Dehydration – why it’s common and important to prevent in old age

Is your elder parent or relative drinking enough water? The answer is – like most of us – ‘probably not’.

Although they may claim they don’t feel thirsty, this doesn’t mean they’re not dehydrated. 

Dehydration is very common in older people, and something you need to watch out for early on as it can lead to poor cognition and serious health issues, including urinary tract infections and falls. Dehydration is a particular risk if your parent or older relative is in an institutional care setting such as a hospital, nursing home or care home.

Ensuring they stay hydrated is crucial. Consuming the right amount of water regulates body temperature, delivers nutrients to cells, removes waste, and keeps organs including the brain (which is 75% water!) performing at their best.  

Read on to learn the signs and consequences of dehydration in older people, and how you can help prevent it.

Why do older people get so easily dehydrated?

Older people can get dehydrated easily for a variety of reasons, including:

  • Decreased thirst – As we age, our ability to sense thirst decreases (particularly so in people who have dementia or who have suffered a stroke).
  • Loss of muscle – Our body’s ability to store water decreases with age as we lose muscle tissue (which is about 75% water)
  • Health conditions – Certain diseases, medications, physical difficulties and memory issues that are common in old age increase the risk of dehydration.
  • Low awareness – Many older people are simply not aware of how much water they drink or should be drinking.  
  • Incontinence – Some older people deliberately drink less fluids due to problems with incontinence, in order to avoid wetting themselves or having to get up in the night to pee.

What can happen when older people are dehydrated?

Severe dehydration is very serious and can even be fatal, but even mild dehydration in older people can lead to a number of avoidable health issues, including:

  • Mental performance – dehydration impacts mental performance, including memory, concentration and judgement, as well as mood.
  • Effectiveness of medication – dehydration can impact the effectiveness of medications such as warfarin, which is used to prevent blood clots.
  • Fatigue – when people are low on fluids and electrolytes, they have less energy and their body may feel tired and weaker than usual. This can affect their quality of life and ability to partake in daily activities.
  • Low blood pressure and falling – dehydration can result in low blood pressure and has been shown to increase the risk of falls and hospitalisation. Falling is one of the most frequent and serious types of injury for anyone aged 65 or over.
  • Infections – dehydration disposes people to infection and increases the severity of infection. In particular, dehydration can increase the risk of urinary tract infections (UTIs) which can lead to acute kidney injury.
  • Pressure sores – dehydration affects cell metabolism and wound healing, and increases the risk of pressure sores in older people who are bed-bound as it reduces the padding over bony points.
  • Trouble swallowing – dehydration can cause problems with swallowing by decreasing the supply of saliva. Food particles can then get stuck in the throat and sucked into the lungs, causing people to choke and cough. Pills can also get stuck and burn the lining of the throat. 
  • Pain recent research shows that even minor dehydration can worsen aches and pains including joint pain and migraines.
  • Dementia early research suggests a link between chronic dehydration and the acceleration of cognitive decline and dementia.
  • Headache – fluid loss in the brain can cause it to temporarily pull away from the skull, leading to a headache.

How do I spot the signs of dehydration in older people?

Thirst cannot be relied upon as a sign of dehydration in older people, as their natural ability to sense thirst is diminished. Instead, you should look out for the following:

  • Dry mouth, lips and tongue
  • Bad breath
  • Sunken eyes and dry, papery skin
  • Drowsiness, confusion and disorientation
  • Peeing infrequently
  • Dizziness and low blood pressure
  • Dark, concentrated, strong smelling urine
  • Cramping in limbs and difficulty sleeping
  • Blurred vision and dry eyes
  • Headache

If you notice these signs, it’s important to consult with their doctor and seek medical advice.

How you can test if someone is dehydrated

There are a few ways to test if your parent or older relative is dehydrated:

  1. Simple skin test: Gently pinch the skin on the back of the hand, arm, or abdomen. If they are hydrated, their skin will spring back instantly. If they are dehydrated, the skin will take longer to bounce back.
  2. Fingernail test: Press their fingernails for three seconds. If they remain blanched for one to three seconds afterwards, this is a sign that they are dehydrated.
  3. Urine colour chart: Check their urine against a urine colour chart like this one.
  4. Blood test: Their doctor can perform a blood test for dehydration, which will check their levels of sodium and potassium (electrolytes) as well as how well the kidneys are working.

