Current Issue:

Hydration and the elderly and making sure your patient is hydrated

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 adults and can precipitate emergency hospitalization and increase the risk of repeated stays in hospital. Dehydration is a frequent cause of hospitalization of older adults and one of the ten most frequent diagnoses responsible for hospitalization in the United-States. Evidence suggests high dehydration rates of elderly patients within hospitals and other health care institutions.

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.

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. With this decrease, the body becomes more susceptible to dehydration from the loss of a small amount of body water. Moreover, the elderly often experience diminished thirst sensation which leads to a reduced fluid consumption.

Also as a consequence of ageing, the kidneys have a reduced ability to concentrate urine and retain water during water deprivation. In addition, ageing kidneys are less able to conserve or excrete sodium.

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.

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, and can lead to cost-savings in geriatric institutions.

• 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

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