Dehydration in Seniors: A Potentially Dangerous Issue

Years ago, I participated in a webinar sponsored by the Coca Cola Company. Ron Maughan, PhD, discussed Hydration, Health and Performance. He presented some very interesting data regarding chronic dehydration (hypohydration) in the elderly and how it affects their health status*. Dr. Maughan reported chronic dehydration in the elderly may be associated with a decline in physical function and also a decline in their cognitive status. Apparently, dehydration can be due to a reduced thirst sensation which occurs as people get older. 

Some drugs that seniors routinely take may suppress their thirst. These drug classes include: SSRI’s, ACE Inhibitors and also anti-Parkinson drugs. Selective serotonin reuptake inhibitors or serotonin-specific reuptake inhibitor (SSRIs) are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. They are also typically effective and used in treating some cases of insomnia. Many seniors routinely take anti-depressants and need to be aware the possibility of  suppressed thirst.

Signs & Symptoms of Dehydration

Unfortunately, some of the signs and symptoms of dehydration can be identical to senile dementia symptoms, age dementia symptoms and Alzheimer’s symptoms. Correcting dehydration can allow the senior to return to a full and normal life. But, not correcting the dehydration may actually ensure the hospitalization of the senior.

The most common signs and symptoms of dehydration include persistent fatigue, lethargy, muscle weakness or cramps, headaches, dizziness, nausea, forgetfulness, confusion, deep rapid breathing, or an increased heart rate. Dehydration is a very serious condition, more than most people realize. Since seniors often have a reduced sense of thirst, dehydration is one of the most frequent causes of hospitalization after age 65.

Other less common signs and symptoms of dehydration can include:

• Excessive loss of fluid through vomiting, urinating, stools or sweating
• Poor intake of fluids, “can’t keep anything down”
• Sunken eyes
• Dry or sticky mucous membranes in the mouth
• Skin that lacks its normal elasticity and sags back into position slowly when pinched up into a fold
• Decreased or absent urine output
• Decreased tears

After reviewing these symptoms, if you or your family member has any of these symptoms, maybe dehydration is the cause of the confusion rather than a diagnosis of dementia or Alzheimer’s.

Dehydration Can Cause Death

According to Dr. Maughan, about 50% of elderly hospitalized with dehydration died within a year of admission. In fact, readmission rates are high due to repeated dehydration. Hospitalization of elderly with a diagnosis of dehydration is a serious and costly medical problem but is preventable.

Prevention of Dehydration in Seniors

Prevention is key to helping seniors remain healthy and also will help drive down costs. Although most people get about 20% of their fluid intake from food, most seniors get about half their fluid intake from solid foods such as fruits and vegetables because seniors have a reduced sense of thirst.  In addition to a reduced sense of thirst seniors also have a reduced appetite.  Reduced thirst and reduced appetite may also be due to their medications. Proper hydration may be a challenge but one strategy that will help keep seniors healthy, alert, active and out of the hospital.  

Institutionalized seniors may need between 1,700 milliliters or 56 ounces and 2,000 milliliters or 67 ounces of daily fluid**. The Institute of Medicine advises men to consume about 13 cups of fluids per day and women should consume about 9 cups per day.

Another way to determine hydration is the color of one’s urine. Urine color for the first void of the day is typically yellow but as the day goes on urine color should be pale (slightly yellow) to colorless. If not, more fluids need to be ingested. Here’s a Urine Color Chart that you might find useful, http://www.rte.ie/tv/useitorloseit/hydration.pdf.  

Check out Table 1. Water Content of Fruits & Vegetables.

Table 1. Water Content of Fruits & Vegetables

                     Food                                             % of Water

Apples (raw) Applesauce (canned, sweetened) Apricots (raw) Apricots (canned) Asparagus (cooked)	84% 80% 86% 78% 91%
Avocados (raw) Bananas (raw) Bell Peppers (raw) Blackberries (raw) Blueberries (raw)%	73% 74% 92% 86% 85%
Broccoli (cooked) Broccoli (flower clusters, raw) Cabbage (raw) Cantaloupe (raw) Carrots (raw)	91% 91% 92% 90% 88%
Cauliflower (raw) Cauliflower (cooked) Celery (raw) Cherries (raw) Corn (1 ear, cooked)	92% 93% 95% 81% 70%
Cucumbers (raw) Grapefruit (pink or red, raw) Grapes (raw) Honeydew Melon (raw) Kiwi fruit (raw)	96% 91% 81% 90% 83%
Lettuce (raw) Mangoes (raw) Nectarines (raw) Olives (ripe, canned) Oranges (raw)	96% 82% 86% 80% 87%
Peaches (raw) Peaches (canned) Pears (raw) Pears (canned) Plums (raw)	88% 79% 84% 80% 85%
Potato (baked) Raspberries (raw) Strawberries (raw) Tangerines (raw) Tomatoes (raw) Watermelons (raw)	75% 87% 92% 88% 94% 92%

 

*Warren et al (1994). The burden and outcomes associated with dehydration among US elderly. 1991. Am J Public Health 84, 1265 – 1269.

**Chidester JC et al (1997). Fluid Intake in the institutionalized elderly. JADA, 97, 23-28.