Hydration in Elders: More Than Just a Glass of Water

As we enter the warmer part of the year, it is more important than ever to drink enough fluids. This is particularly true for children and for persons 65 and older - which could be both the caregivers and their loved ones. Not drinking enough fluids can cause unwanted symptoms, complications from existing disease conditions and may account for many hospitalizations of our elders. Water and juices are the best; coffee, tea and colas with caffeine as well as alcoholic drinks cause the body to lose fluids and are recommended only in small amounts.

Elders are at risk for dehydration for many reasons:

• Age related. There is less water in the older body, greater difficulty for the older kidney to maintain fluid balance and less thirst sensations in older folks in general.
• Disease-related reasons for dehydration range from the complex to the simple. Infections such as pneumonia, chronic obstructive pulmonary disease (COPD) and urinary tract infections increase the need for fluids due to fevers and the overproduction of mucus. Some diseases, such as congestive heart failure, renal disease, stroke or other neurological disorders and diabetes, cause changes in the function of various hormones that regulate the fluid balance in the body. Also, there are acute reasons for dehydration such as prolonged vomiting or diarrhea, over-aggressive diuretic therapy and poor compliance to medication regimens.
• Environmental reasons. A decrease in mobility for those with arthritis, diminished vision or confined to bed rest who cannot as easily meet their own needs. Those with diminished appetite or reluctance to bother others for something as simple as assistance in getting a sip of water are definitely at risk.
• Medication reasons. May cause increased fluid losses through the kidneys. Diuretics, sedatives and laxatives are common, necessary drugs that require close attention to fluid intake. Other drugs and alcohol can cause the kidneys to work harder, and may damage them, making it harder to maintain fluid balance.
• Psychosocial reasons. This is the elder who is cognitively impaired, and possibly unable to drink without full assistance, or those who may intentionally restrict fluid intake in the hopes of decreasing the risk of incontinence.
• Economic reasons. This may include the lack of financial resources to maintain nutritional and fluid intake, extreme or prolonged weather fluctuations and the possibility of elder abuse.

How could you tell if your loved one might be becoming dehydrated? Ask yourself if they have any of the above mentioned risk factors. If they complain of nausea, are lethargic, have headaches, vomiting or dizziness, these could all be signs of dehydration. Call your doctor if your loved one had any or all of these symptoms.

Keep track of how much your loved one actually drinks in a day. A simple way to do this would be to put two quarts of water in the refrigerator first thing in the morning. Give all fluids for your loved one from his or her special pitcher. By the end of the day, they should have drunk most of the 2-quart pitcher. It could be plain water, water with lemon or other fruit juices made with water. Regular tea and coffee do not count because they promote fluid loss. Decaffeinated teas and coffees are OK (if your loved one will not drink plain water or juices) because they are less likely to promote urination. Foods that melt at room temperature, such as gelatin or ice cream also have a lot of water content. Serve foods with sauces, juices and gravies - every little bit helps.

There are some diseases for which it is not appropriate to offer so many fluids: congestive heart failure, cirrhosis of the liver and kidney disease. However, for most of us, young and older, the rule of thumb is to drink, drink, drink to keep the body hydrated, and stay away from the hospital and all the tubes and therapy needed if dehydration does occur.