Symptoms of Dehydration in Elderly: Key Indicators to Watch!

Dehydration can be a serious medical issue for the elderly, as the natural effects of aging make them more susceptible to losing fluids and electrolytes. Recognizing the symptoms of dehydration in elderly early and taking action to increase fluid intake is important to maintain good health.

Global studies suggest that dehydration is responsible for an increased rate of morbidity and mortality in older adults. For instance, research indicates that dehydration has been associated with a higher incidence of urinary tract infections, kidney stones, and in severe cases, renal failure in the elderly (Jéquier & Constant, 2010).

Moreover, a study published in the Journal of Gerontology has found that around 20% of elderly patients admitted to hospitals were dehydrated (Hooper et al., 2015).

Given these facts from global research, it is evident that dehydration in the elderly is a complex issue that requires awareness. In our blog post, we will dissect these symptoms and warning signs, as well as discuss practical measures that caregivers and healthcare professionals can take to ensure adequate hydration in the elderly population.

What Can Cause Dehydration in Elderly?

As we age, our bodies undergo various physiological changes that make us more prone to dehydration. These changes can affect up to 20-30% of older adults (Hooper et al., 2014). Some of these age-related changes include:

• Decreased thirst sensation – Older adults lose some sensitivity to cues that signal dehydration, so they feel less thirsty even when dehydrated.
• Reduced kidney function – The kidneys are less able to conserve water as effectively and concentrate urine.
• Medications – Many common medications like diuretics, laxatives and blood pressure drugs have dehydrating side effects. In fact, Polypharmacy is common in the elderly, with 40% of those over 65 taking five or more medications that may contribute to dehydration.
• Chronic conditions – Diseases like diabetes, dementia, Parkinson’s and stroke increase dehydration risk.
• Mobility issues – Those with limited mobility cannot access fluids as easily.
• Cognitive decline – Dementia and memory loss make it difficult to remember to drink enough.

With these vulnerabilities in mind, it is essential that caregivers monitor hydration status and watch for any emerging signs of dehydration in the elderly. Learning to recognize the symptoms can prevent a small fluid imbalance from escalating into a medical emergency.

Main Symptoms of Dehydration in Elderly

There are several key dehydration symptoms in elderly that tend to manifest when they are getting 0dehydrated. The important symptoms to look out for include:

• Thirst – While it may be diminished, a complaint of thirst is one obvious clue that fluid intake is inadequate. Offering fluids and encouraging the person to drink can help counter early dehydration.

• Dry mouth – A sticky, dry mouth often accompanies thirst as a symptom of mild dehydration. Check for this sign by asking if the mouth feels dry or inspecting the mouth and tongue for sticky saliva.
• Fatigue and weakness – Lack of fluids causes headache, tiredness and muscle cramps or weakness. Severe dehydration can resemble delirium with fatigue.
• Dizziness: Fluid loss reduces blood pressure, resulting in possible lightheadedness, dizziness and balance issues. It can result in falling.
• Nausea – The gastrointestinal tract often signals pending dehydration. Nausea, vomiting and diarrhea expel fluids and electrolytes, while dehydration itself can induce nausea.
• Reduced urination – In dehydration, the kidneys conserve water by producing little urine. Dark yellow urine in low volume indicates concentration from lack of fluids.
• Confusion – Attention, alertness and cognition decline, mimicking delirium and dementia can happen when dehydration is severe.
• Falls – Dizziness and reduced coordination from dehydration lead to increased risk of injurious falls.
• Seizures – Electrolyte imbalance and fluid depletion in the brain can cause seizures in instances of extreme dehydration, though this is rare.
• Low blood pressure – Some dehydrated elderly experience drops in blood pressure upon standing from lying down. Orthostatic hypotension (blood pressure that happens when standing after sitting or lying down) indicates volume loss and can cause lightheadedness. Checking for low blood pressure helps confirm dehydration.

In addition to monitoring for the above acute symptoms, also watch for signs of chronic mild dehydration, which include:

• Dry, flaky skin
• Constipation
• Dark colored urine
• Increased sleepiness or lethargy
• Dry mouth
• Muscle cramps
• Weight loss

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Must Read: Dehydration in elderly: An Evil in Disguise

What Lab Markers Indicate Dehydration?

