Dehydration in Elderly People: Risks, Warning Signs, and Prevention Tips

What Is Dehydration?

Water is the source of life. That may sound like an exaggeration, but it's true. Throughout your life, water is essential for many of your body's functions, including:

• Temperature regulation
• Waste elimination
• Joint lubrication
• Delivery of nutrients to cells
• Blood oxygen circulation
• Skin hydration
• Cognitive function

You become dehydrated when your body doesn't have enough water to sustain these vital processes.

Fortunately, your body is designed to constantly adjust its fluid levels. Thirst is one way this happens. When your body's fluid levels drop, your hypothalamus sends signals that create the sensation of being thirsty. As well, your kidneys preserve water by making your urine more concentrated when you don't have enough fluids in your body.

However, maintaining the right amount of water to avoid the consequences of dehydration can be a little tricky. That's partly because you lose water through sweat and urination, and also through normal bodily functions. For example, you exhale water vapor when you breathe.

And when you lose water, you also lose salt and electrolytes. Electrolytes are electrically charged nutrients that are essential for regular heartbeats, muscle contractions, and more. So losing electrolytes can have serious health consequences.

Why Dehydration Is More Common Among Seniors

Maintaining a healthy balance of water and electrolytes can be an even more complex process for seniors than it is for younger people. As a result, older people are more likely to get dehydrated. And the complications of dehydration in the elderly can be more serious.

According to an article in Frontiers in Molecular Biosciences, dehydration is one of the top 10 reasons for seniors to be hospitalized. And for hospitalized seniors, dehydration can lead to longer stays in intensive care units, increased hospital readmissions, and more placements in long-term care facilities.

Why does the risk of dehydration increase with age? Older adults are prone to dehydration because they can experience several health or lifestyle conditions that lead to low fluid levels. Many seniors experience at least one of the following risk factors:

1. Age-related physical changes

As we age, our bodies contain less water, partly because our kidneys become less efficient. (At birth, we are about 75 percent water, but an elderly body is about 50 percent water, according to an NPR science article.)

However, according to the Nutrition and Healthy Aging article, studies have found that although seniors are at greater risk for dehydration, they drink less water, on average, than younger people. That's often because seniors experience a weakened sense of thirst, so they don't always realize when they need to drink something.

Scientists aren't sure why this happens. But what makes this lack of thirst in elderly people particularly troublesome is that we're generally dehydrated before we feel thirsty. So the elderly get dehydrated quickly because they can't always recognize the signs of needing to take a drink until it's too late.

This reduced sense of thirst is often more pronounced in seniors with Alzheimer's disease or other forms of dementia or in those who have had a stroke. Such seniors may also have difficulties swallowing or asking their caregivers for a drink. As a result, seniors with dementia often need their fluid intake to be carefully monitored.

2. Medication side effects

Many medications that are commonly prescribed to seniors can act as diuretics (i.e., they can increase the production of urine) and contribute to dehydration. Side effects of any medications—particularly blood pressure medications, antihistamines, antacids, and heart medications—should be discussed with a physician.

3. Incontinence issues

The risk for dehydration associated with incontinence isn't necessarily caused by the fluid lost through involuntary urination. Rather, it's related to the fact that many elderly people restrict their fluid intake because they don't want any awkward accidents.

However, it's important to note that reducing fluid intake doesn't necessarily prevent incontinence. According to the National Association for Continence, drinking more water may actually help some seniors deal with incontinence.

As well, when you're dehydrated, your bladder can become more irritable and vulnerable to bacterial infection. So staying hydrated can reduce the risk of UTIs.

If you restrict your fluid intake because you're worried about incontinence, talk to your doctor. He or she can help you to determine how much water you should be drinking.

4. Fear of falling

Some seniors resist drinking a lot of water because they worry about falling if they have to get up at night to pee. But being dehydrated is also a risk factor for falling.

However, it's often a good idea to restrict fluids for a couple of hours before bedtime. Again, talk to your healthcare provider in order to figure out what works for you.

5. Living conditions

Seniors in nursing homes are more likely to become dehydrated because they are often dependent on staff members to help them with their fluid intake. The article in Nutrition and Healthy Aging noted that the highest risk for dehydration is among seniors who seem to be physically capable of getting a drink but have cognitive issues that cause them to forget to drink. So nursing homes and memory care facilities need to have policies in place for monitoring fluid intake.

6. Medical issues

Many seniors have medical conditions that can lead to dehydration. Examples of health problems than can result in fluid loss include diarrhea, fever, and diabetes.

Signs of Dehydration in Elderly People

It's important to be aware of the signs and symptoms of dehydration. In elderly people, the effects of being dehydrated can progress quickly, so you must act fast if you suspect dehydration.

