Hydration and the eldelry
Why hydration matters to the elderly
Ensuring that the elderly are drinking enough fluids is vital for their overall wellbeing. Dehydration in the elderly is linked to mortality and can cause hospitalization. Dehydration is a worrying condition and studies have shown that up to 48% of older patients being admitted to hospital are dehydrated. In nursing homes, up to 31% of patients maybe dehydrated.
Dehydration usually affects those patients who are ill or who are more physically dependant on care. They may be unable to move away from the window where the light is streaming in or move out of a room where the temperature is too hot. In a study in a nursing home where staff were encouraged to provide regular drinks and reminders, the levels of overall wellbeing amongst the clients rose significantly, and there was a 50% decrease in falls. One of the main reasons that the elderly often refuse water is due to a worry about increased visits to the toilet. In the above study, toilet trips initially increased, but soon returned to normal levels.
As we age, changes occur in the body which alter the body’s ability to take on water and can often lead to dehydration.
The main causes of this are:
Thirst response in ageing adults declines, meaning thirst is not recognised
The body does not hold the same amount of water. From the age of 60, body fluid is reduced due to changes in muscle mass. On average body fluid is reduced from 60% to around 52% for men and 46% for women.
Kidney function may be impaired: In some elderly people their kidneys may be unable to concentrate their urine and lose more water than is necessary.
Medical conditions such as dementia, frailty, difficulty in swallowing may all affect a person’s ability to drink.
Ensuring that clients are properly hydrated is vital but more important is understanding the reasons why it happens and what the benefits of regular drinks are. Care givers need to be constantly aware of both the risks and signs of dehydration and have strategies in place to monitor these.
Care givers need to be aware of the clients who have
- Lost their mobility and therefore cannot get themselves a drink
- Suffer from poor sight and find it difficult to pour themselves a drink
- Have a lack of cognitive function, which gives rise for confusion
- Are taking medications such as diuretics and laxatives which lessen the urge to drink
- Have difficulty in swallowing
Care staff must ensure that they are well aware of their clients’ needs and limitations. They must also be aware of their diets and monitor the amount of food that is eaten. Water is not purely obtained by fluids alone, food contains a considerable amount. If the appetite is suppressed and dietary intakes are lessened then fluid intake will also be decreased.
Within a care or nursing home, it is the role of the care givers to offer drinks and foods to prevent dehydration which in turn leads to
- Fewer falls
- Less constipation
- Reduced bladder cancer in men
- Increased wound healing (in particular pressure sores)
Staff within the care environment needs to be adaptive and assess the client. They need to be supportive of their needs.
Opportunities to drink should be encouraged, for example when activities are on offer, drinks should automatically be made available. As it is more difficult to encourage an elderly person to drink, and because they may feel that they have drunk enough very quickly, they will not be drinking sufficient liquids. If this is the case, drinks that encourage thirst, for instance fizzy drinks or fruit juices can be offered.
Nursing staff need to make time for patients who may be positioned inappropriately, for example those who lie on their side and need moving so that a drink can be drunk and be prepared to sit with patients and offer them sips of water rather than just leaving a drink on the side.