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