Dehydration in Seniors

Edited by Tessa Chatham, RN, MSN, BSN, PCCN

Drinking water is more than just a healthy habit when you’re a senior. It’s a necessity. While dehydration may seem like a relatively mild problem, it can lead to serious medical risks if it’s not addressed. Seniors with Alzheimer's or dementia are often at the greatest risk for dehydration.

The symptoms of dehydration are subtle and can be masked by other common signs of aging. As a caregiver, it’s vitally important to know what to look for and how to keep your loved one hydrated, so you can proactively keep your senior healthy.

Why are Seniors More at Risk for Dehydration?

Physical Changes

Adequate fluid allows the body to regulate temperature through sweating, maintain blood pressure, and eliminate bodily waste. However, by the time we’re 80 years old, the amount of water in our body decreases by about 15% from when we were 20. This natural reduction in water makes seniors more vulnerable to dehydration from even slight fluid loss. Let’s explain how that water loss happens.

As we age, our body goes through several changes that affect how we maintain water balance. Starting around age 50, our bodies progressively lose kidney function and are less able to conserve fluid. Seniors also experience a decline in muscle mass, which affects water retention. In addition, we slowly lose the sensation of being thirsty as we age. Naturally, seniors don’t realize they’re dehydrated if they’re not thirsty. Seniors also eat less, so they get less fluid from their food.

Medications

In addition to these physical changes, certain drugs can increase perspiration or urination, which can interfere with the body’s natural fluid balance. Common examples are diuretics, laxatives, blood pressure medications, and antihistamines. In addition, psychotropic medications, such as antipsychotics for dementia, cause dryness of the mouth, constipation, or urinary retention. Since seniors are often taking multiple medications, you can see how easily dehydration can develop slowly over time.

Illnesses or Conditions

Seniors with certain medical problems have an increased risk for dehydration. For example, individuals with Alzheimer's, dementia and Parkinson's disease often have swallowing disorders that affect their hydration. Those with diabetes can also be at risk, especially if they urinate frequently. Patients with illnesses that cause vomiting or diarrhea (such as those undergoing chemo) are at the highest risk. If your loved one has any of these conditions, monitoring dehydration should be a high priority for you and their healthcare team.

How to Spot the Signs of Dehydration

Initial Signs

The worst thing about dehydration in seniors is that it’s often not recognized until they become very ill. Caregivers should always be watching for the signs of dehydration in their loved one.

It’s important to note that the symptoms below will not definitively prove that your loved one has dehydration. In older adults, the most accurate way to diagnose dehydration is through laboratory testing of the blood. Use this list as a guide and talk to their healthcare provider with your concerns.

Headaches
Cramping in the limbs
The inability to produce tears while crying
Dry mouth
Thick saliva
Dark yellow or brown urine
Issues producing urine
Cloudy or fogged brain
Joint pain
Unusual cravings for food
Fatigue and weakness
Irritability

For seniors with Alzheimer’s or other forms of dementia, even mild dehydration can cause noticeable worsening in confusion or thinking skills.

Advanced Symptoms

When dehydration has advanced to a more critical stage, the symptoms can become more severe. You may see:

Convulsions
Confusion
Bloating
Severe muscle contractions
Low blood pressure
Wrinkled skin
Dry and sunken eyes
Rapid breathing
Rapid and weak pulse

If symptoms do not remedy themselves quickly, caregivers should get their loved one to a hospital.

Complications Associated with Dehydration

When a senior is severely dehydrated, they can suffer from more than just cramps and headaches. Several serious health complications can arise, including:

Brain swelling – When a person is severely dehydrated and then consumes too much water at once, the cells in the brain can try to store it too quickly. This can cause damage in the brain or even rupture brain cells.
Loss of consciousness – Seniors can pass out during extreme dehydration, which can lead to other injuries from the fall.
Kidney failure – When the body is extremely dehydrated, the kidneys can no longer remove waste from the blood.
Seizures – Electrolytes carry electrical signals between cells. If your electrolytes are out of balance, normal electrical messages can get confused. This leads to involuntary muscle contractions.
Hypovolemic shock – This occurs when low blood volume causes a drop in blood pressure and a decrease in the amount of oxygen in your body.

