Hydration For Seniors

Why Do Older Adults Become Dehydrated Quickly?

There are several reasons why dehydration is more common among seniors. Let’s take a closer look at some of them.

A Decline in Total Body Fluid

As we get older, the amount of water our bodies hold begins to decrease. As an older adult, you are more responsible for replenishing your body’s water reserves much more than when you were younger. Everyone loses muscle as we age, and muscle atrophy accelerates as you approach about 70 years old.

Muscles hold the most water, and there are over 600 muscles in the human body! This makes up by far the most weight in humans, so you can see why as we lose muscle we lose water. Also, when partaking in exercise of any form, be sure to hydrate afterwards.

Lowered Thirst Response

It seems intuitive to rely on your body’s natural signals when it comes to your needs. After all, it’s what you have been doing for your whole life. Like we mentioned above, your brain does not work as efficiently as you age, so the signals it sends to let you know you’re thirsty also do not work as well. Thus, you won’t feel like you should drink water even though your body needs it. So even if you don’t feel quite so thirsty, you should have a regular hydration schedule. In other words, reach for that glass of water often!

Decreased Kidney and Brain Function

As you age, your kidneys and brain tend not to work as efficiently as they used to. Your kidneys are responsible for filtering blood and creating water which becomes urine, and your brain is responsible for sending these instructions to your kidneys. Since there is decreased function of both, you have two reasons why you lose more water. First, your brain isn’t telling your kidneys to create the right amount of urine, and then on top of that, your kidneys don’t create the usual correct amount. Unfortunately, this is just part of the aging process.

Underlying Conditions and Medications

Many older adults need to take medications for different conditions as you age. Some common conditions or symptoms that cause direct dehydration are:

• Diarrhea
• Sweating
• Overheating/heat exhaustion
• Blood Loss
• Increased Urination

Diabetes and hypertension are also common causes of dehydration. With uncontrolled diabetes or high blood sugar, your body attempts to lower the sugar in your blood, and it does this by excreting more water in the form of urine from your body. In addition, you want to make sure that you are on the right dose of diabetes medications – if you force out too much blood sugar through medications, you will also force out water/urine.

Hypertension is another common cause of excessive water secretion. This happens usually after years of uncontrolled hypertension. High blood pressure will eventually hurt kidneys (think of it as pressure from the blood that is directly hitting the kidneys, like chipping away at the blood vessels that course through the kidneys), and if your kidneys don’t work as well, they will produce too much water/urine.

In addition, there are some medications that can cause dehydration, usually through causing increased urination. The most common types of medications that can cause increased urination as a side effect are:

• Diuretics: Heart failure is the most common cause of fluid retention in the body. Your heart doesn’t pump as efficiently, and therefore blood and water get “backed up” into your body and lungs. Diuretic drugs (which many people call “water pills”) such as Lasix and Bumex essentially force you to urinate, and a side effect can be dehydration.
• Anti-hypertensives: These medications dilate your blood vessels; therefore, more blood is filtered through your kidneys causing more urine production and therefore loss of water.
• Drugs for enlarged prostate: Medications such as Finasteride help shrink the prostate. As this happens, more urine is produced, and you can become dehydrated.
• Drugs for anxiety: Medications such as Valium and Xanax work by relaxing your muscles; they also relax the muscles around your bladder, which causes you to urinate more.

Alcohol Consumption

In general, everyone should be mindful of their alcohol consumption. Alcohol interrupts the signal between the brain and kidneys that regulates urine production. Because of this, people who are drinking alcohol urinate more than they should.

Infection

Bladder infections are a common cause of excessive urination and dehydration. The excessive bacteria and inflammation –– as your body fights the infection –– cause irritation of the bladder itself. This results in bladder spasms, so you will often urinate without meaning to. Additionally, in an effort to fight the infection, your brain tells your bladder to urinate more, essentially trying to “flush out” the bacteria from your body, but this can result in urinating too much, causing dehydration.

