Management of Dehydration in Elderly People - An Overview

Introduction-

Fluid intake is essential for people of all ages, but it is more important for older adults. Dehydration occurs when one lose more fluid than we take in, and the body does not have enough fluid to function properly. Hydration is vital because it keeps the electrolytes in the body balanced, keeps the blood volume normal, aids in digestion, and transportation of nutrients, carry waste product out of the body, maintain the oral cavity moist, regulates the body temperature, rebuild cells and also helps the kidneys to function properly. Without enough fluid, the body will shut down, and it can even become deadly.

As we age, the total body fluid in the body also decreases, leading to a decrease in the water reserve available for the body. As a result, About 40 % of seniors are underhydrated, which can lead to dehydration and cause a variety of serious health problems. Adults aged 65 and above have the highest hospital admission rates for dehydration. One-third of elderly living in long-term care facilities experience an episode of dehydration on an average span of 6 months.

What Are the Problems Associated With Dehydration in Older People?

The elderly are also at more risk of inadequate hydration because of decreased metabolic rate, energy expenditure, renal function (kidneys clean blood toxins and transform waste into the urine), cardiovascular function, neurologic function, and cardiovascular function. Dehydration is not only a danger in the warmer months, but it can also occur at any time. Many seniors experience dehydration without realizing they are dehydrated- another reason dehydration is most dangerous in seniors.

• One of the side effects of aging is decreased thirst. As people age, they often do not feel thirsty as they used to and do not notice when they need water which can easily lead to dehydration.

• Some older individuals are associated with conditions like dementia which can make them forget to consume fluids.

• Decrease interest in food due to decreased sense of taste and smell and inability to chew food due to improper dentition.

• Increased prevalence of lactose intolerance.

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• The functioning of the kidneys can decline with age, leading to more water loss through urination.

• Side effects of medications like diuretics and blood pressure medications can also lead to increased water loss through urination in some cases.

• Underlying health conditions like diabetes or kidney stones cause more fluid loss than normal.

• Heat exposure- spending time in hot or humid conditions can increase fluid loss through sweating.

• Illness associated with vomiting and diarrhea.

• The elderly are more susceptible to fainting due to fluid loss.

• Mobility problems- It is more difficult for older adults with mobility issues to get water independently.

• Dehydration in older people also adds to the risk of mental confusion.

• Swallowing disorders due to Parkinson's disease or dementia puts the elderly at more risk of dehydration.

• Dehydration can also cause medication toxicity and pressure ulcers.

• Diminished drinking due to fear of incontinence at night.

What Are the Signs and Symptoms of Dehydration?

The early signs and symptoms of dehydration are often overlooked or unnoticed because they are some of the most common signs of health problems in general.

1. Mild Dehydration- Dryness of mouth, dry skin, dark colored urine or less amount of urine, dizziness, headache, fatigue, feeling sleepy, muscle cramps, and weakness.

2. Moderate Dehydration- Inability to produce sweat or tears, irritability, and confusion.

3. Severe Dehydration- Dry and sunken eyes, pale skin, trouble walking, severe muscle cramps, especially in the legs, weight loss, and constipation.

A pinch test is used to look for signs of dehydration quickly. One has to gently pinch ½ to ¼ inch of skin on the back of their hand for a second and observe if it goes back quickly to its original shape; if the skin stays pinched or is going back slowly, it can be a sign of dehydration. Other than clinical symptoms, urine, and blood tests can also be done to determine dehydration, as suggested by the doctor.

How to Manage Dehydration in Older Adults?

The first goal is to determine whether the dehydration has been caused because of water depletion or sodium and water depletion since both show similar clinical features, and a misdiagnosis can lead to a delay in treating the condition. Water depletion is characterized by high levels of salt in blood and urine, whereas in salt and water depletion, there are high levels of nitrogen in blood but low salt. The following steps can be followed to manage dehydration-

1. The first important step is making sure that they are taking enough water throughout the day according to their body weight and also encouraging them to take their fluids in small amounts or sips.

2. Keeping water sources or water bottles nearby for the older adults as they might have difficulty moving or if they are bedridden.

3. A family person or a caregiver can remind them to take their fluids on time.

4. Markings on water bottles to help track the amount of water intake.

5. Sometimes, older adults become rigid in taking water; in that case, plain water can be replaced with natural or low-sugar smoothies and juices.

6. Eating in small amounts many times a day will increase the frequency of fluids throughout the day.

7. An increase in fluid-rich foods, fruits, and vegetables like watermelon, pineapple, oranges, cucumber, lettuces, or low-sodium soup broth will contribute to overall fluid intake.

8. Avoid coffee or high-protein drinks.

9. Remind them about the disadvantages of dehydration, as drinking more water can also lessen the risk of fatal coronary heart disease, bladder cancer, constipation, colorectal cancer, and UTIs.

10. In moderate dehydration, intravenous hydration and urgent care can be given, or subcutaneous infusion, through the skin of the belly or thigh. In severe dehydration cases, short-term dialysis can be administered.

Conclusion-

Despite being a common problem, most dehydration cases go undiagnosed without proper assessment in the older population. It may seem like minor dehydration, but it can cause some major impacts. While dehydration treatment is relatively safe and easy, the goal is to prevent it rather than treat it.