Dehydration is widely prevalent among older adults.
In fact, it’s one of the top 10 most frequent diagnosis reported for hospitalizations in people aged 65 years or older (1).
Dehydration often leads to poor health and medical outcomes, increased hospitalization, and even premature death.
Therefore, it’s important that caretakers and medical professionals know the signs and symptoms of dehydration in older adults.
What Is Dehydration?
Simply defined, dehydration is a condition that occurs when you use or lose more water than you take in.
Water serves several important functions in the body including:
- Temperature regulation
- Blood flow
- Joint lubrication
- Waste excretion
- Nutrient absorption
- Electrolyte balance
Without sufficient water, your body can’t perform these functions properly.
People of all ages can become dehydrated, but older adults in particular are at an increased risk.
Dehydration Is Common in the Elderly
Older people are more prone to dehydration due to the various physiological changes that occur in the aging process.
These changes include:
- Decreased thirst mechanism. Everyone has a thirst mechanism that lets you know when it’s time to rehydrate. In the elderly, however, this thirst sensation is lessened (2).
- Less total body water. There is a decrease in lean body mass and increase in body fat with aging. Water makes up a large percentage of lean body mass but only a small percentage of fat mass (3).
- Decreased kidney function. The kidneys’ ability to filter toxins from the blood declines with age. This means the kidneys are less efficient in concentrating urine in less water, meaning older people lose more water (4).
- Cognitive impairment. Healthcare professionals may not perceive cognitively impaired residents in nursing facilities as being at risk for dehydration and tend not to present them with fluids (5).
Dehydration may also be complicated by many diseased states such as diabetes and mental or physical impairments.
Older people are also likely to take multiple medications, including diuretics and laxatives which can further increase the risk of dehydration (6).
Signs and Symptoms of Dehydration in Older Adults
There is no gold standard for the correct diagnosis of dehydration in older adults (7).
The most reliable indications of dehydration include (8):
- Missing drinks between meals
- Expressing fatigue
- Lack of armpit moisture
Unreliable — but commonly cited — signs and symptoms of dehydration in older adults include:
- Urine color
- Dry mouth
- Feeling thirsty
Ways to Keep the Elderly Hydrated
Older adults are at an increased risk of dehydration.
Therefore, it’s important to inform them about the importance of drinking enough water, even if they don’t think it’s necessary due to decreased thirst sensations.
A fluid intake of 30 milliliters per kilogram of body weight or a minimum of 1.6 liters per day is recommended for older adults, unless they are on a fluid restriction (9).
Older adults don’t have to drink only water to stay hydrated. Beverages like tea, coffee, fruit juices, milk and soups all contribute to overall fluid intake.
Finding out what temperature they enjoy — hot drinks to cold, or the other way around — can also help.
Older adults can also get hydration from the foods they eat. The best choices are fruits and vegetables, which contain about 90% water, and lean meats.
The Bottom Line
Dehydration is highly prevalent among older adults and often leads to poor health outcomes and increased mortality.
Older people are more likely to become dehydrated due to the natural aging process, diseases like diabetes, as well as a side effect of medications like diuretics or laxatives.
Assessing fluid intake, fatigue and armpit moisture may be the most reliable indicators of dehydration.
In addition to water, older adults can meet their fluid needs through other beverages and by increasing their intake of foods high in water.
Nutrition & Hydration
This downloadable training addresses the role of proper nutrition and hydration in maintaining older adults’ strength and health in long-term care facilities.