Dehydration In the Elderly Is A Year-Round Struggle, But Doesn’t Have To Be

It’s been a scorching past couple of months. Across the U.S. and the world, temperature records dropped like flies this summer. Notoriously rainy London saw its picturesque green spaces burned to an unsightly, ocre crisp, with the rolling estates of Hampstead Heath looking more like a high summer’s African savannah. As people across the planet continue to experience heat waves and droughts the likes of which they’ve never felt, they’re finding themselves at a greater risk of dehydration than ever before.

In seniors, this is especially dangerous. The trouble is that with it’s oddball constellation of symptoms dehydration can sometimes be tricky to diagnose. Our body becomes less efficient as we age; things it did with ease when we were young—like hold on to water, or not make us groan when standing up—become challenging.

For a species comprised of at least half H2O (the percentage drops as we grow older, from about 70% to 50% over time), this is less than ideal. So with that in mind, considering dehydration is in fact a year-round risk for seniors, we wanted to take a look at how this serious condition can affect our aging population, and what can do to diagnose, treat, and prevent it.

Dehydration Risk Factors

As we age, we lose our ability to perceive thirst as keenly as when we were young. For the seniors in your care, this natural state means that they are less likely to consume as much liquid as they need to stay healthy. This quickly puts an individual who is already low on body water at an even greater risk of dehydration.

One study, which looked at elderly patients as they were admitted to the hospital, showed that 37% were dehydrated upon arrival. Additional research suggests that one in five older individuals living in assisted care does not drink enough fluids.

For individuals with Alzheimer’s or other forms of dementia, who may not remember to ask care staff for a glass of water, this risk is even greater:  they’re six times more likely to be dehydrated. This is especially problematic considering that even mild dehydration can exacerbate their cognitive symptoms, leading to increased confusion and worsened thinking skills.

In some cases, seniors may be reluctant to drink fluids out of fear of incontinence and the embarrassment that can come with it. Anxieties about toilet issues are very common among the residents of care homes, but it’s a worry that often goes unnoticed in care homes, because individuals are unlikely to want to discuss it.

And yet, studies actually show a positive relationship between proper hydration and a decrease in anxiety levels among the elderly. This might not correlate for individuals with continence anxiety, but it’s something to keep in mind when searching for ways to improve the mental health of residents.

Other factors that contribute to dehydration include mobility issues, medications (aka “water pills,” with diuretic properties) used to treat high blood pressure, acute illnesses (vomiting, fever, diarrhea, and infection all contribute to water loss), being a resident of an assisted living facility (where access to fluids is largely dependent on the availability and attentiveness of caregivers), and difficulty swallowing.

Diagnosing Dehydration

Dehydration can be very difficult to diagnose. The symptoms it presents with are all easily attributable to other conditions, and they may not always present in a clear cut way, so symptoms on their own are not a reliable basis for a diagnosis.

Some of the most common symptoms, and the ones that people are told to look out most with dehydration, include:

• Extreme thirst
• Decreased frequency of urination
• Dark-colored urine
• Fatigue
• Dizziness
• Confusion and delirium (either new, or worse than usual)
• Racing heart (typically a rate exceeding 100 bpm)
• Low systolic blood pressure
• Sunken eyes

Rather than simply basing a dehydration diagnosis on symptoms, it makes more sense to keep on eye out for these, and then follow up with a more reliable test.

For older adults, a laboratory blood test is the most accurate method of diagnosing dehydration. Studies have shown that routine tests done by care homes to spot signs of dehydration (such as pinching the skin on the back of the hand, or performing a urine dipstick test) are also unreliable.

Prevention of Dehydration

Of course, the best method of treating dehydration among seniors is to prevent it from happening in the first place. With this in mind, there are a number of steps that a caregiver or nursing staff can take to ensure an individual receives enough fluids.

Here are just a few:

• Make fluids available throughout the day, and on a schedule.
• Since older adults might be reluctant to drink a large glass of water in one sitting (see:  continence issues), consider offering smaller quantities of fluid more frequently.
• Provide a beverage that the individual in your care enjoys.
• Ask whether they prefer to drink through a straw (this might be easier, mobility-wise, than having to lift a cup to their mouth)
• Keep a urination log, and a log of their fluid intake, and note when instances of incontinence occur. Check in with your resident about whether toilet issues are a reason why they are reluctant to drink.
• Consider placing the older individual on a bathroom schedule. This might be especially appropriate for someone with memory troubles or mobility issues.

Dehydration is a serious condition, and if left unchecked can lead to kidney failure and death. While mild dehydration is usually easily treatable by merely increasing fluid intake and electrolytes, the worst cases call for a trip to the emergency room for intravenous fluids, or even dialysis and other kidney-supporting methods.

Hospital visits are scary, no matter the reason, and they put an enormous amount of stress on an individual and their family. Making sure the older person in your care is properly hydrated is one of the simplest ways to ensure their health and happiness, and will go a long way toward improving their quality of life.

If you or anyone under your care is exhibiting symptoms of dehydration, or any other worrisome symptom, please be sure to contact a licensed medical provider for further assistance.

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