The Importance of Adequate Intake of Fluids

By the National Care Planning Council

Dehydration – failure to consume adequate fluids to replace those that are lost – is a major problem for the elderly. About 10% of all hospitalizations are directly attributable to dehydration. Seniors are particularly susceptible to becoming dehydrated. It can even result in death if severe enough.

As we age our bodies store less water. This is because muscle mass decreases as one grows older and muscles are the primary storage site for water. This means for older people there are less reserves for the body to draw down if it needs more water. Aging seniors also have a less acute sense of thirst and they are more tolerable to warm temperatures which leads to dehydration. Typically, most people drink fluids when they eat. The elderly eat less and often don’t drink fluids when they eat and the rest of the time they often forget about drinking.

Elder abuse or neglect by caregivers can also result in a senior not receiving enough fluids. Seniors receiving oversight from others are simply not given enough to drink. Chronic illnesses such as diabetes make elders specifically susceptible to dehydration. People with other chronic problems such as kidney disease, alcoholism and adrenal gland disorders are also susceptible to dehydration. For whatever reasons, many older individuals forget to drink because their body does not tell them they need to drink. In other cases, individuals who are disabled may not want to visit the bathroom that often because of the difficulty of walking and they will deliberately limit their fluid intake to avoid having to urinate. Other older individuals rely on laxatives to avoid constipation and this has a tendency to flush water out of their systems.

Maintaining hydration is extremely important. Hydration is needed to regulate blood electrolytes, regulate body temperature, maintain blood pressure and eliminate bodily waste through the kidneys and alimentary canal. At some point, cellular function slows down or ceases without enough water.

As with nutrition, individuals in long-term care facilities seem to suffer more. One study found that 31% of patients or residents in these facilities were dehydrated. Researchers found that 48% of older adults admitted to hospitals after treatment in emergency departments had signs of dehydration in their laboratory results.

Older people who get enough water tend to suffer less constipation, use less laxatives, have fewer falls and, for men, may have a lower risk of bladder cancer. Less constipation may also reduce the risk of colorectal cancer. Drinking a lot of water also seems to lessen the risk of fatal coronary heart disease.

Symptoms of Dehydration

If dehydration is not identified and treated, the consequences to health are significant, including confusion, disorientation, loss of consciousness, rapid but weak pulse, and lowered blood pressure. If rehydration is not started, the situation can become life-threatening.

Here are some signs of dehydration.

Mild dehydration:

  • Dryness of mouth; dry tongue with thick saliva
  • Unable to urinate or pass only small amounts of urine
  • Dark or deep yellow urine (for someone properly hydrated, urine should normally be moderately yellow in color or even clear)
  • Cramping in limbs
  • Headaches
  • Crying but with few or no tears
  • Weakness, general feeling of being unwell
  • Sleepiness or irritability

More serious dehydration:

  • Low blood pressure
  • Convulsions
  • Severe cramping and muscle contractions in limbs, back and stomach
  • Bloated stomach
  • Rapid but weak pulse
  • Dry and sunken eyes with few or no tears
  • Wrinkled skin; no elasticity
  • Breathing faster than normal

Maintaining Hydration

Individuals living alone must be aware of the need to consume fluids either through eating foods that are high in water content or drinking water or flavored drinks. A general rule of thumb is to divide the body weight in pounds by three and drink the number of ounces of water each day equivalent to the quotient. For example, for a 150 pound woman, divide by three which yields 50. This would be the number of ounces of liquid to be consumed. In this case this is equivalent to about six, 8 ounce glasses of water.

Here are some strategies to help aging seniors maintain proper hydration.

  • If the elder’s current intake is below the required amount, have them increase the amount they drink gradually.
  • Encourage your loved one not to wait until thirsty to start drinking water: At that point dehydration has already started.
  • One sign of proper hydration is the color of the urine—it should be clear or a somewhat yellow. Dark yellow urine or brown yellow urine might indicate dehydration.
  • Alcohol should be avoided. Minimize the number of beverages with caffeine because of its diuretic effect, causing the kidneys to excrete more water.
  • When you see early signs of dehydration, offer a sports drink to enable quick replenishment of water and electrolytes needed by the body.
  • Severe dehydration requires medical attention; if you see any signs or even just suspect it, call the doctor.

Here are some tips for preventing dehydration in aging seniors by RKT published July 26, 2012

1. Variety

Having to drink the same liquid in the required amounts every day can be discouraging. Although it is important to drink water on a regular basis, the body also benefits from the liquid in other water based drinks and foods, like a glass of natural juice or a snack of watermelon wedges. The advantage of having a variety of types of liquids and water-based fruits and vegetables around the house is that it increases motivation to eat or drink and it therefore increases chances of keeping hydrated.

2. Convenience

One of the issues that can affect how much an elderly person consumes is the convenience of getting a drink. If they are upstairs and would like a drink of water but all the glasses are downstairs, they might be discouraged to go get one. Keep a bottle of water and glasses handy next to the elderly person’s bedside, or consider investing in a water dispenser that will be close to their preferred place of seating. Having drinks and hydrating foods easily accessible as they move around the house or nursing home facility is important.

3. Reminders and Counting Down

It can be helpful to have a daily visible reminder for an elderly person of how much liquid he or she needs to consume every day, which is generally eight glasses a day, and be able to mark down how much they have had and how much they have left to go. Be careful not to make it feel too much like a chore, however. Even for the caretaker’s sake, having a way to keep track and set reminders will help ensure that the patient is getting enough liquid to prevent dehydration in the elderly.

4. Avoiding Diuretics

There are some common drinks which have caffeine and can increase the chance of dehydration in the elderly as they cause the body to release more liquid. These include tea, coffee and caffeinated soft drinks. Replace caffeinated beverages with decaffeinated versions of the same products, or offer alternatives such as water infused with electrolytes or vitamin-rich juice mixes.

5. Address the Fear of Incontinence

As people age, it’s not uncommon to have weakened pelvic muscles and fear having ‘accidents’, especially at night. Helping the elderly to feel comfortable will make drinking enough liquids a less stressful and potentially embarrassing process. Ensuring that the bulk of liquids are consumed earlier in the day, emphasizing the importance of using the bathroom before bed, and using incontinence-friendly undergarments are all ways to safeguard against accidents and help prevent dehydration in the elderly.

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