• Recognize the common symptoms of dehydration and how they may specifically present in elderly populations.
• Learn the risks associated with dehydration in the elderly and the health benefits of proper hydration.
• Understand how to prevent dehydration in elderly patients through encouragement or necessary assistance.

Drinking enough water is important for all age groups but especially for older adults who are at greater risk for dehydration. Dehydration is the most common fluid and electrolyte issue among the elderly.

Many older adults are underhydrated and do not even realize it. Dehydration can lead to several other health issues including urinary tract infections, falls, and kidney stones.

Older adults are more likely to become dehydrated because they naturally have less water in their bodies as they age. They are also more likely to have health conditions or take medications that increase their risk of dehydration such as blood pressure medications that are known to flush water from the body.

In addition to these risk factors, elderly patients are less sensitive to the feeling of being thirsty, have a decreased ability to keep fluid levels in balance, take medications that cause diarrhea or sweating, and have less efficient kidneys, which results in urine containing more water.

Symptoms of Dehydration

Dehydration symptoms in the elderly often go unrecognized because many of the signs of dehydration can be caused by other health conditions or brushed off as medication side effects. It is easier to get dehydration under control the earlier it is caught to prevent serious complications from happening.

As a nurse, it is important to familiarize oneself with the symptoms of dehydration in an effort for early identification to be noted.

Early Dehydration Symptoms:

• Dry Mouth
• Dark-colored urine or very scant amounts of urine
• Fatigue
• Dizziness
• Headaches
• Muscle cramps
• Weakness
• Irritability

Serious Dehydration Symptoms:

• Low blood pressure
• Confusion
• Difficulty ambulating
• Fast and weak pulse
• Bloating
• Dry eyes and sunken appearance to eyes
• Fast respirations
• Uncontrolled shaking of the body

Along with observing for the symptoms listed above, one can assess dehydration by completing the dehydration skin test. First, gently pinch the skin on the back of the hand, arm, or abdomen. Hydrated skin will spring back instantly. If the skin takes longer to bounce back or gives a “tenting” appearance, then dehydration is very likely.

Risks of Dehydration

Medications may not work properly if the elderly are not well hydrated. If the symptoms of dehydration in elderly patients are not spotted then it may also cause other health problems such as fainting, seizures, blood clot complications, and hypovolemic shock (when blood pressure volume causes a drop in blood pressure and a drop in the amount of oxygen in the body).

The average adult should consume a minimum of half-gallon of water a day; however, since each elderly adult takes different medications and has different health conditions, it is important to talk with the patient’s physician to find out how much water is best for each individual.

Benefits of Hydration and Prevention of Dehydration

Aside from avoiding serious health problems in the elderly, keeping this population well hydrated has its other benefits too:

• Less constipation and a reduced need for laxatives
• Fewer falls due to the confusion, fainting, and weakness that can come from being dehydrated.
• Reduced risk of urinary tract infections

The most important strategy in the prevention of dehydration is to recognize when a patient’s fluid intake is inadequate and encourage them to drink more water.

Elderly patients may not drink enough because they are worried about incontinence, especially if they need assistance using the bathroom. They may be physically unable to get a drink and may not receive the help they need to stay properly hydrated.

Staff training on the importance of hydration, monitoring of fluid intake, assistance when necessary, and the adaptation of the patient’s preferred fluids are all important in long-term care. Offering a full glass of water during medication passes may also be helpful and encouraging the patient to drink as much as possible throughout the day is imperative to maintain adequate hydration.

The Bottom Line

Dehydration is a very common occurrence in the elderly population due to the normal effects of the aging process, health conditions, and medication side effects. Like with other illnesses, early detection and nursing intervention is vital in achieving positive health outcomes for the patient and prevention of serious complications.

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