Dehydration is surprisingly very common in the elderly. In fact, at any given time, hospitalizations for dehydration typically involve older individuals more than those from any other age group. Mild to moderate dehydration is common, and at times, not even diagnosed.
There are many reasons why the elderly are at an increased risk for getting dehydrated. First, most of them typically have some underlying health conditions for which they take medications. And some of these medications, particularly diuretics/water pills, work by making the body lose more water and sodium than the amount that gets in. Long term use of water pills is the leading cause of dehydration in the elderly.
Secondly, they are prone to diseases such as urinary tract infections and opportunistic infections. Pneumonia and flu are common in the elderly, where dehydration is the natural consequence.
Some individuals are chronically in a nursing home getting supplemental nutrition via tube feeds. These are high in protein which breaks down into urea which is also a weak diuretic. Urea drags free water in the urine and can make the individual depleted of water.
Now take into account the drop in thirst sensation that happens naturally as we grow old. Which means, the one simple mechanism that can prevent us from getting dehydrated, i.e. thirst, does not work well in this age group. The result is a continuous but undetected loss of water from the body, without the ability to replace those fluids.
Unfortunately, this results in infections, kidney failure and changes in mental status that can frequently lead to repeated hospital stays in this population.
How to prevent dehydration in the elderly?
When it comes to dehydration, the mantra “prevention is better than cure” is truly the holy grail. Staying hydrated is the best way of preventing dehydration. But when the elderly do not have a robust thirst mechanism as the gatekeeper, what is the best way to prevent dehydration then?
Below are some principles that can help prevent dehydration in the elderly:
Develop a hydration routine: Which means, chalking out a diet plan and including hydration, as a part of it. A simple way we advocate patients is by putting in alarms, for about 5 times in a day. The individual knows that when the alarm goes off, it is time to drink a glass of water.
Know your total target liquid intake in a day: Some elderly individuals have fluid restrictions due to underlying health conditions such as congestive heart failure. A typical rule of thumb is to have a total fluid intake of between 1.5 – 2 liters of liquid in a day. In heart failure, a bit more restriction may be needed. Discuss this with your doctors frequently to clearly define an achievable goal.
Use a measuring container to guide you: A water bottle that is marked with fl.oz and/or liters is particularly useful to guide the intake of water. Another way is by generalizing it to a number of glasses of liquid/day. E.g. a general rule could be to consume about 5-6 glasses of 8 oz. each of water per day.
Avoid drinking sodas: Sugar in sodas is counter productive to hydration. Sugars sit in the stomach too long and drag water out of the blood vessels into the GI tract. This defeats the purpose of hydration. Hence it is vital to reduce the intake of sodas in the elderly and substitute it with water or water-based hydration formulas.
Try flavoring the water to improve compliance: Water can be hard to drink particularly for the elderly. Flavored water (zero calorie) such as Hint® can increase compliance.
Avoid alcohol intake: Alcohol can dehydrate even young healthy adults, so the elderly need even more caution.
Reduce caffeine intake: A cup of coffee in the morning is acceptable but any additional caffeine can interfere with sleep in the elderly and dehydrate them. Caffeine is a weak diuretic.
Use an electrolyte hydration drink mix: Elderly can be deficient in electrolytes in addition to being low on water. Using an electrolyte drink mix such as MAGNAK® can allow replacement of electrolytes and water at a faster rate and correct electrolyte deficiencies.
Diagnose dehydration early: By using a simple exam looking for signs of dehydration such as a dry tongue or decreased skin turgor, dehydration can be picked up early and can improve outcomes significantly in this vulnerable group.
Dr. Kharait is an MD and a practicing Nephrologist in Northern California. He completed his Residency in Internal Medicine and Fellowship in Nephrology from the University of California, San Francisco. He has a PhD in Molecular Physiology from the University of Pittsburgh and specializes in treating patients with electrolyte disorders and kidney diseases.
Dr. Kharait’s sports nutrition blog is created from his “real-world” clinical experience as a Renal and Electrolyte Specialist (Nephrologist). An author of multiple, original peer-reviewed journal articles within this field for the last decade, and an inventor of numerous patented electrolyte formulas, he strives to be on the leading edge of electrolyte science for both athletes and those suffering from gut disorders. Learn more about how electrolytes interact with our body, including calcium, sodium, potassium and magnesium. Blog posts and articles related to performance and health are here to help, educate, and inform.
