Staying Hydrated is Important

Even in Winter – Staying Hydrated is Important For the Elderly

By Beth O’Keefe MPH, BSN, RN, CCM
Care Coordinator for VNSNY CHOICE Health Plans

The human body is made up of between 60 and 80 percent water and staying hydrated is one way our bodies stay healthy and in a state of equilibrium. Most of us associate dehydration with summer heat and increased thirst, but dehydration can occur anytime – even during the depths of winter’s cold weather. The elderly are at particular risk.

Dehydration occurs when someone loses more fluids than they take in, leaving the body with an insufficient amount of fluid to replace what has been lost throughout the day.

Why are the elderly more at risk than the rest of the population? Physiologically, as we age, two things happen to us: first, a lower percentage of our body weight is water, which means that any drop in the percentage of water in the body of an elderly person causes a much greater effect that that same drop does in the body of a younger person; second, the “thirst drive,” which is what triggers people to drink fluids – thus leading us to drink, to replace fluids lost due to heat, the evaporation of sweat, physiological processes, etc. – becomes less sensitive in the elderly.

Dehydration can also arise in the elderly due to a self-imposed limitation of fluid intake on the part of many elderly people. As a consequence of attempting to minimize the frequency of having to urinate due to functional difficulties in physically getting to the toilet or a commode; as well as to minimize the frequency of possible episodes of incontinence (inability to hold their urine until they get to the toilet/commode); many elderly limit their fluid intake, which can lead them to develop dehydration.

As a Registered Nurse Care Coordinator with the VNSNY CHOICE Health Plans serving Central New York and the Hudson Valley, my colleagues and I make a point to remind the homebound and frail older individuals we serve to maintain their fluid intake by drinking plenty of water and other fluids (nonalcoholic) so they stay hydrated, especially when home heating systems are going full blast, and even if they are not thirsty.

Know the Facts:

  • Older adults have a greater risk of dehydration. It’s extremely important to monitor fluid intake to make sure the appropriate amount of fluids are being taken in. While the amount of fluid needed by individuals actually varies based on their body mass index (BMI); as a rule of thumb, a suggested intake amount is 6-8 8 ounce glasses of fluid a day (the range allowing for gross size differences between small, frail elderly people and larger more robust elderly people). Additionally, certain health conditions, medications and other factors also increase the risk of developing dehydration.
  • Common causes of dehydration are: inadequate fluid intake; overly heated environments, illness; medications – including diuretics which cause fluid loss; vomiting and diarrhea. Untreated dehydration can lead to confusion, weakness, fatigue, dizziness, falls, urinary infections, worsened respiratory status, and even death.
  • Dehydration looks different in an elderly person. The wrinkled, looser, thinner, less elastic skin of the elderly person is a normal physiological change and therefore skin turgor is not an effective way to check most elderly people for dehydration. Headaches, which are often a sign of dehydration in younger people, are not a reliable sign in the elderly.
  • If an elderly person exhibits signs which can possibly be attributed to dehydration, their doctor of health care professional should be contacted and they should be taken in for a medical evaluation as soon as possible. It is very easy to check a person for dehydration. While symptoms of dehydration can be attributable to other causes as well, dehydration IS frequently the culprit. The earlier dehydration is determined to be the issue, the sooner and more likely it is to be reversed without serious consequences. Similarly, if the cause is not dehydration – it is still more likely to be addressed successfully when it is treated expediently.

Further Thoughts Concerning Dehydration in the Elderly:

  • Maintain adequate fluid intake. Be especially aware that certain medications, such as diuretics, cause fluid loss, and make sure to maintain optimal fluid intake. A caveat here is that the treatment of certain medical conditions necessitates the limitation of fluids (renal failure), and in those situations, as always, people need to follow the instructions of their health care providers.
  • Avoid, or limit, alcoholic beverages.
  • Limit caffeine intake. Coffee and sodas tend to dehydrate the body more quickly.
  • Be aware of the effect of overly heated environments and avoid overly heated living situations. If you can’t regulate the heat in a senior’s room, apartment or home, try cracking a window for the infusion of some cooler fresh air.
  • Familiarize yourself with the signs, symptoms and causes of dehydration in the elderly. The elderly person and those involved in their lives should be educated to the consequences of dehydration and the importance of avoiding dehydration. Help them to work out difficulties in getting to the toilet/commode. Encourage them to discuss specific concerns with their health care provider, for possible referral to Physical and Occupational Therapy. Consider and support adjunct options such as a toileting schedule and the use of depends, pads or pull-ups to alleviate the fear of surprise accidents.
  • If you are an elderly person, or are involved in caring for or supporting an elderly person, and suspect dehydration, provide them with fluids and contact their health care provider.

Seeking Medical Treatment:

  • Contact the person’s health care provider to report any symptoms of dehydration; or any new, unusual or worsening signs or symptoms the person exhibits or complains of.
  • 911 should be called and emergency medical assistance obtained if any of these signs occur: confusion or sudden behavior changes, fainting, weakness, lethargy, loss of consciousness, shallow rapid breathing, gray or pale skin, seizure activity, fever higher than 102 °F, diarrhea for more than two days, decreased urine production, constant vomiting or vomiting for more than a day.

To learn more about health plans that help elder New Yorkers live more comfortably, safely and independently in their own homes, visit www.VNSNYCHOICE.org or call 1-855-AT CHOICE (1-855-282-4642).