24 May 2023

Dehydration in the elderly: Symptoms and Causes

9 min read

It goes without saying that staying hydrated is very important for the human body to function properly and for us to stay healthy, especially the elderly. And as sixty percent of our body is made of water it is vital that the elderly especially drink enough fluids to ensure that their mind and body work efficiently.

However, this seems to be an increasing problem for the elderly – many struggle to stay hydrated as they get older because well, simply said, it just becomes harder for their bodies to retain water.

As a result, they are more prone to being dehydrated – a condition where the body loses more fluids than it takes in. In this blog we will look at what dehydration is, the causes, symptoms, management and how it affects the elderly.

What is dehydration?

Dehydration is a health condition caused by an insufficiency of fluid and electrolytes in the body. It occurs when the body utilizes or loses more water than it consumes.

Mild to severe dehydration in elderly people is often associated with extreme thirst. The mouth, lips, and tongue become dry and eyes become sunken. In addition, the skin lacks elasticity.

The decrease in body fluid causes reduced frequency and amount of urination as well as the passage of dark-colored urine.

Fatigue and headache are other prominent signs of dehydration. Prolonged dehydration is also associated with low blood pressure, and rapid heart and breathing rates.

Severe dehydration can affect normal brain activity, leading to dizziness, confusion or disorientation, mood swings, shock, and even unconsciousness.

What are the symptoms of dehydration in the elderly?

The most common signs or side effects of dehydration include:

• Fatigue or lethargy
• Muscle weakness and cramps
• Cracked lips
• Headaches
• Dizziness
• Nausea
• Forgetfulness and confusion
• Deep rapid breathing or an increased heart rate or low blood pressure
• Sunken eyes
• Dry or sticky mucus around and in the mouth
• Low urination
• Urinary Tract Infection (UTI)
• Constipation
• Pressure sores
• Dry or itchy skin
• Not sweating
• Urinating less
• Poor skin turgor

The more serious medical episodes from dehydration include:

• Psychosis or delirium (most common causes of delirium is dehydration and infection, a UTI is     considered an infection)
• Can lead to heat injuries including heat stroke
• Urinary and kidney problems
• Seizures
• Low blood volume shock (hypovolemic shock)
• Extreme dehydration can lead to death
• Can lead to a higher risk of falls
• Higher mortality rate
• Increased risk of stroke

Causes of dehydration in elderly

There are multiple causes or risk factors associated with dehydration in the elderly.

  • A decline in total body fluid. As we age, the amount of fluid in our bodies begins to decrease. This means there are few water reserves available for your body to use as you get older
  • Lowered thirst response. Feeling thirsty is your body’s way of letting you know you need water. However, because the thirst response becomes weaker with age, older adults may not know they need to drink.
  • Decreased kidney function. The function of the kidneys can decline with age, meaning that more water may be lost through urination.
  • Health conditions and medications. Some older adults have underlying health conditions or take medications. In some cases, these conditions or meds can lead to an increase in water loss through urination.


Prevention and Management of Dehydration

The best way to prevent dehydration in the elderly is to identify when and why the individual is not drinking enough fluids. One of the major barriers for inadequate fluid intake is physical inability, for eg, if it is difficult for an elderly person to reach a source of drinking water.

A fear of frequent urination or a fear of urinating before reaching the toilet is another possible reason for reduced fluid intake. This could be an outcome of reduced physical strength/ability, eventually leading to infrequent/inadequate fluid consumption.

These situations can be prevented by providing abundant water within reach as well as help in reaching the toilet well in time. Another method could be to routinely offer water with medications and before daily physical activities.

To increase the daily fluid intake and reduce the symptoms of dehydration, it is also important to provide the elderly with fresh and palatable water or other favourite fluids, perhaps by adding a slice of fresh lime or frozen fruit to add flavour.

It is also important to keep in mind that certain drinks, often cause dehydration:

Soft Drinks can actually make your dehydration worse and lead to further kidney-related dehydration problems.
Alcohol, including beer. As refreshing as a cold beer might sound when you’re exceptionally thirsty, you should avoid alcohol if you’re trying to rehydrate.
Caffeinated drinks. Caffeinated and alcoholic beverages act as diuretics, causing you to urinate more than usual and increasing your fluid loss compared to your fluid intake. This includes coffee, black tea, green tea, and energy drinks.

Tips to improve hydration

• If drinking water is too difficult, attempt to swap straight water with alternatives.
• To encourage hydration, instead drink cordials (mixed in with water), fruit or vegetable juices, and change up the temperature of drinks (like non-caffeinated tea or cooling homemade lemonade).
• Avoid driving caffeinated drinks and alcohol, as they can dehydrate you.
• Keep a journal to track your fluid intake or even set a reminder on your phone to drink water, it can give you the kick you need to rehydrate.
• Additionally, a lot of our consumption of water comes from a variety of fruit and vegetables. Eating water-rich foods can be another way to keep your hydration at steady levels. For example, cucumbers are 96 percent water, and other vegetables, like tomato, spinach, broccoli and brussel sprouts are also water rich.
• Even if you don’t feel thirsty, if you haven’t consumed water for a while, it might be a good idea to take a break and get a drink. By the time you’re thirsty, your body is already dehydrated.

Dementia and hydration challenges

• When it comes to an older person with dementia, it can be a lot more difficult to manage appropriate hydration levels.
• Water is incredibly important to prevent behavioural changes, delirium and depression in people with dementia.
• However, a person with dementia is likely to forget to drink or may even lose the ability to drink.
• Not only that, but it’s also easy for a person with dementia to be dehydrated, if they are taking medication, it could be causing a diuretic effect.
• The latter stages of dementia also makes it difficult for an older person to swallow. This is called dysphagia. An older person may choke water or be unable to swallow it. A speech pathologist can help with these dysphagia issues.
• Lastly, if dementia has progressed far enough that the individual has lost their mobility or their ability to communicate, they may be unable to explain they need water or go to someone who can provide them with water.