Identifying & Preventing Dehydration in Seniors

Dehydration can be a chronic health issue among seniors. It happens for a variety of reasons, but unless the condition has advanced to an acute state the remedies are usually simple.

Dehydration means that the body is not retaining enough fluid for optimum function. The blood vessels are the super highways of the body, delivering nutrition to cells and removing waste products. When the body becomes dehydrated the traffic gets sluggish, and these backups can cause a wide variety of problems. Left unchecked, dehydration may eventually lead to kidney failure, so it is important that care givers identify the causes, symptoms, and solutions.

Typical Causes of Dehydration

When fluid levels diminish, the body’s first defense against dehydration is to signal “thirst” to the brain. At the same time, the kidneys begin concentrating urine in order to prevent the loss of existing fluid. Unfortunately these mechanisms begin to break down as we age, and seniors become less receptive to thirst, so they are often unaware that they are lacking sufficient fluid. Typical causes of dehydration in seniors include:

  • Lack of urinary continence – may provoke reluctance to drink
  • Memory problems – forgetting to drink
  • Mobility problems – making it physically difficult to get something to drink
  • Living situation – reliance on others to provide beverages
  • Acute illness – vomiting, diarrhea, fever, infection
  • Medication – especially diuretic medications commonly used to treat high blood pressure or heart aliments

Physical Symptoms of Dehydration

If serious dehydration is suspected, it is always best to have a physician confirm the diagnosis via laboratory blood tests. However, there are a number of physical symptoms commonly associated with the condition that are readily identified:

  • Dry mouth and/or dry skin in the armpit (lack of perspiration)
  • Low systolic blood pressure
  • High heartrate (100 bpm or higher)
  • Less frequent urination and/or dark colored urine
  • Dizziness/weakness
  • New or more intense than usual confusion (delirium)

In older adults, weakness and dizziness can provoke falls, which may lead to serious injury. Seniors who already experience memory issues are prone to noticeable worsening of cognitive functions, as was the case with Stan.

Stan, 84, was living independently when his son began noticing changes in his behavior. He seemed unable to maintain conversation beyond a few sentences, and his personal grooming declined dramatically. He would complain of “not feeling right”, but when pressed for details became confused and defensive. Stan refused to seek medical attention and became reclusive. The situation came to a head when the sheriff showed up at the son’s door with Stan in tow, explaining that Stan had backed his vehicle up a curb, narrowly missing a fire hydrant, and was unable to recall his own name. Subsequent tests revealed that Stan was severely dehydrated. Even with the administration of IV fluids, it took nearly two weeks of constant attention from his family to return Stan to his rational mind.

When Stan was able to communicate, he admitted avoiding liquids because he was embarrassed about experiencing incontinence. He further confessed that due to knee problems it was painful for him to get to the kitchen, so most of the time he just ignored his thirst. For Stan, overlooking his physical needs led to a breakdown in cognitive function, which eventually led to severe dehydration.

Treatment and Prevention of Dehydration

As previously noted, if acute dehydration is suspected, it is best to allow medical professionals to intervene in order to diagnose and treat. However, for mild dehydration, the remedies are fairly straightforward. The primary resolution is to have the person ingest fluids by mouth. Plain water is fine, but a drink containing electrolytes (such as a sports drink, juice, or even bouillon) is preferred. Keep in mind that seniors will generally drink smaller portions than younger adults, so don’t expect them to down a bottle of Gatorade in one sitting. Instead, identify the senior’s preferred beverages and offer them consistently throughout the day. Experts recommend that older adults’ fluid intake be about 57 ounces during a 24-hour period. That amount is roughly equal to seven (8-ounce) servings.

Be sensitive to physical concerns that discourage fluid intake. Like Stan, many seniors have issues with incontinence but are too embarrassed to verbalize the problem. The key to overcoming this issue is to provide an undergarment or pad to absorb urine leakage, and to explain that it is a temporary solution during rehydration. Sites that specialize in senior health products, such as, offer excellent guidance and support in selecting appropriate products. Absorbent underclothes may become a permanent answer to an on-going problem, but the important point is that the senior understands that it will alleviate the embarrassment associated with incontinence.

Always offer encouragement by making it easy to ingest fluids. While decaffeinated beverages are recommended, many seniors demand their coffee or tea throughout the day, and as long as that is not the only beverage they are drinking, it is generally safe to allow. If physical problems such as tremors or weakness in the hands exist, offer a closed container with a straw rather than an open cup. Intake of watery foods is another excellent way of inducing hydration. Soups, fruits with high liquid content (melon, grapes, apples), gelatin, and popsicles are usually appealing and easy to eat. Another option is to specify that a full glass of water needs to be taken with medication. Older adults will often accept that type of instruction.

While it is not always possible to avoid dehydration in older adults, it is possible to be proactive in prevention. Offer a variety of appealing beverages and water-heavy foods, and be sensitive to physical conditions that discourage liquid intake. Remember – hydration equals happy and healthy seniors.


Lelie Kernisan, MD