As well, symptoms of dehydration in the elderly are often progressive. In the initial stages, you can tell if an elderly person is dehydrated by checking for the following signs of mild dehydration:

• Cracked lips
• Dry mouth
• Dry skin, particularly in the armpits
• Less frequent urination than normal

More severe effects of dehydration in the elderly are:

• Dark-colored urine (instead of what it should be: the color of pale straw)
• Strong-smelling urine
• Dizziness
• Increased heart rate
• Muscle cramps
• Crying without tears
• Confusion
• Irritability
• Fatigue
• Headaches
• Fainting

However, it's important to keep this in mind: Dehydration symptoms in adults who are in their senior years aren't always clear-cut. For example, some medications can affect the color of urine. As well, although dehydration can cause hallucinations in the elderly, cognitive changes from dementia or even side effects from certain medications are also sometimes responsible for the experience of perceiving things that aren't there.

So how can you identify potential dehydration?

Here's one good strategy: If you experience any of the symptoms above, simply drink some water, then see if the symptoms improve in 10 to 15 minutes. (Or if you suspect that a loved one is dehydrated, make sure that he or she gets some water, then wait and look for improvement.)

You should go to the ER for dehydration when you or the elderly person in question is experiencing any confusion, unexplained irritability, or sleepiness.

Always remember that getting prompt medical care is the most reliable way to know whether a senior is dehydrated. That's because dehydration is diagnosed in the elderly through blood tests that check their electrolyte levels and kidney functions. (Urine tests aren't always reliable for seniors.)

Treating Dehydration: What to Do and When to Seek Help

If an elderly person is dehydrated, you should give him or her a glass of water right away. But if his or her symptoms don't improve, it's best to head to the emergency room or call 911.

In the emergency room, dehydration treatment usually starts with an assessment to determine the degree of the problem. For mild cases, carefully observing patients and ensuring that they drink plenty of electrolyte-containing fluids may be all that's needed.

But for moderate dehydration, intravenous (IV) treatment is often necessary. And in severe cases, further intervention may be required. For example, if a person's kidneys are affected, he or she may require dialysis. And an older person who is experiencing confusion or other more serious signs of dehydration may need to be admitted to the hospital.

So the treatment and time required for recovery from dehydration, in elderly people especially, depends a lot on the degree of the problem, as well as on the person's overall health. But taking fast action can help reduce the recovery time. That's why it's important not to ignore the symptoms of dehydration in elderly people.

How to Prevent Dehydration in Elderly Adults

With a few proactive strategies, preventing dehydration in the elderly is possible. Being aware of the risks is a good first step. So is remembering this simple fact: Elderly people can stay hydrated by drinking enough water.

But many seniors wonder exactly how much water is enough. After all, you may have heard or read that everyone should drink eight cups of water each day. Recently, however, many experts have backed away from the eight-cups-a-day rule.

Here's what's best: Consider all of the factors that can influence how much water you need to drink, including any medications you take, your body weight, and your activity level. Discuss all of it with your physician.

In other words, an elderly person should drink an amount of water in a day that is based on the personalized advice of his or her doctor. There's no universal rule for the amount you should drink.

It's also important to remember that you can drink beverages other than water to reach your daily fluid requirements. Even though water is a great beverage, a study in The American Journal of Clinical Nutrition found that other drinks may be more effective because they don't lead to as much urine production. The study determined that milk, orange juice, and commercially prepared electrolyte replacement drinks were better at preventing dehydration.

When choosing an electrolyte replacement drink, be mindful of the sugar content. Although it was created as a children's drink, Pedialyte is suitable for elderly people because it has many important electrolytes. It also contains less sugar than many other similar options. For instance, a sports drink like Gatorade is good for dehydration, but the sugar level is often high.

In part because of their reduced sense of thirst, many older people find it difficult to get enough fluid in a day. Here are some tips that can make beverages more appealing:

1. Keep in mind that not all fluids come in a glass.

Many foods contain a lot of water. Vegetables, most fruits, and soups can all contribute to your daily fluid intake. (In fact, when elderly people stop eating, they increase their risk for dehydration because they are no longer getting any fluids from food.) Try using a little creativity by making popsicles with fruit juice or blending smoothies with fresh greens.

2. Use technology.

Check out some of the many apps (such as Hydro Coach or WaterMinder) that can track the number of drinks you consume in a day or that notify you when it's time for a drink.

3. Keep drinks nearby and visible.

Seniors often miss out on drinking fluids because they simply forget or can't access them. An attractive water bottle provides a portable way to always have a drink at hand.

