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Dehydration risk and increase with age: Part 1 of 2

Dr. Mackarey's Health & Exercise ForumDEHYDRATION …increased risk associated with age! Part 1 of 1

Summer heat and humidity are here and the risk of heat related illnesses are particularly high for those over 65, especially dehydration. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year round. Furthermore, age related changes in 50-60 year olds can also make one vulnerable to dehydration if they are active and exercise in the heat. Recently, a local medical professional and good friend of mine was hospitalized for several days due to dehydration and associated illness. He is an active, fit, healthy 59 year old who continued his daily running for exercise during the July heat wave.

It is often forgotten that, next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.

In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.

Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.

Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. The elderly often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly persons may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.

Elders may suffer headaches, fainting, disorientation, nausea, a seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.

Those who care for the elderly whether at home or in a health care facility need to be alert to the following symptoms:

  • CHANGE IN MENTAL STATUS (CONFUSION)
  • WARM,MOIST SKIN WITH POOR SKIN ELASTICITY: gently pull the skin on the forehead and over the breastbone by pinching and releasing a skin fold; if the skin remains elevated for 3 seconds or more, dehydration is suspected
  • DRY, STICKY MOUTH WITH CRACKED LIPS AND DRY FURROWED TONGUE
  • DRYNESS IN NOSE
  • DECREASED BLOOD PRESSURE
  • INCREASED HEART RATE (RACING HEART; HEART BEATING TOO QUICKLY)
  • CONSTIPATION
  • CONCENTRATED URINE WITH SCANTY OUTPUT: as the urine becomes more concentrated and dark, it irritates the bladder and may increase the urge to void resulting in frequent, small voiding (urine output)
  • WEIGHT LOSS
  • SUNKEN, TEARLESS EYES
  • FAINTING WHEN STANDING UP (FEELING LIGHT-HEADED AND DIZZY WHEN STANDING AFTER SITTING OR LYING DOWN)

Plain old tap water is a good way to replenish fluid loss. Some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed form the stomach. Consuming alcoholic and caffeinated beverages actually has an opposite, diuretic effect!

Visit your doctor regularly and listen to your body.

Keep moving, eat healthy foods, exercise regularly, and live long and well!

Contibutor: Janet M. Caputo, DPT, OCS

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” Next week: Part 2 – Dehydration Prevention”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.