Alzheimer’s and Dementia

While not related to the body’s ability to retain fluid, older adults who struggle with memory loss often forget to drink or struggle with the physical act of drinking. This is why, as a caregiver, it is essential to keep track of when a loved one or patient takes in fluids, how much they imbibe, and the specific types of liquids.

A chart, or another written system, can be helpful so that even on the busiest of days, a person with Alzheimer’s or dementia does not begin to suffer from dehydration. The consequences of dehydration for an older adult are much harder to remedy than in younger folk, and indeed, it is easier to simply make sure that an older person’s fluid intake is appropriate, healthy, and nurturing.

Mobility and Incontinence

While an older person may still have good thirst recognition, it is unfortunate that mobility and dissatisfaction with bladder functionality will often prevent an older adult from seeking out water and fluids. Sometimes, this may even cause them to avoid drinking fluids altogether. Trying to reach for a drink or the thought of dealing with having to get up and go to the bathroom repeatedly, especially if you have chronic pain or arthritis, can make drinking seem like more of an inconvenience than a necessity.

The fact is that less fluid intake worsens incontinence. Explaining this may be a long conversation with your loved one, but as far as mobility is concerned, a caregiver, or older person themself, should keep healthy hydrating foods easily accessible.

Signs of Dehydration in the Elderly

According to the Mayo Clinic, these are the most common signs to look out for in an older adult who may be dehydrated:

• Dry Mouth
• Fatigue
• Dizziness
• Muscle Cramps
• Confusion
• Dark Colored Urine
• Extreme Thirst
• Less Frequent Urination
• Constipation (water is required for proper colon function and gut motility)

If these sound like common occurrences for either you or a loved one, you might want to look into increasing your water intake, but check with your doctor first, as drinking too much water can also be a problem (though unlikely). One of the most significant risks involved in dehydration among older adults is that many of the symptoms go unnoticed. This is either because they are hard to glean or because patients with dementia have difficulty communicating.

For this reason, I aim to emphasize the importance of responsible hydration. Keep track of your fluid intake (for yourself or a loved one), and frequently replenish, even when you sometimes don’t want to.

How To Prevent Dehydration

Now you know why, and a little bit about how an older adult is more at risk of becoming dehydrated. Here comes the important part — how do you prevent dehydration?

Depending on the leading issue causing insufficient water intake, some tools may be more helpful than others. Overall, responsible hydration is the key to keeping anyone healthy.

Keep track, and most importantly, remember the things that bring the most joy! Humans love to eat and drink. Believe it or not, fruits and vegetables contain a lot of water (and fiber!), so if you do not enjoy water itself, it is helpful to eat fruits and veggies. You can also flavor water to make it more delicious.

With that said, you should limit your caffeine intake. Caffeine can overstimulate the bladder and cause you to urinate more than you should. A few cups of coffee or tea, however, do not contain enough caffeine to cause this. Other drinks that should be avoided are very sugary drinks such as soda. They contain an excessive amount of sugar, and your body often tries to get rid of this sugar by having you urinate.

Also, make sure to stay in a cool environment. Too much heat or sun can cause excessive sweating and dehydration. Make sure you take water with you if you are going to be outside in the sun.

Hydration doesn’t have to come exclusively from water. Naturally, you still want to make sure that you get two or three daily glasses of actual water; however, there are some other unexpectedly wholesome sources of hydration:

• Skim milk
• Strawberries, cantaloupe, and watermelon (most fruits, in general, have super high water content)
• Popsicles
• Broths and soups
• Yogurt
• Lettuce, celery, and tomatoes (just like fruits, most veggies have remarkable water content)
• Flavor additives for water

Keeping Track of Your Hydration

Now you know why, and a little bit about how an older adult is more at risk of becoming dehydrated. Here comes the important part — how do you prevent dehydration?

Depending on the leading issue causing insufficient water intake, some tools may be more helpful than others. Overall, responsible hydration is the key to keeping anyone healthy.

