Dehydration in the Elderly

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Dehydration in the Elderly on the Geriatric Nutrition Connection, Woman drinking coffee and smiling

Dehydration in the elderly is common!

Dehydration can happen to anyone at any age, but dehydration in the elderly is more common. On top of that, it can be more dangerous! This article will help shed some light on how to watch for the signs of dehydration in the elderly. You will walk away with a better understanding of dehydration in the elderly, and you will know what to do to prevent it!

Dehydration impacts seniors in nursing homes and hospitals, plus about 40% of seniors living in the community(1). For the elderly, dehydration is a common cause of hospital admissions. Being well hydrated is so important for seniors. At the same time, dehydration is one of the most common problems I see when working with the elderly as a geriatric dietitian (learn more about me!).

As a geriatric dietitian, I work with elders to discover what their challenges to hydration are. For instance, I help elders create goals for hydration, and think of ways to make positive impacts on their daily habits to meet those goals.

Continue reading for more information on dehydration in the elderly, how to prevent it, and ways to encourage hydration in seniors.

Water is important for a healthy body

Water is important to every function of the body, and when the body is “dry” lasting damage is possible.

Adequate hydration is essential to every normal body function including:

  • digestion of food
  • body temperature regulation
  • cushioning the organs (including the brain)
  • cushioning of joints
  • removal of waste through urine and feces

Dehydration impairs the body functions listed above. This may lead to headaches or confusion, pain in the joints, or constipation. If dehydration in the elderly continues and worsens, organs may even fail.

Why the elderly are at higher dehydration risk

Dehydration in the Elderly on the Geriatric Nutrition Connection, 6 risk factors the elderly have for dehydration

-Loss of muscle mass

Hydration is challenging for many seniors, as aging causes a natural decrease in the body’s water due to loss of muscle mass. Lean muscle holds 40% of the body’s water stores, and as this muscle disappears, so do these water reserves(2). This makes it even more important for the elderly to drink fluids throughout the day to make up for the fluids that were lost.

-Decrease in thirst sensation

Aging also causes a decrease in thirst sensation(3). Due to this, seniors may not feel thirsty even though they are dehydrated.

-Chronic disease

Chronic diseases that are common in older people can increase the risk of dehydration. 

For example, diabetes puts an elderly person at a higher risk of dehydration.  When blood sugar is high in the body, the kidneys are triggered to excrete the excess sugar through the urine. As a result, urine is lost in an attempt to bring blood sugar, and this can lead to dehydration.

Kidney disease can also impact water shifts in the body that may lead to dehydration.

-Forgetfulness

Forgetfulness could cause a senior to overlook hydration throughout the day, especially if a caregiver is not present to provide reminders to drink. Those with dementia are especially at risk of dehydration, as they are unable to seek out adequate fluids throughout the day. 

-Lack of mobility or loss of motor function

Other seniors may suffer from a lack of mobility that may prevent them from obtaining beverages. For example, with aging comes other conditions including arthritis, Parkinson’s disease, and stroke. These make walking to get water, carrying dishes or cups, or drinking from a glass difficult or impossible. 

Some elderly people have trouble twisting off the lid of a water bottle because of arthritis. Other elders may have tremors, and the shaking causes liquids to splash out of the cup when drinking. It is important to think beyond fluid ingestion when considering why someone is dehydrated.

Mobility is especially important to think about when assessing hydration when the elderly person is in a healthcare environment. In long-term care centers or even the hospital, the elder may be confined to a bed and unable to walk to a sink or pick up a glass that has fallen. Here, the elder is reliant on staff to obtain fluids and sometimes drink them.

-Bladder control issues

Bladder control issues are sometimes seen in the elderly. Some who suffer from incontinence may control how frequently they need to urinate by intentionally limiting their fluid intake to prevent urination. Limiting fluids in the evening is also common to prevent needing to urinate overnight. In these cases, other providers such as a physician should be consulted to determine if there is anything that can be improved medically.