In severe cases, dehydration has led to comas or even death. Therefore, any senior showing the signs of severe dehydration should go to the hospital. When the body is truly dehydrated a simple glass of water will not be enough to avoid these potentially life-threatening side effects.

How is Dehydration Treated?

Mild dehydration can be treated by having the person take more fluids by mouth. It’s best to have the person drink something with electrolytes, such a rehydration solution, a sports drink, juice, or even bouillon. But in most cases, drinking water will help. Moderate dehydration is often treated with intravenous (IV) hydration in urgent care, the emergency room, or even the hospital. Some nursing homes can also treat dehydration with a subcutaneous infusion. They provide fluid through a small IV needle placed into the skin of the belly or thigh. Severe dehydration may require additional intervention to support the kidneys, or even short-term dialysis.

How to Prevent Dehydration in Seniors

Assessing Water Needs

Although the normal level of hydration can vary from person to person, most medical experts recommend this formula: Take your weight in pounds and divide by three. That’s the number of ounces you should drink daily. For example, a 150-pound woman would need 50 ounces of water daily, or about six 8-ounce glasses of water.

Proactive Steps

Make sure your loved one drinks an adequate amount of fluids during the day. Bear in mind – older adults (especially those 80 and older) can’t drink a full 8-ounce glass of water all at once. It fills them up uncomfortably and could cause incontinence issues. Drinking small sips throughout the day is the best approach.

It’s also important for seniors to eat healthy, high-water content fruits such as watermelon, berries, grapes and peaches as well as water-rich vegetables like tomatoes, lettuce and summer squash. Soups are also a good way to introduce more liquid into the diet. If your loved one is thirsty that means they’re already dehydrated. You can get a boost of hydration by providing a sports drinks or electrolyte-filled drinks like Pedialyte.

Education

Remind your senior about the importance of drinking, even if they don’t feel thirsty. If there’s resistance, it’s perfectly fine to add natural juice or milk. Just be conscious of sugar content, especially for those with diabetes. They should also avoid alcohol, caffeinated beverages, and high protein drinks, as these can have the reverse effect. An important note – Seniors with medical conditions like heart failure or kidney failure may have more specific fluid needs, often times requiring fluid restrictions or limitations. Be sure to consult with their doctor before making changes to a loved one’s diet or liquid intake.

Talk to Healthcare Team

If you’re concerned about dehydration, or your loved one needed treatment recently, speak to their doctor about changing medication and any other strategies to prevent dehydration. As noted above, older adults often take multiple prescriptions, and these could be adding to the problem. You should also follow up with their doctor if your loved one recently had an illness that caused vomiting or diarrhea, as these could reduce their fluid to dangerous levels.

Special Considerations

If your loved one has certain conditions, there are some added challenges to ensuring they stay hydrated.

Urinary incontinence – This might make seniors reluctant to drink a lot of fluids.
Memory issues – They may forget to drink or forget to ask others for a drink.
Mobility problems – They are reliant on others to provide fluids.
Swallowing issues – This is common for individuals with Alzheimer’s, dementia or Parkinson’s.

If they’re in a nursing home, talk with the staff about these issues if they affect your senior. You want to make sure they’re providing adequate liquids within reach and monitoring the amount of fluids your loved one has each day. They should assist residents with drinking, provide a straw, offer a variety of beverages, and offer drinks between mealtimes. Equally important, your loved one should be able to use the toilet on a regular schedule, and whenever needed, to avoid incontinence.

Dehydration is quite common, but it’s also very preventable. By taking some simple, practical steps to keep your loved one hydrated, you can avoid uncomfortable symptoms, hospitalizations, and serious medical issues.