Hydration in Elderly

Ensuring adequately hydration is fundamental for health and wellbeing in all ages but some population groups are especially vulnerable to dehydration.

It is clear from the literature that dehydration remains a significant problem in the elderly, especially for those above 85 years old and institutionalized ones.

The dehydration is multifactorial and as people age, become more susceptible to dehydration for several reasons:

  • Reduces body’s ability to conserve water;
  • Fluids loss is increased (infection, dementia, diuretics, etc.);
  • Thirst sense becomes less acute;
  • Decrease the ability to respond to changes in temperature;

It also happens that water intake is conditioned by common problems in this age, including mobility difficulties, vision impairment, swallowing problems, cognitive impairment or even self-imposed limitation of fluid consumption.
Older adults, especially people living in nursing homes or alone, tend to drink less than younger people and sometimes may forget to drink.
Thus, assessing hydration status is essential for prevent, control or reverse the situation through early intervention plans and adapted to each specific case.

Some clinical signals of dehydration are:

  • Reduction in sweating (dry axilla)
  • Dark urine
  • Dry mouth
  • Decreased skin turgor
  • Sunken eyes
  • Changes in level of consciousness
  • Strong smelling and dark urine
  • Physical and mental fatigue
  • Headaches
  • Increased muscle cramps
  • Hypotension
  • Constipation

Dehydration in elderly can be a precipitating factor for a number of acute medical conditions as confusional states, delirium, renal failure, infection, falls and pressure ulcers, increasing hospital stay, morbidity and mortality.

Prevention of dehydration, primarily based on ensuring adequate fluid intake, may improve health, functional status and quality of life.

Daily water intake recommendations, for adults, are usually 1.5 to 2 liters, depending of individual factors as body volume, health status, daily activity and external factors, as temperature, diet, that might lead to increased requirements.

Drinking water is the best known way to maintaining a correct hydration status and should constitute the bulk of daily intake but there´s other drinks and foods that can be useful to provide fluids intake:

  • Tea and Infusions
  • Milk
  • Fruit juice
  • Flavored water
  • Soup
  • Fruit
  • Gelatine

There are some strategies, in addition to providing drinks for elderly, to improve fluid consumption during the day:

  • Monitoring fluid status.
  • Include liquid ingestion in daily routine (eg. drink a glass of water after wake-up, drink a glass of water with medicines).
  • Provide liquids readily available (drink often).
  • Properly managed cases of urinary incontinence and reduced mobility so that patients will be less likely to avoid fluid.
  • Encourage the consumption of foods rich in water.
  • Maintaining fluids intake registers.
  • Raising awareness among the elderly, their families and caregivers of the risks of dehydration.