Dehydration and the Elderly - Activity Planning During a Heat Wave by M. Celeste Chase, AC-BC, ACC, CDP

Dehydration and the Elderly A widespread blanket of increasing rising temperatures is expanding across much of the country. . . . And of course, hot weather always increases the risk of dehydration. Older aging populations are vulnerable to climate change-related health impacts for a number of reasons. The body’s normal aging process causes the body’s systems mechanisms, that are meant to protect us from dehydration, to work less efficiently as we age. The elderly population does not have the same internal thirst signals with age progression and consequently do not take action to reach the necessary liquid consumption. Experts generally recommend that older adults consume at least 57.5 fluid ounces or 7.1 cups within a 24 hour period. (https://link.springer.com/article/10.1007/s12603-009-0023-z) NOTE:  Elderly people should not be encouraged to consume large amounts of fluids at once but rather small amounts throughout the day. Factors that put older adults at risk for dehydration include (includes but not limited to): Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids. Memory problems, which can cause older adults to forget to drink often, or forget to ask others for something to drink - even mild dehydration, can cause noticeable worsening in confusion or thinking skills. Mobility problems associated with aging, such as muscle and bone loss, which can make it harder for older adults to get something to drink. Older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure. Dehydration can also be brought on by an acute illness. Older adults are also more likely to have a chronic health condition, such as diabetes, that requires medications for treatment. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated. Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure. Additionally, chronic mild dehydration may further exacerbate constipation problems. Physical signs of dehydration may include: high heart rate (usually over 100 beats per minute) low systolic blood pressure dry mouth and/or dry skin in the armpit less frequent urination dark-colored urine delirium (new or worse-than-usual confusion) sunken eyes Caffeine and Dehydration Coffee or Tea please!  We all know only too well how important it is for our seniors to enjoy a nice cup of coffee or tea while gathering in morning socials to shake off those morning cob webs and get ready for the day’s events.  Is there any other way to start the day? Technically caffeine is considered a weak diuretic. By definition, a diuretic is a product that increases the body’s production of urine. Hence water, or any drink consumed in large volumes, is a diuretic. It should be noted that urinating more does not inevitably lead to dehydration (excessive loss of body water). http://theconversation.com/health-check-does-caffeine-cause-dehydration-73965 Current studies suggest that caffeinated coffee or tea is not proven to be particularly dehydrating in people who drink them regularly. Caffeine, however, may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine for our senior population. Feel free to offer decaffeinated drinks but if an older person particularly loves his/her morning cup of (caffeinated) coffee, there is no reason why they cannot partake unless it is physician ordered to avoid such liquids. Help Them Stay Hydrated Here are some reasonable approaches to help your seniors remain hydrated during current rising temperatures: Identify continence issues that may make the older person reluctant to drink. Consider a toileting schedule, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties. Offer fluids in small amounts throughout the day; consider doing so on a schedule. Ensuring the appeal of the beverages you offer – they will drink more if they enjoy it. Determine if your senior prefers drinking through a straw. Enlist interdisciplinary staff in your efforts. Track in a journal how much the person is drinking; be sure to note when you try something new to improve fluid intake. Offer more fluids when the senior is ill (seek nursing oversight). Reducing Swallowing Problems By Making Liquids Thicker While you focus on actions to prevent dehydration issues be mindful of anyone with a swallowing disorder, often experienced in the elderly.  Normal aging causes reduced muscle tone in the pharynx and esophagus and other changes that affect swallowing. Thickened drinks are normal drinks that have a thickener added to make them thicker. They are often recommended for people who can no longer swallow normal fluids safely, because normal drinks go into their lungs, causing coughing, choking or more serious risks such as chest infections and aspiration pneumonia (seek nursing oversight). More Ways to Keep Seniors Cool in Hot Weather Offer a cooling snack like popsicles (use cupcake liner to catch drips). Place a cool washcloth on the back of the neck and a pan of cool water close by to periodically re-cool the towel. Meals should be cold like chicken or pasta salad instead of heavy hot dishes like pot roast. Encourage clothing that is lightweight and in light colored cotton so it’s easy to adjust to the temperature throughout the day by removing layers of clothing. https://dailycaring.com/10-tips-to-keep-seniors-cool-in-hot-weather/ Calendar Programs Older people can have a tough time dealing with heat and humidity. The temperature inside or outside does not have to reach 100°F (38°C) to put them at risk for a heat-related illness. Be mindful of the temperatures when planning programs. Restrict your events to locations that offer cool environments. For outings; seek senior-friendly places that offer air conditioning (Restaurants, Shopping Mall or Stores, Public Library, Art Museums, Movie Theaters). Senior exercise programs may need to shortened in duration and restricted to easy and simple range of motion programs to prevent over- exhaustion. Don’t forget the hydrating liquids!   Stay Cool!       Have a topic request or question for Celeste? 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