Dehydration is quite a common problem among seniors, and can become quite a serious one if not spotted. In one study, it was found that almost a third of residents in nursing homes were dehydrated, while another study found that almost half of the older adults admitted into hospital after treatment at emergency departments had signs of dehydration.
Dehydration happens when the body loses more fluids, via urination, sweating, etc., than it takes in. Once this happens, the body doesn’t have enough fluid to maintain itself; water is used for everything from regulating temperature to pumping blood around the body.
The importance of staying hydrated
Drinking water is good for the body as it can help to lower your heart rate and improve endurance, making exercising much easier. It can also help you keep a clear mind and improve your mood by alleviating feelings of fatigue.
Getting dehydrated can lead to weakness and dizziness, which can lead to more falls, and adversely affects memory, concentration and reaction times. It’s known to worsen the cognitive symptoms (especially forgetfulness and confusion) in those suffering from dementia.
Lack of fluid intake can also lead to low blood pressure and skin conditions, as well as affecting how the kidneys and the urinary tract function. Severe dehydration can lead to acute kidney failure and kidney stones, leading to an increase in hospitalisations and even death.
Causes and risk factors
There are a number of different factors that can lead to dehydration in older people – not just general changes as the body ages (older adults have less total body water to begin with).
Diuretic medications are often prescribed for issues such as high blood pressure, while other medications may induce excessive sweating or diarrhoea – all of these lead to a loss of fluids from the body, which will need regular replacing.
Illnesses and infections that cause diarrhoea, vomiting or fever can mean a high loss of fluid, and strokes or Parkinson’s disease can lead to difficulty swallowing. We also lose kidney functions as we age, meaning our bodies cannot retain liquid as efficiently. Those suffering from incontinence may be reluctant to drink much for fear of making it worse. For those with mobility issues or who require assistance with food and drink, staying hydrated can be a chore, and this can be exacerbated for those living in nursing homes as access to fluids depends not just on the availability of staff but also their training and awareness when it comes to hydration.
It’s not just physical problems; dehydration is more common in those who suffer from confusion and depression, or other cognitive impairments that may mean they forget to drink as often, or to request assistance to do so.
With age also often comes a reduced sense of thirst, especially in those with Alzheimer’s disease or those who have suffered a stroke, meaning that they may not realise when they should be hydrating. Trusting that they’ll drink when they feel thirsty doesn’t always work.
Signs of dehydration
If you’re concerned about dehydration, there are a number of signs that you can look out for.
1 - Physical signs may include dizziness or headaches, dryness of the mouth and lips, dry inelastic skin, sunken eyes, rapid heart rate, low blood pressure and an inability to sweat or cry. Urine that is dark and strong-smelling is also a common symptom of dehydration.
2 - Other signs may include drowsiness, confusion and disorientation, as well as a worsening in other symptoms, like delirium, for those who suffer from cognitive difficulties.
However, it is important to note that the presence or absence of any of these signs is not a reliable way to diagnose or detect dehydration in the elderly; any or all of these things may be a result of other health or age-related problems.
If you suspect mild dehydration, then you can test getting the person to drink some fluids, especially something with electrolytes such as sports drinks or juice, and see if this leads to any improvement after 5-10 minutes.
However, for a definitive diagnosis, the best thing is for them to see a doctor, who will evaluate them and possibly order some blood tests. From here, moderate dehydration can be treated with an IV hydration line. Severe dehydration may require additional care over longer term, or possibly even a brief period on dialysis, so catching it early is vital.
How to encourage hydration
It’s not always easy to make sure that you get enough liquid throughout the day – here are some helpful tips and strategies to make sure that you or your loved one stays hydrated.
Remember that there are options other than just water! Smoothies, milkshakes, sports drinks and juice can all provide some variety, and a diet that includes fruits and vegetables (especially watermelon, tomatoes and cucumbers) can also help. Soup or broth are excellent in cold weather, and popsicles are good for when it’s hot. Tea and coffee are fine in moderation as they are mostly water and the amount of caffeine is relatively small, but be careful of alcohol as it can have a diuretic effect. Even if just drinking water, you can spice it up by infusing it with herbs or fruit slices. Try a variety of drinks at different temperatures to work out what is preferred. Be sure to consider any relevant health issues however, such as avoiding high sugar drinks for diabetics or high sodium drinks for those with high blood pressure.
Make sure that liquids are easily accessible – keeping a bottle or pitcher of water next to the bed or a favourite chair is great, especially for those with mobility issues, and encourages drinking frequently during the day.
If you’re caring for an elderly person, make sure to offer them fluids frequently throughout the day, ideally in small/moderate amounts, on a schedule they can get used to. Don’t expect them to drink lots all in one go!
If your elderly loved one is in care, make sure to talk to staff about the availability and variety of drinks they provide, how they monitor hydration, and their training in recognising dehydration.
If there are any issues around incontinence, or difficulties reaching the bathroom which might make them reluctant to consume too many fluids, make sure to take the time to address these. If certain medications have a diuretic side effect, then consider seeing if there are other medications available.
Try tracking hydration by monitoring body weight – if they’ve lost 2 pounds or more after 24 hours, then they may be slightly dehydrated. Track your efforts in trying different drinks and what they seem to prefer, as well as how much and when they are drinking during the day. Everyone is different, and it may be a case of trial and error to figure out what works best for them!
Remember that the amount of water we need varies from person to person and actually relates to your weight – drinking “eight glasses a day” is a myth. It’s recommended to drink in ounces roughly a third of what you weigh in pounds; for example, someone weighing 120 pounds should drink 40 ounces a day, which is only five 8-ounce glasses.
Useful products to stay hydrated
Keeping hydrated can be a challenge, but there are a few handy items out there that can help.
Infusion bottles are a great way to make water interesting; their inner section can hold fruit or herbs such as mint, which then slowly flavour the water the longer that they are left in. These are available everywhere, from Amazon to Wilko’s.
Similarly, cold infusion “bags”, most recently popularised by Twining’s, are just like tea bags but you use them with cold water instead of hot. Appliances like SodaStream are another way of putting a spin on regular water.
Rehydration mixes like those sold in pharmacies or shops like Holland & Barrett, or hydration drinks like Gatorade can be useful if you feel you or your loved one is already suffering from mild dehydration, however always be aware of what they contain with regards to existing medications or health conditions. If in doubt, consult your doctor.
For the more tech-savvy, there are a number of apps out for your smart phone that can help remind you to stay hydrated and keep track of your consumption during the day.
Finally, you can get bottles that track your drinking. Droplet was developed with healthcare professionals and trialled in hospitals and care homes, specifically with the elderly in mind. Their kit consists of mugs and tumblers that fit onto a “smart” base, which monitors the frequency of your drinking and gives you gentle visual or audial reminders to stay hydrated.