Water makes up about 60% of the human body and is necessary for survival (1). Proper hydration is necessary for almost all body processes.
The elderly are at greater risk for dehydration. Adequate hydration is important to maintain and/or improve health, functional ability, and quality of life (2).
*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you.
What is Dehydration?
Dehydration is the harmful loss of body fluid which is not sufficiently replaced. Versus normal hydration status which is when enough fluid is in the body and in the correct places.
Hypertonic Dehydration
Hypertonic dehydration is when there is insufficient fluid in the body from inadequate drinking or excessive sweating (3).
This type of dehydration may also be referred to as hyperosmotic, intracellular, water-loss or low intake dehydration (4).
Isotonic Dehydration
Isotonic dehydration occurs when there is insufficient water in the body along with salt loss, such as from medications or diarrhea (5).
This type of dehydration may also be referred to as iso-osmotic, extracellular and salt-loss dehydration (6).
Causes of Dehydration in the Elderly
Dehydration can occur in older adults for several reasons including (7):
- Fever
- Diarrhea
- Nausea and vomiting
- Frequent urination
- Increased sweating/hot temperatures
- Wound drainage
- Blood loss
- Inadequate fluid intake
- Diuretic (water pill) use
- Restricting fluids to avoid incontinence
- Gastrointestinal (GI) bleeding
Risk Factors for Dehydration
A variety of factors put the elderly at increased risk for dehydration (8, 9, 10):
- Lower muscle mass
- Declined kidney function
- Physical disabilities
- Impaired cognition
- Decreased sense of thirst
- Medication use: diuretics, laxatives, psychotropic medications
- Nausea and vomiting
- Diarrhea
- Lower total body fluid
- Dysphagia: swallowing difficulty
- Impaired communication
- Uncontrolled diabetes
- Fear of incontinence
- Dependence on others for food and fluid intake
- Impaired skin
- Rapid breathing
- History of dehydration
- Depression
- Medically ordered fluid restriction
- Infection
- Inadequate staffing for institutionalized individuals
- Social isolation
Signs of Dehydration
Assessing fluid balance can be particularly challenging in the elderly (11). There are some signs and symptoms that may be present, however usually multiple are exhibited during true dehydration (12, 13).
- Dry, furrowed tongue
- Sunken eyes
- Dry skin
- Poor skin turgor (elasticity)
- Dry inner lining of the nose and/or mouth
- Abnormal hydration related lab values
- Increased confusion
- Lethargy & irritability
- Dark, strong smelling urine
- Decreased urine output
- Delayed capillary refill time
- Rapid pulse
Complications of Dehydration
Dehydration in the elderly is associated with many adverse health outcomes, which is why adequate hydration is so important (14, 15, 16, 17, 18).
- Decreased saliva production
- Increased morbidity and mortality
- Hospital readmissions
- Delirium
- Fatigue
- Falls
- Fractures
- Heart Disease
- Constipation
- Kidney failure
- Impaired skin and delayed healing
- Infections
- Decreased functional ability
Importance of Adequate Hydration
Inadequate hydration in the elderly can lead to medical complications, declined physical functioning, and poor quality of life. Proper hydration is necessary for many body functions.
Thermoregulation
Drinking enough fluids is important to properly regulate body temperature.
Blood flow to the skin and sweating keep the body from overheating, however during dehydration this cannot always occur adequately (19).
If dehydration is not corrected it can impact the cardiovascular system and affect blood pressure.
Blood Pressure Regulation
Sufficient fluid intake is necessary for blood pressure regulation. Poor hydration can lead to a drop in blood pressure.
This can especially occur when changing positions from laying to standing due to decreased orthostatic tolerance; resulting in increased risk of syncope (fainting) (20).
Transporting Nutrients
Adequate hydration is needed to transport oxygen and nutrients to cells, tissues, muscles, and organs, including the brain.
Without proper hydration many body processes, including metabolism, cannot occur appropriately. Therefore, dehydration has widespread negative effects on the body.
Removing Waste Products
When hydration is inadequate the kidneys decrease urine output. The ability for elderly bodies to perform this defense mechanism is reduced.
Waste products can build up in the body, which can cause increased confusion and other negative consequences. Dehydration can also impact bowel function.
Preventing Constipation
Adequate fluid intake is necessary to pull into the bowels and soften the stool, so it can easily pass through the gastrointestinal (GI) tract.
Lubrication of Joints, Eyes, and Skin
Having enough water in the body is necessary to lubricate joints and help absorb shock.
Poor hydration leads to drier, rougher skin that has less elasticity. This can negatively affect skin’s ability to act as the body’s barrier (21).
Dehydration may also contribute to development of dry eyes, cataracts, refractive changes, and retinal vascular disease (22).
Increasing Fluid Intake
Ensuring adequate hydration is important for the elderly to avoid the complications of dehydration. Drinking enough fluids can be challenging for older adults.
Finding ways to improve fluid intake can be important to avoid dehydration. Strategies to boost hydration can be helpful for preventing dehydration.
Try some of these ways to increase fluid intake (23, 24):
- Keep fluids within reach
- Provide routine toileting
- Increase beverage options
- Use high contrasting colored cups
- Remind frequently to drink
- Make drinking social
- Use easy to handle cups
- Provide necessary assistance with drinking
- Use beverage carts or hydration stations
- Provide fluid containing foods: soup, popsicles, watermelon
Use the links above to get your hydration station started right from Amazon.
*This article contains affiliate links. I may earn a commission from qualifying purchases at no extra cost to you.
In dehydration thirst is typically satisfied before complete rehydration is achieved (25). Fluid intake must continually be a priority for older adults and their caregivers.
Artificial Hydration
There may come a time when fluid balance is unable to be achieved without Intravenous (IV) hydration. This may be from acute illness, such as urinary tract infection (UTI).
However, dehydration may also occur as part of a chronic, progressive condition such as dementia. This is when advanced directives come into play as whether life prolonging measures are desired.
Final Thoughts
The elderly are at increased risk of dehydration. Seniors cannot rely on thirst signals for adequate drinking. Monitoring hydration status and encouraging frequent fluids can help combat dehydration.
