Hydration in older age

Posted on: 12 April 2019 by 50connect editorial

Hydration is often overlooked when it comes to health and wellness advice but is just as important as a well-balanced diet and regular exercise. Here are some tips to help you spot the tell-tale signs

dehydration

A recent study carried out by the UCLA School of Nursing has shown how dehydration amongst older people is often not properly recognised and can lead to many health problems including urinary tract infections and frequent falls.  The same study also highlighted that adults over the age of 65 have the highest hospital admission rates for dehydration. Although these findings are from the US, it’s a similar story here in the UK as dehydration is often overlooked and is of particular concern amongst those in someone else’s care such as hospitals and care homes.  

Why does the body need water?

Water makes up around 50-60% of your body weight and is a major component of muscles and organs. Water is required by the body to transport nutrients around in the blood, discard waste, digest food and reduce body temperature by sweating. Glucose is stored in muscle tissue as glycogen and for every gram holds 3-4g of water. 

You can survive for some time without food but your chances of survival in the absence of water are less promising as all the cells, tissues and organs in the body require water to work properly.  Water constantly moves through cells with about 10% of your body water being replaced every day with a fresh supply.  Blood for example is about 93% water and muscles are around 73%, whereas fat is about 10%.

How is water balanced in the body?

The balance of water in and out of your cells is monitored by membrane osmoreceptors and when fluid is restricted, thirst is triggered, and anti-diuretic hormone is released which reduces loss of water via the kidneys and restores balance.

How do older people become more dehydrated?

These processes decline with age and as such the thirst sensation reduces making it a less reliable way to identify dehydration. Other factors that contribute to dehydration in older people include the use of diuretics or laxatives which can exacerbate fluid losses and also reduced muscle mass leaving smaller fluid reserves (water is stored in muscle with glycogen – the body’s way of storing glucose for energy). Conditions such as diabetes can also make dehydration worse if poorly controlled.

Older people may also limit the amount of fluids they drink for any number of reasons such as the loss of enjoyment for certain drinks, reduced mobility or strategies to avoid incontinence or frequent visits to the bathroom.  Social seclusion can also play a role as routines are lost and people forget to drink regularly, which also occurs in those with dementia.

What are the risks of dehydration in older people?

Dehydration is associated with many poor health outcomes, which includes hospitalisation and in certain cases and increased risk of death. Energy levels and fatigue are also affected by dehydration even in mild cases and this increased tiredness can reduce motivation and mood. One serious complication often overlooked is the impact of dehydration on the risk of falls as a result of low blood pressure, weakness and dizzy spells. 

Water is also important for the health of your kidneys and urinary tract so when restricted can increase the risk of infections or kidney damage. Constipation is also an issue for older people but keeping well hydration can ease this condition and assist fibre in food to swell and do its job properly.

How can you tell if someone is dehydrated?

As thirst may not be a reliable indicator in older people, it’s important to recognise any other signs that may point towards dehydration.

  • Dryness of the mouth, lips and tongue
  • Sunken eyes
  • Dry skin with little elasticity
  • Drowsiness
  • Confusion or disorientation
  • Dark and strong-smelling urine

Useful ways to help older people to stay well hydrated

  • Encourage older people to drink by making them something to drink when visiting at home or in a care setting.  Don’t ask, just make a cup of tea for you and the person you’re visiting.
  • Keep fluids to hand and make them desirable to drink.  Having a jug of iced water or low-calorie squash to hand means the chances of drinking are more than if it wasn’t available.
  • Using electrolyte sachets or tablets dissolved in water can be a good way to assist with hydration (try Healthspan Your Electrolyte - £3.95 for 20 sachets).
  • All fluids count and this includes smoothies and even foods with a high liquid content such as soups, broths, yoghurt, jelly and custard.
  • Watery fruits and vegetables can be a nice refreshing way to hydrate.  Try slices of melon, pineapple or cucumber.  
  • In some cases, it may be necessary to help an older person overcome the barriers that are preventing them from drinking such as worries about not reaching the toilet in time or physical inabilities.

Hydration is often overlooked when it comes to health and wellness advice but is just as important as a well-balanced diet and regular exercise.  Amongst older people, warding off dehydration is even more important as it’s not as easily recognised and can result in many poor health outcomes as a consequence.

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