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12 March 2019
As part of national Nutrition and Hydration Week, dietician Bernice Chiswell from Bedford Hospital highlights the importance of preventing dehydration in older people.
How do we know we need to drink? Because we feel thirsty. By the time we feel thirsty we are already slightly dehydrated and just 2% dehydration affects our concentration.
It’s a little known fact that as we get older our sense of thirst weakens. This is one reason why dehydration is such a problem in older people and why everyone working with the elderly or caring for an older family member needs to be aware of the signs of dehydration and know what to do to avoid it.
Our bodies are two-thirds water but we are losing this vital fluid all the time; from going to the toilet, sweating and even the act of breathing uses up more than a pint of water a day. Illnesses like diabetes and vomiting and diarrhoea can also cause dehydration, as can some medicines (diuretics) which increase the number of times you have to go to the toilet.
Symptoms of dehydration can include feeling thirsty (although not always in older people); a dry mouth, lips and eyes; feeling tired, dizzy, lightheaded or confused; passing urine fewer than four times day and having dark yellow or stronger smelling urine. It can also increase the risk of constipation, low blood pressure, gall stones and pressure sores. And many older people admitted to hospital with urinary tract infections and injuries from falls are found to be dehydrated.
A simple test to see if someone is dehydrated is to gently pinch the skin on their forearm. If it remains puckered and creased for more than a few seconds, then it is likely they are suffering from dehydration.
To combat the problem of dehydration among older people, Bedfordshire Clinical Commissioning Group runs the Drinkwell project for care home staff to ensure their residents stay hydrated and healthy. But the advice it offers is suitable for all older people, whether they are in residential care or living at home.
As a general rule, older people should aim to drink at least six to eight drinks a day (about 1.6 litres). Drinks can include water, fruit juice or cups of tea and coffee – it all counts. However, those who enjoy a pint of beer or glass of wine shouldn’t start overindulging on their favourite tipple as drinking alcohol will cause dehydration, not prevent it, and increase the risk of falls.
A number of obstacles have been identified as to why older people don’t drink enough, but the Drinkwell project offers solutions to help overcome them.
If someone in your care is reluctant to drink because they fear it will result in them having to go to the toilet more often, risking an embarrassing “accident”, then you can reassure them that this is not the case. On the contrary, a urine tract infection and resulting incontinence is more likely to be due to dehydration than from drinking more.
Another concern is that drinking more will result in frequent visits to the bathroom during the night. But by drinking more during the morning and easing off on fluid intake in the evening can reduce the number of nocturnal toilet trips.
Getting older people to take a drink with every meal and when they have visitors can also go a long way to keeping their hydration levels up. Another top tip is to encourage them to take any medication with a full glass of water. Not only will this improve hydration, it helps antibiotics to work effectively and reduces the risk of side-effects.
Taking regular drinks is not the only way to achieve the correct daily fluid intake. Certain foods can also help hydrate the body, such as soup, ice cream, cereals with milk and milky puddings. Fruit and vegetables, which are 80-90% water, are also excellent hydrating foods and provide other health benefits too.
If someone has a poor appetite or unwanted weight loss, then nourishing drinks can be chosen to increase hydration, such as milk shakes or hot drinks made with full cream milk. And adding some extra skimmed milk powder to these further boosts protein intake.
Dehydration is a big problem among older people, but by following this simple advice it is a problem that can be avoided.
National Nutrition and Hydration week runs from 11-17 March. For more information visit: https://nutritionandhydrationweek.co.uk/