Dehydration: A Hidden Risk to the Elderly

Sudden shifts in the body's water balance can frequently result in dehydration, and the physical changes associated with aging expose the elderly in particular to the risks of dehydration. One serious danger to the elderly is that they may not know about their dehydrated condition, which could lead to it not being treated and result in more serious consequenses.

In one study of residents in a long-term care facility, author Janet Mentes reported that 31 percent of patients were dehydrated. In a related study, researchers found that 48 percent of older adults admitted into hospitals after treatment at emergency departments actually had signs of dehydration in their laboratory results.

What causes dehydration in the elderly?

Dehydration in seniors is often due partly to inadequate water intake, but can happen for many other reasons as well including diarrhea, excessive sweating, loss of blood, diseases such as diabetes, as well as a side effect of prescribed medication like diuretics. Aging itself makes people less aware of thirst and gradually lowers the body's ability to regulate its fluid balance.

Elders may not feel thirst as keenly.
Scientists warn that the ability to be aware of and respond to thirst is slowly blunted as we age. As a result, older people do not feel thirst as readily as younger people do. This increases the chances of them consuming less water and consequently suffering dehydration.

Less body fluids, lower kidney function.
The body loses water as we age. Until about age 40, the proportion of total body fluids to body weight is about 60% in men and 52% in women (the gender difference is due to greater muscle mass and lower body fat in men compared to women; muscle cells contain more water than fat cells). After age 60, the proportion goes down to 52% in men and 46% in women. The reason for the decline is the loss of muscle mass as one ages and a corresponding increase in fat cells.

In addition, the kidneys' ability to remove toxins from the blood progressively declines with age. This means the kidneys are not as efficient in concentrating urine in less water, thus older people lose more water.

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

Recognizing Dehydration Symptoms
Those caring for elderly persons should watch for these signs of dehydration.

Mild Dehydration Symptoms
Dryness of mouth; dry tongue with thick saliva

• Unable to urinate or pass only small amounts of urine; dark or deep yellow urine
• Cramping in limbs
• Headaches
• Crying but with few or no tears
• Weakness, general feeling of being unwell
• Sleepiness or irritability

More Serious Dehydration Symptoms

• 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

Dehydration: Staying Hydrated
Everyone knows—but many people seem to forget—that water is what sustains life. Here are just two of the benefits of being hydrated:

1. 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 reduce the risk of colorectal cancer.
2. Drinking at least five 8-ounce glasses of water daily reduces the risk of fatal coronary heart disease among older adults.

Caregivers should make sure the older person has water by their side at all times. Encourage frequent drinking in moderate amounts.

A good formula for how much water is needed every day is to take one-third of the person's body weight in pounds and drink the equivalent number of ounces of water daily. For example, a 150-pound woman would need 50 ounces of water daily, or about 6 8-ounce glasses of water.

Other Hydration Tips to Consider:

• 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 pale yellow.
• 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.