As we get older, body water content decreases, the
risk for dehydration increases, and the consequences
become more serious.
Dehydration has been associated with increased
mortality rates among hospitalized older adults1 and
can precipitate emergency hospitalization and
increase the risk of repeated stays in hospital.2,3
Dehydration is a frequent cause of hospitalization of
older adults and one of the ten most frequent diagno
-ses responsible for hospitalization in the United-
States.3 Evidence suggests high dehydration rates of
elderly patients within hospitals and other health care
institutions.2
Dehydration has also been associated with various
morbidities, such as impaired cognition or acute
confusion, falling or constipation.
The cost associated with dehydration may be very
high: a study conducted in 1999 in the United
States evaluated the avoidable costs of
hospitalizations due to dehydration at $1.14 billion.4
Why are the elderly more susceptible to dehydration?
The amount of body water decreases by
approximately 15% (about 6 L) between the ages of
20 and 80.5 With this decrease, the body becomes
more susceptible to dehydration from the loss of a
small amount of body water.6 Moreover, the elderly
often experience diminished thirst sensation which
leads to a reduced fluid consumption.7,8 Also as a
consequence of ageing, the kidneys have a reduced
ability to concentrate urine and retain water during
water deprivation.9 In addition, ageing kidneys are
less able to conserve or excrete sodium.10
Insufficient fluid intakes can also be the result of
limitations such as reduced swallowing capacity,
decreased mobility, or comprehension and
communication disorders. Disease-related factors,
such as incontinence can increase water losses.
Dehydration may also be caused by warm
temperature, inadequate staffing in institutions, or
use of laxatives or diuretics.1
What steps can be taken to prevent
dehydration in the elderly?
Prevention is primarily based on ensuring adequate
fluid intake. Raising awareness of the elderly, their
families and caregivers on the risks of dehydration
and its consequences is fundamental for dehydration
prevention,1,11and can lead to cost-savings in geriatric
institutions.12,13
SOME STRATEGIES FOR ENCOURAGING
FLUIDS CONSUMPTION9,11
- Offer fluids regularly during the day
- Make liquids readily available all day (at bedside
or chairside in geriatric institutions) by placing
containers such as small bottle of water or sippy cups
- Encourage consumption of fluids with medication
- Provide preferred beverages
- Prescribe and safeguard a minimum intake of
1.5 L in periods of increased risk for dehydration
References:
- Mentes J. Oral hydration in older adults: greater.
awareness is needed in preventing, recognizing, and
treating dehydration. Am J Nurs. 2006;106:40-9;
quiz 50.
2.Begum MN, Johnson CS. A review of the literature
on dehydration in the institutionalized elderly.
E SpenEur E J ClinNutrMetab. 2010; 5:e47-e53.
3.Sheehy, CM, Perry PA, Cromwell SL. Dehydration
: biological considerations, age-related changes, and
risk factors in older adults. Biol Res Nurs. 1999;
1:30-7.
4.Xiao H, Barber J, Campbell ES. Economic burden
of dehydration among hospitalized elderly patients.
Am J Health Syst Pharm. 2004;61:2534-40.
5.Gille D. Overview of the physiological changes
and optimal diet in the golden age generation over 50.
European Review of Aging and Physical Activity
2010;7:27-36.
6.Rikkert MG, MelisRJ, ClaassenJA. Heat waves
and dehydration in the elderly. BMJ. 2009:339:b2663.
7.Schols JM, De Groot CP, van der Cammen TJ,
Olde Rikkert MG.Preventing and treating dehydration
in the elderly during periods of illness and warm
weather. J Nutr Health Aging 2009;13:150-7.
8.Kenney WL, Chiu P. Influence of age on thirst and
fluid intake. Med Sci Sports Exerc. 2001; 33:1524-32.
9.Bennett JA. Dehydration: Hazards and Benefits.
Geriatric Nursing 2000;21:84-8.
10.Silver AJ. Aging and risks for dehydration. Cleve
Clin J Med. 1990:574:341-4.
11.Faes MC, Spigt MG, Olde MGM, Rikkert MD.
Dehydration in Geriatrics. Geriatrics and Aging
2007;10:590-6.
12.Simmons SF, Alessi C, Schnelle JF. An
intervention to increase fluid intake in nursing home
residents: prompting and preference compliance.
J Am GeriatrSoc 2001;49:926-33.
13.Robinson SB,Rosher RB. Can a beverage cart
help improve hydration? GeriatrNurs.
2002;23:208-11.