-Swallowing impairment

As people age, swallowing may also become more difficult. Some elders may receive a dysphagia diagnosis made by a speech-language pathologist because their swallow is dangerous under certain conditions. 

Thickened liquids are commonly prescribed by speech-language pathologists to ensure safety for those struggling with safe swallowing. Some find thickened liquids unpalatable and struggle to drink an adequate amount to stay hydrated. 

Signs and symptoms of dehydration in the elderly

Dehydration can impact seniors in various ways. Common signs and symptoms of dehydration include:

  • Dark-colored urine
  • Fatigue
  • Headaches
  • Muscle cramps
  • Dizziness
  • Constipation
  • Decreased blood pressure
  • Dry mouth
  • Sudden weight loss

If dehydration continues, more serious signs and symptoms could be:

  • Confusion
  • Severe cramping
  • Difficulty walking
  • Sunken eyes
  • Dry, wrinkled skin that has lost elasticity (turgor)

In a clinical environment, dehydration is commonly diagnosed through lab work. The most frequently seen type of dehydration in the elderly is isotonic dehydration. Isotonic dehydration occurs when equal amounts of water and electrolytes are lost from the body, like from vomiting or diarrhea.

Things that determine a person’s fluid needs

Hydration needs vary widely among seniors depending on medications, activity, environment, health factors, and lifestyle. For example, a person undergoing renal dialysis requires far fewer fluids in a day than someone not needing this specialized treatment. A senior in Texas during the summer may need more fluids than a senior in Seattle during the same season. 

Prescription medications may lead to dehydration, especially those that are diuretic medications (cause water excretion). 

Fluid needs can change

There are things that increase an elderly person’s fluid needs. One example that can cause dehydration in the elderly is hot weather. When the weather is hot, the body will sweat to try and cool off. When water is released from the body as sweat, seniors need to drink more to replace what was lost. Other examples that can increase are fever, wounds, and infections.

Calculated fluid needs

As a geriatric dietitian, I usually recommend 1 milliliter of water per calorie (based on calculated calorie needs) or 30 milliliters of water per kilogram of body weight. This is for a senior with no health concerns that impact how much fluid they can consume. 

So, for a person whose calorie needs are around 2000 calories per day, their fluid needs would be 2000 milliliters. This is equal to 8 ½ cups of water. A full nutrition assessment allows for a more specific fluid goal. 

I encourage you to contact your physician or a geriatric registered dietitian. These professionals can help determine your specific daily fluid goal. 

Ways to prevent dehydration in the elderly

Once a senior’s fluid goals are known, there are many ways to promote hydration if needed:

  • You can offer the preferred fluid type and temperature. Make sure to ask if there is a preferred beverage or flavor (i.e. tea or water). Also ask about the temperature of fluids (i.e. fluid with ice or at room temperature).
  • Try and include high water content foods in the diet. Fruits and vegetables, soups, jello, popsicles, and ice cream all can help hydrate.
  • You can offer fluids with every meal and snack.
  • You can offer a variety of fluids. This way the elder will not get bored of the same beverage.
  • You can encourage extra fluids when the elder takes their medications.
  • Make it easy to get to fluids around the house. This could mean leaving bottles of water in a basket near the recliner the senior likes to sit in.
  • Jot down fluid intake throughout the day on a piece of paper to get a better idea of how much the senior drinks.

Dehydration in the Elderly on the Geriatric Nutrition Connection, Chart of 5 strategies to promote hydration for seniors

How to advocate for your loved one living in a nursing home or assisted living facility

Always check with the staff and registered dietitian of the community for any restrictions before you bring anything into the community

  • You could bring in labeled and shelf-stable beverages to keep in their room. This could include bottles of water, flavored water, bottled tea, or tea bags.
  • Bring in “Crystal Lite” or other drink flavoring.
  • Ask the care staff to add drinks into your loved one’s plan of care at certain times of the day.
  • Brainstorm with the care staff on how to help your loved one drink more.
  • Make sure your loved one’s beverage preferences are noted by the facility’s kitchen and by the nursing staff.
  • Does your loved one need a different type of cup? Lighter, heavier, handled, and lidded cups all may be good options. Speak to staff about possible therapies like occupational therapy, or if a different kind of cup is available.

