Water Everywhere! But Why Aren’t Elders Drinking?

With supermarket and convenience store shelves awash with bottled water, it's inconceivable that anybody could be dehydrated. Yet studies suggest a third of elders are chronically dehydrated, which can result in some very bad health outcomes.

Dehydration takes place when an individual loses more fluids than they take in. The human body is constantly in a state of losing water. If fluids aren't replaced, the body eventually does not have enough water available to perform natural bodily functions.

Chronic dehydration is not usually caused by the unavailability of water, but by several other factors. These include:

Aging Changes

• The human body is composed primarily of water, but the amount diminishes as we age. Infants are 70% to 75% water; young people, 60% percent. By old age, the proportion drops to around 50%, in part because the kidneys' ability to retain water decreases with age.
• With increasing age, the ability to perceive thirst decreases. Some people, such as those with stroke totally lose the ability to know if their body needs water (because the part of their brain that regulates body processes is affected). Not knowing when the body is dangerously low on fluids is one reason that so many elders struggle with dehydration during heat waves. Human beings can go for more than three weeks without food, but less than a week without water.

Health Conditions

• Medications. Many elders with heart failure and high blood pressure are taking diuretic medications (water pills), which increases water loss. Also, some of the medications taken for constipation and mood/depression disorders lead to increased water loss.
• Impaired sleep. Some elders don't take their diuretic medications during the nighttime because it makes them get up during the night to toilet and disturbs their sleep.
• Cognitive impairment. Individuals with dementia may not remember or want to routinely drink fluids. As well, individuals may not have the ability to ask for fluids and/or their fluid preferences.
• Impaired mobility. Many elders don't drink enough because they fear the difficulty of getting to the bathroom and the risk of falling, especially during the night. Not drinking, however, is not a good solution since dehydration can make elders more likely to fall.

Consequences

Many individuals are not aware that dehydration can lead to health problems.

Common conditions may include:

• Confusion
• Weakness
• Constipation
• Headache
• Dizziness/loss of balance
• Urinary tract infections

Warning Signs

Even if a person doesn't feel thirsty, there are outward signs of dehydration, which can include:

• Irritability
• Exhaustion
• Decreased urination and dark urine color
• Dry mouth and tongue
• Low blood pressure and a weak pulse

Another way to test for dehydration is to perform a skin "recoil” test. To do this, pinch a fold of skin on the person's forearm or hand and watch how quickly it returns to normal. If the skin is slow to flatten and remains in the form of a tent, the person may be moderately or severely dehydrated.

Prevention

How Much Water Do We Need?

• The common standard of eight 8-ounce glasses a day has been largely discredited. However, there is no universally accepted figure to take its place. That normal level of hydration varies widely from person to person. As well, a person's diet can greatly affect hydration levels: fruits (especially watermelon), vegetables, and soups are mostly water-based. In general, larger people need to drink more water, as do people who exercise and those who perspire heavily, but there is no ‘one-size-fits-all' remedy.
• The best advice is to increase one's hydration on hot/humid summer days and pay attention to the warning signs of dehydration; especially decreased urination or inadequate urine output. Also, check that urine is light, yellow in color. Dark urine is an early sign of dehydration. For individuals with chronic health conditions, ask your family doctor for guidance on fluid intake.

Education

• Making elders aware on the importance of hydration and the risk factors for dehydration is important. When people know that they should not trust thirst but should drink because it is healthy for them, water intake generally increases. Families should also talk to loved ones at risk for dehydration about what beverages they most like to drink. Individuals tend to increase their fluid intake if are given the beverages they prefer.
  Cognitive Impairment
• Dementia is a major challenge for family caregivers to stay on top of a person's hydration status. Verbal prompting to drink between meals can be effective in improving fluid intake. Incorporating ice chips, iced lollypops, juice bars, gelatin, ice cream, soup, broth, fruit and vegetable juices, lemonade and flavored water will also help.

Other Hydration Tips

• Have water easily reachable throughout the day. Put water, or preferred beverages, near individuals throughout the day. Keeping a water bottle next to the bed or their favorite chair could help, especially if they have mobility issues.
• Develop a water schedule (like a schedule for taking medicine). Reminders and prompts using smartphones or devices can be helpful.
• Encourage drinking water by repeating self-care actions like brushing teeth.
• Use the taking of medications as an opportunity to take water.
• Focus on mobility issues. Many elders don't drink because they don't want to go to the bathroom. Encourage exercise to improve an individual's walking and balance. Also, arrange the person's living quarters to make the bathroom well-lit and easily accessible, removing anything that could contribute to a fall. This will make the person more confident in their ability to get to the bathroom when needed.

Rein Tideiksaar Ph.D., PA-C is the president of FallPrevent, LLC, Blackwood, N.J., a consulting company that provides educational, legal and marketing services related to fall prevention in the elderly. Dr. Tideiksaar is a gerontologist (healthcare professional who specializes in working with elderly patients) and a geriatric physician's assistant.