Ways to prevent dehydration in older people

Around 20% of water in the average diet comes from food but the rest comes from drinks, so it’s important that older people have a regular intake of the right kind of fluids. This is easier said than done but there are some great tips, tools and technology that can help:

  • Drink first thing in the morning – get them to drink 2-3 large glasses of water first thing in the morning when they get up, and then another 3-5 glasses over the day, stopping around 5pm or 6pm if they have concerns about going to the bathroom at night.
  • Add a pinch of salt and squeeze of lemon – for their first daily glass of water, adding a pinch of salt and squeeze of lemon will ensure they get enough sodium as well as other important minerals that help to ensure absorption into the cells.
  • Eat more fresh fruit and vegetables – Fruits and vegetables like cucumber, celery and watermelon have a high water content, not to mention other essential nutrients and fibre.
  • Eat more ‘wet foods’ – eating wet foods like soup, yoghurt, porridge or pureed fruits is a great and easy way to get more fluid into their diet as well as being nourishing.
  • Make water less boring – drinking water on its own can be boring and bland, and some people just don’t like it.  Adding slices of orange, lemon or cucumber, or adding mint or cinnamon sticks can make it more palatable and appealing. Otherwise, non-sweetened herbal teas are also a good option, like mint or Camomile, or drinking milk. Variety is important.
  • Get a hydration reminder water bottle – you can buy water bottles that help you track and improve your water consumption throughout the day.
  • Set hydration alarms – set ‘drink water’ alarms on their mobile phone at 3-hour intervals throughout the day.
  • Make access easy – to avoid them having to get up and go to the kitchen every time, keep a carafe or jug of water and a glass or a water bottle in the living room, or wherever they spend most of their time.
  • Put a note on the fridge – a written note on the fridge or stuck on a kitchen cupboard where they will see it is also a good reminder.
  • Avoid processed foods – highly processed foods are often lacking in moisture and also laden with salt, which makes the body pull water out of the cells.
  • Limit caffeine and alcohol – both alcohol and caffeine are diuretics, which means they remove water from the body (alcohol more so) by increasing urination. Getting your parent or older relative to cut down on alcohol, perhaps replacing with low or non-alcoholic alternatives, makes a big difference.  There are many non-alcoholic beers, spirts and wines these days. Switching to decaffeinated tea and coffee is also recommended.
  • Get them to monitor their own urine – print out a urine chart for them to keep in the bathroom as a reminder to check their urine and drink more if it shows signs of dehydration.
  • Monitor medications – Some medications can contribute to dehydration. Check with your parent or relative’s doctor to see if any medications they are taking may have this effect.

In summary

If you’re caring for your elderly parent or relative, or they are in a care home, it’s important to be mindful of the risks and consequences of dehydration and to ensure they are getting regular fluid intake.

Although it can be challenging, particularly if your relative has dementia, there are many different approaches and techniques you can use to get them to consume adequate fluids and avoid the health consequences of dehydration.

Always consult with a healthcare provider for personalised advice, especially if your parent or relative has underlying health conditions or is taking medications that may impact hydration. Severe dehydration may require medical attention, and it’s important to investigate and address any underlying causes.

Common questions

  • What is the fastest way to hydrate an elderly person?

If the elderly person is dehydrated due to illness or heat, you may consider using oral rehydration solutions that contain electrolytes. These can be purchased over the counter at a local pharmacist. If you notice these signs of dehydration, it’s important to consult with their doctor and seek medical advice.

  • What are the symptoms of severe hydration in the elderly?

Symptoms of mild to severe hydration include dry mouth, lips and tongue, drowsiness and confusion, dark strong urine or peeing infrequently. It’s important to note that older adults may not feel thirst as acutely as younger individuals, which can make it more challenging to recognize dehydration in this population. If you suspect severe dehydration, especially in an elderly person or someone with underlying health conditions, seek medical attention promptly.

  • Can dehydration in the elderly be fatal?

Yes, dehydration in the elderly can be serious and, in severe cases, it can lead to life-threatening complications if left untreated. It’s crucial to monitor for signs of dehydration in the elderly and take preventive measures, such as encouraging regular fluid intake, offering hydrating foods, and addressing any underlying health issues

  • Can dehydration cause confusion?

Yes, dehydration can lead to confusion, especially in more severe cases.  If you notice signs of dehydration or confusion in an individual, especially in an older person or someone with underlying health conditions, it’s important to address the dehydration promptly and seek medical advice for appropriate evaluation and intervention.

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