What fluids help prevent dehydration in the elderly?

There are many opinions on what fluids “count” towards a fluid goal. When a senior is needing hydration, most fluids, even caffeinated ones like coffee, count. 

Caffeine does have a diuretic effect (stimulates urination) in large doses. However, the amount of caffeine that people typically drink is not shown to be associated with dehydration(4). The main goal is to get fluids into the body to support hydration. Milk, water, tea, juice, sport drinks, and coconut water all are hydrating. Alcohol is not hydrating, and doesn’t count as a hydrating fluid.

Dehydration in the Elderly on The Geriatric Nutrition Connection, Water with berries and mint, Elderly Beverage Idea

Food and drink ideas to prevent dehydration

  • Water
  • Juice
  • Tea (hot or cold)
  • Coffee (hot or cold)
  • Milk
  • Sports drinks
  • Coconut water
  • Sparkling water
  • Water flavored with lemon or lime
  • Water flavored with herbs like mint
  • Applesauce
  • Melon wedges
  • Pudding
  • Gelatin
  • Ice cream
  • Frozen yogurt
  • Fruit smoothies
  • Popsicle

Don’t forget to ask for preferences!

It is so important to ask a senior what they like to drink.

Naturally, people are more accepting of things when they enjoy them! This will make hydration way more successful.

Also remember that preferences may change over time. Because of this, check in every so often to see if preferences should be updated.

To make hydration more successful, ask the elder: 

  • What would you like to drink?
  • When would you like to drink it?
  • At what temperature would you like to drink it?
  • In what vessel would you like to drink it from?

Conclusion

Dehydration in the elderly population can dangerous, but there are many ways to help! You can catch dehydration earlier if you watch for the signs and symptoms of dehydration. Then, action can be taken to give more fluids!

For those struggling with hydration, there are ways to encourage more fluid intake. This includes offering a variety of fluids throughout the day and tracking intake. A geriatric dietitian can help determine specific fluid goals and can support seniors in meeting those goals!

(Please feel free to share the charts and graphs within this post. Please give credit to The Geriatric Nutrition Connection and link back to this page.)

 

Here are some items that I mentioned above to get you started: (I get commissions for purchases made through links in this post.)

Sources

  1. Stookey, J. D. (2005) High prevalence of plasma hypertonicity among community-dwelling older adults: Results from NHANES III. Journal of the American Dietetic Association 105: 1231–1239.
  2. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004;7(4):405-410. doi:10.1097/01.mco.0000134362.76653.b2
  3. Bak A, Tsiami A. Review on Mechanisms, Importance of Homeostasis and Fluid Imbalances in the Elderly. Curr Res Nutr Food Sci 2016;4(Special Issue Elderly October 2016).
  4. Maughan RJ, Griffin J. Caffeine ingestion and fluid balance: a review. J Hum Nutr Diet. 2003 Dec;16(6):411-20. doi: 10.1046/j.1365-277x.2003.00477.x. PMID: 19774754.
  5. Stookey, J. D., Pieper, C. F., Cohen, H. J. (2005) Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years. Public Health Nutrition 8: 1275–1285.
  6. https://newsroom.ucla.edu/releases/study-finds-a-lack-of-adequate-hydration-among-the-elderly
  7. Meade, Robert D. et al. Aging attenuates the effect of extracellular hyperosmolality on whole-body heat exchange during exercise-heat stress, J Physiology,2020;598(22):5133-5148.
  8. Salivary Osmolality, Function, and Hydration Habits in Community-Dwelling Older Adults
  9. Janet C. Mentes, PhD, APRN, BC, FGSA, FAAN, Michelle A. DeVost, MPH, Karabi Nandy, PhD. First Published February 6, 2019 Research Article Find in PubMed.
  10. Jéquier, E., Constant, F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr 64, 115–123 (2010).
  11. Taylor K, Jones EB. Adult Dehydration. [Updated 2021 Oct 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.