4. Make drinks enticing and consider alternatives to water.

Some seniors find water a bit too boring. Adding a little juice or a flavored drink mix can boost its appeal. Sparkling water is also a nice change.

So if you know a senior who is struggling to get enough fluids, ask what his or her preferred non-alcoholic drink is. (But remember that diabetics should limit sweet drinks, and seniors with hypertension should limit drinks with sodium.)

5. Create routines.

Adding fluid intake to daily routines will make drinking a habit. For example, if you take medication, drink a full glass of water with it.

6. Work on fall-prevention strategies.

Feeling more confident on your feet can reduce worries about falling at night if you have to pee.

7. Work with staff in assisted living facilities or nursing homes.

Seniors in residential or long-term care facilities can face extra challenges in getting enough fluids. If you're concerned about a loved one, be sure to talk to the facility's staff to find out how they encourage and monitor fluid consumption.

Some strategies used in these facilities can include:

• Using beverage carts to offer drinks
• Serving plenty of soft foods with high water content
• Scheduling times for staff to remind residents to drink something
• Hosting "happy hours" with fancy, nonalcoholic drinks

Products that can help prevent dehydration:

Electrolyte powder: Simply add to water to help restore and replenish electrolytes.

Water bottle with time markers: This 32-ounce water bottle with a leak-proof lid helps you keep track of your water intake. Large time and measurement markers make this suitable for older adults. This water bottle includes a foldable mouthpiece and attachable straw is backed up with a 5-year warranty.

Water flavoring drops: Sugar-free drops to add to water for people who prefer flavor to plain water. Pro-tip: add to sparkling water as a healthier alternative to soft drinks.

SodaStream sparkling water maker: Save money and reduce waste by making your own sparkling water.

Kitchen timer: With a sleek, stainless steel design, this digital timer has large, backlit digits and adjustable volume. You can set and monitor for two events simultaneously. The memory program restores the last timer date after it finishes, so you can preset for your loved one to help them remember to hydrate. Option to use with the magnetic back or a tabletop stand, so it is conveniently close as needed.

Aquaphor lip repair ointment: Soothe and repair dry, chapped lips if you do become dehydrated. This lip repair ointment contains shea butter and chamomile and is preservative and fragrance-free.

Cetaphil moisturizing lotion: Hydrate dry skin with this fragrance-free lotion that is made with shea butter. Non-greasy formula that is designed to protect sensitive skin for 24 hours.

Consequences of Dehydration in Seniors

You may have already experienced some mild dehydration effects. Most of us have. If so, you probably didn't feel that you were at your best. Perhaps you experienced some of the possible dehydration symptoms, including:

• Fatigue
• Memory problems
• Poor concentration
• Irritability
• Headache

These symptoms can appear quickly. In fact, according to the article in Age and Ageing, even a small drop in our body-fluid levels (as small as two to three percent) can lead to physical and cognitive problems in older adults.

The long-term effects of not drinking enough water are the factors that lead to chronic dehydration. Elderly people can experience some of the following symptoms when they're chronically dehydrated:

• Low blood pressure
• Dizziness
• Skin problems, including pressure sores
• Constipation
• Kidney problems, including kidney stones
• Increased risk of urinary tract infections

If left untreated, you can die from dehydration. Some of the severe dangers of dehydration are:

• Seizures: Dehydration can lead to an electrolyte imbalance. In elderly people, particularly those with cardiac problems, the consequences can be grave. Because electrolytes carry electrical signals to our muscles, changes to our body's electrolyte balance can lead to seizures. Warning signs of an electrolyte imbalance include:
  • Muscle cramps
  • Irregular heartbeat
  • Mental confusion
• Shock: Low blood volume shock (also called hypovolemic shock) happens when we experience a sudden drop in blood volume. Dehydration can lead to low blood volume, which in turn leads to a drop in blood pressure and, sometimes, shock.
• Kidney failure: Dehydration complications such as low blood volume can reduce blood flow to the kidneys, which can cause lasting damage to the renal system over time.
• Heat exhaustion or heat stroke: When we get too hot, our bodies cool down by sweating. But if we don't have enough fluid to produce adequate amounts of sweat, we can quickly become overheated.

Depending on a person's overall health, a person can typically survive about 3 days without water. In general, a loss of more than 10 percent of a person's body weight through fluid loss is a medical emergency that can lead to death if not treated.

Knowledge Is Prevention

Being aware of the risk of dehydration is the first step toward averting it. So don't hesitate to talk to your healthcare providers about creating strategies for getting enough fluids. And watch for the warning signs of dehydration (in yourself and your loved ones). Although dehydration in elderly people can be serious, it's also preventable and treatable.