Keep track, and most importantly, remember the things that bring the most joy! Humans love to eat and drink. Believe it or not, fruits and vegetables contain a lot of water (and fiber!), so if you do not enjoy water itself, it is helpful to eat fruits and veggies. You can also flavor water to make it more delicious.

With that said, you should limit your caffeine intake. Caffeine can overstimulate the bladder and cause you to urinate more than you should. A few cups of coffee or tea, however, do not contain enough caffeine to cause this. Other drinks that should be avoided are very sugary drinks such as soda. They contain an excessive amount of sugar, and your body often tries to get rid of this sugar by having you urinate.

Also, make sure to stay in a cool environment. Too much heat or sun can cause excessive sweating and dehydration. Make sure you take water with you if you are going to be outside in the sun.

Hydration doesn’t have to come exclusively from water. Naturally, you still want to make sure that you get two or three daily glasses of actual water; however, there are some other unexpectedly wholesome sources of hydration:
seven cups of water per day.

Here’s an example of a daily hydration schedule:

• One glass of water when you wake up.
• Some kind of fluid with breakfast (orange juice or a nice cup of tea)
• A drink or water-rich food between breakfast and lunch.
• A drink with lunch.
• A drink or hydrating snack in the afternoon— afternoon tea, anyone?
• A drink with dinner
• A full glass of water before bed (doesn’t need to be at the bedside table if night urination interrupts your sleep)

If you’ve been counting, we’re at roughly seven glasses. Here’s where the schedule comes in. You can make a chart and record precisely what you are having and how you feel at the end of each day. You can do something as simple as put tally marks on a whiteboard for every liquid you have.

If all of this sounds confusing to you, there is one easy way to keep track of your water: see how your urine looks! A very light yellow is a good sign that you are well-hydrated. Urine that is very clear is a sign of too much water, and dark yellow or brown means you should be drinking more water.

The fact is that it’s not an exact science. The point of keeping track of your hydration isn’t to force yourself to drink a rigid eight glasses of water a day; instead, it’s to make sure that you’re getting enough. It’s a ballpark estimate. It’s about being self-conscious, health-conscious, and self-caring.

Hydration Advice for Caregivers

Prompt Them To Drink

Keep a schedule of your loved one’s fluid intake, and do not be afraid to prompt them when the time comes. Chances are, depending on their condition, they may not alert you when they are thirsty, even if you’re right there. It is also a good idea for you to examine the patient’s urine for color and signs of infection such as blood, pus, or cloudiness in the urine.

Color and Flavor

Older persons without natural thirst recognition, especially those who have dementia or Alzheimer’s, are more attracted to bright, colorful, flavorful things. Offer things that are fun and tasty. Would you want to drink water if someone was forcing you to? You’re not even thirsty, and on top of that, it’s difficult to swallow? Probably not. You can also refer to the list of hydrating foods and help them find a favorite, hydrating snack.

Keep Fluids Accessible

An older person with mobility issues may find it a hassle to reach fluids, even when they are very thirsty. Keep a glass or a bottle of something they enjoy next to their favorite chair, within arms reach, or at the very least make cups or glassware an easy grab if they are capable of and interested in fetching their liquids from the fridge. (Note: it is much safer for those with limited mobility to use plastic instead of glass which may shatter and cause injury.)

Keep Track

If an older adult isn’t capable of (or too interested in) keeping track of their hydration, it’s in your hands. The same simple methods can be applied for keeping track of your intake. Tally marks and elaborate charts are helpful.

In Closing

Our bodies are made mostly of water, but that doesn’t mean we have an endless supply. Like a sponge, we dry out if the water doesn’t come from somewhere else. Our bodies, like oil to a machine, function correctly when water maintains them: every single thing in our body works better when hydrated, from moving to digestion, to thinking and speaking properly. As an older adult, don’t risk neglecting maintenance on yourself or your loved one. Staying hydrated can taste good, and, most importantly, it makes you feel your best every day.