If available, clinicians can also check laboratory tests and vital signs to verify and quantify dehydration:

• Elevated hemoglobin and hematocrit (blood thickens with less plasma)
• Electrolyte abnormalities – low sodium, potassium, chloride
• High or high normal blood urea nitrogen (BUN)
• Increased urine specific gravity and osmolality
• Tachycardia (heart rate over 100 bpm)
• Orthostatic hypotension – a drop in systolic blood pressure of 20mmHg or more upon standing indicates volume depletion
• Poor skin turgor – tenting or wrinkling of skin when pinched shows poor hydration

These objective measures can support the subjective symptoms and aid in understanding the severity of dehydration symptoms in elderly for proper treatment.

Elders Who Are Risk of Dehydration

While all elderly are at increased risk, certain populations are exceptionally prone to dehydration. These include:

• Frail seniors – especially nursing home residents or homebound elderly living alone with limited mobility
• Those with dementia – unable to recognize thirst and remember to drink
• Insufficient kidney function
• Diabetics
• Disabled or bedridden – reliance on others to provide hydration
• Those on multiple medications – diuretics, blood pressure pills, laxatives
• Recent surgery or hospitalization – IV fluids or fasting then abrupt stoppage after discharge
• Chronic diarrheal illness
• Dysphagia or swallowing disorders – mechanical difficulty drinking
• Alcoholism – interferes with fluid balance and suppresses thirst drive

Caregivers and family members of vulnerable seniors should be vigilant about watching for early symptoms of dehydration and facilitating increased hydration.

Consequences of Dehydration in Elderly

If not promptly treated, dehydration in the elderly can lead to serious health complications, including:

• Falls and fractures – dizziness and weakness lead to dangerous falls
• Heat injury – less ability to regulate temperature
• Kidney damage – especially in those with chronic kidney disease
• Medication toxicity – dehydration alters drug metabolism
• Infection – fluids help defend against bacteria and pneumonia
• Impaired cognition – attention, orientation and memory decline
• Seizures or coma in extreme cases
• Death – severe dehydration can be fatal without treatment. Older adults with co-morbidities are most vulnerable.

The dire effects of severe dehydration underscore the importance of prevention through early recognition and intervention at the first symptoms of dehydration in elderly person.

Providing frequent fluids, assisting with drinking and monitoring intake are key.

Also Read: Five Reasons to Drink Water – Important Hydration Health Facts

Treatment of Dehydration

How do you keep an elderly person from getting dehydrated?

• At the first signs of possible dehydration, offer the older person plenty of fluids – ideally cool, clear water – and encourage them to drink if able. For those with certain conditions like chronic heart failure, check with a doctor about fluid volume limits.
• If oral fluid intake is not sufficiently reversing dehydration, intravenous (IV) fluids may be needed, especially if there are signs of moderate to severe dehydration. Replacing electrolytes as well as fluids may also be important.
• Underlying contributing factors also need to be addressed including:
  • stopping or adjusting diuretic doses
  • treating infections with antibiotics
  • anti-diarrheal medications
  • managing diabetes

• Preventing dehydration through education,
• reminders to drink,
• providing favorite beverages and monitoring intake

All the above mentioned points are important to minimize complications from dehydration in elderly and keep them healthy.

Regular hydration assists every system in the body and is a simple but vital component of good care. It is something that has to be monitored.

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References:

1. Jéquier, E., & Constant, F. (2010). Water as an essential nutrient…64(2), 115-123.
2. Hooper, L., Abdelhamid, A., Ali, A., Bunn, D. K., Jennings, A., John, W. G., … & Hunter, P. R. (2015). Diagnostic accuracy of calculated serum, 5(11), e008846.
3. Hooper, L., Bunn, D. K., Downing, A., Jimoh, F. O., Groves, J., Free, C., Cowap, V., Potter, J. F., Hunter, P. R., & Shepstone, L. (2015). Which frail older people are dehydrated?…1(2), 47–51.