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’re 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 dysphagia, 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 fluids 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 axillae; a dry tongue with longitudinal furrows; sunken eyes; reduced passage of urine; dark yellow urine; and decreased weight.