Hydration and the elderly

As we get older, body water content decreases, the risk for dehydration increases, and the consequences become more serious.

Dehydration has been associated with increased mortality rates among hospitalized older adults1 and can precipitate emergency hospitalization and increase the risk of repeated stays in hospital.2,3

Dehydration is a frequent cause of hospitalization of older adults and one of the ten most frequent diagnoses responsible for hospitalization in the United-States.3
Evidence suggests high dehydration rates of elderly patients within hospitals and other health care institutions.2

Dehydration has also been associated with various morbidities, such as impaired cognition or acute confusion, falling or constipation.

The cost associated with dehydration may be very high: a study conducted in 1999 in the United States evaluated the avoidable costs of hospitalizations due to dehydration at $1.14 billion.4

Why are the elderly more susceptible to dehydration?
The amount of body water decreases by approximately 15% (about 6 L) between the ages of 20 and 80.5 With this decrease, the body becomes more susceptible to dehydration from the loss of a small amount of body water.6
Moreover, the elderly often experience diminished thirst sensation which leads to a reduced fluid consumption.7,8
Also as a consequence of ageing, the kidneys have a reduced ability to concentrate urine and retain water during water deprivation.9 In addition, ageing kidneys are less able to conserve or excrete sodium.10

Insufficient fluid intakes can also be the result of limitations such as reduced swallowing capacity, decreased mobility, or comprehension and communication disorders. Disease-related factors, such as incontinence can increase water losses. Dehydration may also be caused by warm temperature, inadequate staffing in institutions, or use of laxatives or diuretics.1

What steps can be taken to prevent dehydration in the elderly?

Prevention is primarily based on ensuring adequate fluid intake. Raising awareness of the elderly, their families and caregivers on the risks of dehydration and its consequences is fundamental for dehydration prevention,1,11and can lead to cost-savings in geriatric institutions.12,13

SOME STRATEGIES FOR ENCOURAGING FLUIDS CONSUMPTION9,11

  • Offer fluids regularly during the day
  • Make liquids readily available all day (at bedside or chairside in geriatric institutions) by placing containers such as small bottle of water or sippy cups
  • Encourage consumption of fluids with medication
  • Provide preferred beverages
  • Prescribe and safeguard a minimum intake of 1.5 L in periods of increased risk for dehydration

 

References:

  1. Mentes J. Oral hydration in older adults: greater awareness is needed in preventing, recognizing, and treating dehydration. Am J Nurs. 2006;106:40-9; quiz 50.
  2. Begum MN, Johnson CS. A review of the literature on dehydration in the institutionalized elderly. E SpenEur E J ClinNutrMetab. 2010; 5:e47-e53.
  3. Sheehy, CM, Perry PA, Cromwell SL. Dehydration: biological considerations, age-related changes, and risk factors in older adults. Biol Res Nurs. 1999; 1:30-7.
  4. Xiao H, Barber J, Campbell ES. Economic burden of dehydration among hospitalized elderly patients. Am J Health Syst Pharm. 2004;61:2534-40.
  5. Gille D. Overview of the physiological changes and optimal diet in the golden age generation over 50. European Review of Aging and Physical Activity 2010;7:27-36.
  6. Rikkert MG, MelisRJ, ClaassenJA. Heat waves and dehydration in the elderly. BMJ. 2009:339:b2663.
  7. Schols JM, De Groot CP, van der Cammen TJ, Olde Rikkert MG.Preventing and treating dehydration in the elderly during periods of illness and warm weather. J Nutr Health Aging 2009;13:150-7.
  8. Kenney WL, Chiu P. Influence of age on thirst and fluid intake. Med Sci Sports Exerc. 2001; 33:1524-32.
  9. Bennett JA. Dehydration: Hazards and Benefits. Geriatric Nursing 2000;21:84-8.
  10. Silver AJ. Aging and risks for dehydration. Cleve Clin J Med. 1990:574:341-4.
  11. Faes MC, Spigt MG, Olde MGM, Rikkert MD. Dehydration in Geriatrics. Geriatrics and Aging 2007;10:590-6.
  12. Simmons SF, Alessi C, Schnelle JF. An intervention to increase fluid intake in nursing home residents: prompting and preference compliance. J Am GeriatrSoc 2001;49:926-33.
  13. Robinson SB,Rosher RB. Can a beverage cart help improve hydration? GeriatrNurs. 2002;23:208-11.
old woman drinking water

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