JNHA - The Journal of Nutrition, Health and Aging

, Volume 13, Issue 2, pp 150–157

Preventing and treating dehydration in the elderly during periods of illness and warm weather

  • J. M. G. A. Schols
  • C. P. G. M. De Groot
  • T. J. M. Van Der Cammen
  • M. G. M. Olde Rikkert
Preventing and Treating Dehydration

Abstract

Objective

Translate the available knowledge on ageing and dehydration into main messages for clinical practice.

Main points

Older people are more susceptible to dehydration than younger people. This is partly due to lack of thirst sensation and changes in the water and sodium balance that naturally occur as people age. It is also, to some degree, attributable to the fact that elderly people, both those living at home and those living in institutions, often have various impairments, disabilities and/or handicaps (comorbidity). They also tend to use numerous drugs and medication for these illnesses (polypharmacy). Multimorbidity and polypharmacy often overstress the normal age-related physiological changes in the water and sodium balance and therefore increase elderly people’s risk of dehydration,especially during intercurrent infections or warm weather. Elderly people, whether they are living on their own or in an institution, and especially elderly people that can no longer take care of themselves because of cognitive, sensory, motor and/or ADL impairments, need extra help to stay hydrated. The most important strategy is simply a matter of ensuring that elderly people consume a sufficient amount of fluids (at least 1.7 liters every 24 hours). Additional strategies include making healthy drinks and water easily available and accessible at all times and reminding and encouraging the elderly to consume these fluids. Elderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day. When the recommended fluid intake cannot, for whatever reason, be realized, fluids can be administered via catheter or by hypodermoclysis. In more specific and severe cases, fluids can be administered intravenously.

Conclusion

The prevention, signaling and treatment of dehydration in the elderly is an important multidisciplinary endeavor. Formal and informal care providers need to continuously be aware of the risk factors and signs of dehydration in the elderly, especially during periods of very warm weather and when older people are ill. Standard professional care for high risk patients is imperative.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ferry M. Strategies for ensuring good hydration in the elderly. Nutr Rev 2005;63(6):S22–S29.PubMedCrossRefGoogle Scholar
  2. 2.
    Wilson MG. Dehydration. In: Pathy MSJ, Sinclair AJ, Morley JE eds.. Principles and Practice of Geriatric Medicine 4th ed. England: John Wiley & Sons Ltd,; 2006:321–328.Google Scholar
  3. 3.
    Gaspar PM. Water intake of nursing home residents. J. Gerontol Nurs 1999;25(4):23–29.PubMedGoogle Scholar
  4. 4.
    Faes MC, Spigt MG, Olde Rikkert MGM. Dehydration in geriatrics. In press, Geriatrics and Aging, 2007.Google Scholar
  5. 5.
    Lavizzo-Mourey R, Johnson J, Stolley P. Risk factors for dehydration among elderly nursing home residents. J Am Geriatr Soc 1988;36:213–218.PubMedGoogle Scholar
  6. 6.
    Molaschi M, Ponzetto M, Massaia M et al. Hypernatremic dehydration in the elderly on admission to hospital. J Nutr Health Aging 1997;1(3):156–160.PubMedGoogle Scholar
  7. 7.
    Schoeller DA. Changes in total body water with age. Am J Clin Nutr 1989;50:1176–1181.PubMedGoogle Scholar
  8. 8.
    Ayus JC, Arieff Al. Abnormalities of water metabolism in the elderly. Semin Nephrol 1996;16:277–288.PubMedGoogle Scholar
  9. 9.
    Phillips PA, Rolls BJ, Ledingham JGG, Forsling ML, Morton JJ, Crowe MJ, Wollner L. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med 1984;311(12): 753–759.PubMedGoogle Scholar
  10. 10.
    Ritz P. Investigators of the Source Study and of the Human Nutrition Research Centre-Auvergne. Chronic cellular dehydration and the aged patient. J Gerontol A Biol Sci Med Sci 2001;56:M349–M352.PubMedGoogle Scholar
  11. 11.
    Wilson MM. Morley JE. Impaired cognitive function and mental performance in mild dehydration. Eur J Clin Nutr 2003;57:S24–S29.PubMedCrossRefGoogle Scholar
  12. 12.
    Embon OM, Rose GA. Rosenbaum T. Chronic dehydration stone disease. Br J Urol 1990;66:357–362.PubMedCrossRefGoogle Scholar
  13. 13.
    Wrenn K. Fecal impaction. N Engl J Med 1989;321:658–662.PubMedGoogle Scholar
  14. 14.
    Gershan JA, Freeman CM, Ross MC et al. Fluid volume deficit; validating the indicators. Heart Lung 1990;19:152–156.PubMedGoogle Scholar
  15. 15.
    Weinberg AD, Minaker KL. Dehydration: evaluation and management in older adults. JAMA 1995;274:1552–1556.PubMedCrossRefGoogle Scholar
  16. 16.
    Olde Rikkert MGM, van’t Hof MA, Baadenhuysen H, Hoefnagels WHL. Individuality and responsiveness of biochemical indices of dehydration in hospitalized elderly patients. Age Ageing 1998;27:311–319.CrossRefGoogle Scholar
  17. 17.
    Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc 1985;33:278–285.PubMedGoogle Scholar
  18. 18.
    Bastiaanssen WCM, Kroot LAJ. How much fluid do healthy old people use? Hoeveel vocht gebruiken gezonde oude mensen? Tijdschr Gerontol Geriatr 1994;25:197–2004.Google Scholar
  19. 19.
    Ribbe MW, Ljunggren G, Steel K, Topinková E, Hawes C, Ikegami N, Henrard JC, Jónnson PV. Nursing homes in 10 nations: a comparison between countries and settings. Age Ageing. 1997;26Suppl 2:3–12.PubMedGoogle Scholar
  20. 20.
    Schols JM, Crebolder HF, van Weel C. Nursing home and nursing home physician: the Dutch experience. J Am Med Dir Assoc. 2004;5(3):207–212.PubMedCrossRefGoogle Scholar
  21. 21.
    Chidester JC, Spangler AA. Fluid intake in the institutionalized elderly. J Am Diet Assoc 1997;97:23–28.PubMedCrossRefGoogle Scholar
  22. 22.
    Frisoli A, Paula AP de, Feldman D et al. Subcutaneous hydration by hypodermoclysis. A practical and low cost treatment for elderly patients. Drugs Aging 2000;16:313–319.CrossRefGoogle Scholar
  23. 23.
    Sasson M, Shvartzman P. Hypodermoclysis: an alternative infusion technique. Am Fam Physician 2001;64:1575–1578.PubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2009

Authors and Affiliations

  • J. M. G. A. Schols
    • 1
  • C. P. G. M. De Groot
    • 2
  • T. J. M. Van Der Cammen
    • 3
  • M. G. M. Olde Rikkert
    • 4
  1. 1.Nursing Home Medicine, Department of General Practice, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
  2. 2.Department of Human NutritionWageningen UniversityWageningenthe Netherlands
  3. 3.Section of Geriatric Medicine, Department of Internal MedicineErasmus University Medical CenterRotterdamthe Netherlands
  4. 4.Dept of Geriatric MedicineRadboud University Medical CentreNijmegenthe Netherlands

Personalised recommendations