Causes and Risk Factors of Dehydration in Elderly
The age by itself does not cause dehydration. Older people can be hydrated just as well as younger adults. Wrinkled skin in old people is usually due to skin dehydration and sometimes, additionally, due to overall dehydration. Old people at greater risk for dehydration:
- Living in nursing homes
- Chronic diseases with pain, nausea or other symptoms that mask the feeling of thirst
- Water pills (diuretics), such as lasix, which stimulate urine excretion
Some older people have decreased feeling of thirst and some avoid drinking in fear of urinary incontinence. Chronic dehydration is common in older individuals 2.
Seniors may not recognize dehydration by themselves and may not look much different when dehydrated. Reliable symptoms and signs of dehydration in elderly include sudden, unintentional drop of body weight, decreased frequency of urination and dark urine.
Other common symptoms include confusion and irritability.
Assessment of Dehydration in Elderly
- Regular measuring of body weight (sudden drop of body weight for 1-3% speaks for mild dehydration, 3-6% weight loss for moderate, and a loss greater than 6% for severe dehydration.
- Dark urine speaks for moderate to severe dehydration.
- Decreased skin elasticity is unreliable sign of dehydration in elderly.
- Increased blood sodium level (hypernatremia) speaks for dehydration.
The most common mechanism of dehydration in elderly is insufficient drinking that leads to hypernatremic dehydration (increased blood sodium levels). This type of dehydration (when mild or moderate — up to 6%v loss of body weight) can be treated with drinking beverages (about 1.5 liter of water for each kilogram of body weight loss). Severe dehydration (>6% body weight loss) might need intravenous infusion, usually “physiological solution,” which is 0.9% solution of sodium chloride (saline). Beverages appropriate to treat dehydration
Old people often have decreased sense of thirst so it is important they drink regularly even when not thirsty.
Old people, when dehydrated, are at increased risk of developing 1:
- Bedsores or pressure ulcers (in bedridden persons or those i wheelchairs)
- Kidney failure (in kidney patients)
- Heart failure (in heart patients)
- Fainting and falls possibly resulting in bone fractures (mainly in women with osteoporosis)
- Memory loss
- Hallucinations (may be a symptom of severe dehydration or a symptom of dementia, which can become worse in dehydration)
- Infections, especially in hospitals (community-acquired pneumonia).
Dehydration and Death
Dehydration can worsen the course of certain conditions, such as heart disease or kidney disease and thus increase the risk of death. On the other hand, some otherwise healthy older people may be surprisingly resistant to dehydration. Here you can read how long can you survive without water.