By recognizing a potential problem early, you may save an elder adult from a debilitating complication. Here's what you need to know. Because dehydration and malnutrition can have such serious consequences in older patients, make early recognition and treatment a priority. Use the following information and guidelines to assess for problems and intervene appropriately.

Why dehydration threatens
if the patient doesn't have enough fluid to adequately cool her body. The result is a downward spiral of dehydration and increasing body temperature, further raising fluid needs and compounding dehydration.

Signs and symptoms of dehydration include irritability, confusion, tachycardia, low urine output, dry skin, constipation, fecal impaction, dizziness, hypotension, infection, bowel blockage, and skin breakdown.If allowed to continue unchecked, dehydration may lead to falls, stroke, renal failure, and death.

* Psychological factors, such as depression, which can cause a loss of appetite and fluid intake. Elderly patients also may purposefully decrease their fluid intake to eliminate frequent trips to the bathroom or to control incontinence.

Looking for problems
Whenever you assess an elderly patient, look for the following signs of dehydration:
• dry mucous membranes
• irritability
• confusion
• dizziness
• muscle weakness
• acute weight loss of 2 or more pounds; 2.2 pounds (1 kg) equals about 1 liter of fluid over a few days
• decreased urine output
• increased heart rate
• fever

Monitor fluid intake and output, weigh the patient daily, and watch for ominous trends: decreasing intake, increasing output, changes in lab results, and changes in emotional or mental status. If you suspect dehydration, review her care plan for anything that may be contributing to a fluid imbalance, such as N.P.O. status, fluid restrictions, or diuretic use. When, for whatever reason, a patient can't reach for and hold a glass of water, include ways to encourage fluid intake in the care plan. For example, set up a schedule for offering fluids.