Dehydration and the Older Adult

Dehydration is a condition that results in a reduction in total body water which can be caused by insufficient fluid intake, increased fluid loss or both in older adults.

Dehydration can increase the risk of other problems including constipation, delirium, venous thromboembolism, delayed wound healing, electrolyte imbalance, and even renal failure.

As the nurse, you'll identify risk factors, recognize signs and symptoms and prevent dehydration in your older adult patient.

Risk factors for dehydration can be categorized as can drink, can't drink, won't drink and end of life can drink. Refers to individuals who don't drink enough fluids even though they have access to fluids and are physically able to drink.

This can be due to age related changes such as decreased thirst, sensation, lack of knowledge about fluid intake goals or if they require prompts to remember to drink.

For example, an individual with cognitive impairment like dementia may simply forget to drink fluids throughout the day.

Additionally, some individuals may require an increased fluid intake if they are prescribed diuretics or medications with anticholinergic effects like psychotropics.

Others experiencing an acute illness involving fever, vomiting or diarrhea will need more fluid intake to address excess fluid loss.

Next can't drink refers to individuals who are unable to drink. This can be related to factors like dysphasia or difficulty swallowing.

The need for physical aids to assist with drinking or the need for assistance from others to consume fluids. Others can become dehydrated when they're NPO meaning they are restricted from taking anything by mouth.

There are also certain comorbid conditions like heart failure which may require individuals to have a restricted fluid intake potentially leading to dehydration.

Then there's won't drink, which refers to individuals who have access to fluids and can drink. But don't, this can include individuals who avoid drinking due to fear of being incontinent or those who prefer to sip small but insufficient amounts of fluid throughout the day.

Lastly, there's end of life which includes one or more of the previously mentioned categories in a terminally ill individual.

Now, there are certain signs and symptoms of dehydration in an older adult that you should keep in mind. These include dry mucous membranes and axilla, a dry tongue with longitudinal furrows, sunken eyes, reduced passage of urine, dark yellow urine and decreased weight.

If dehydration is prolonged, your patient may report dizziness and you may note tachycardia or low BP. Also remember that checking skin turgor is not a reliable indicator of hydration due to age related loss of subcutaneous tissue.

You can also check your patient's laboratory test results to identify indicators of dehydration including serum osmolarity.

B un creatinine sodium glucose and bicarbonate. Once dehydration is identified, implement the prescribed rehydration plan for all patients include strategies to prevent dehydration in their plan of care.

Begin by helping your patient identify their daily fluid goals and encourage intake by routinely providing your patient with water and other preferred fluids.

If your patient has an acute illness, like gastroenteritis or fever, be sure they have access to rehydration solutions and encourage them to sip on it routinely to replenish fluid losses for patients with dysphasia provide appropriately modified fluids like those with putting like consistency to promote intake while preventing aspiration.

You can also modified fluid containers or offer assistance based on your patient's functional abilities as needed. For instance, your patient with weakness may benefit from using a lightweight cup.

Your patient with arthritis may find a cup with handles easier to use. And your patient with dementia may need you to assist them with eating and drinking for your patients who are NPO.

You can advocate for the shortest time required to be without oral intake. If your patient avoids drinking due to fear of incontinence, help them develop a toileting routine.

Lastly, if your patient has a caregiver at home, you can discuss your patient's daily fluid intake. Goal, emphasize the importance of fluids, instruct them to offer fluids each time they enter their loved one's room as well as during and between meals and review signs and symptoms of dehydration.

Encourage your patients and their caregivers to report to their healthcare provider right away if they notice signs or symptoms of dehydration.

All right. As a quick recap dehydration is a condition that results in a reduction in total body water, which can be caused by insufficient fluid intake, increased fluid loss or both.

As the nurse, you'll identify risk factors for dehydration, recognize signs and symptoms of dehydration and prevent dehydration in your older adult patient.