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Senior Citizen Health & Medicine
 Senior Citizens Most Likely to Suffer from
Dehydration
Latest in series "A New Look at the Old" highlights
risks for seniors
June 27, 2006 – The latest article in the series "A
New Look at the Old," features studies on the serious problems that can
develop for senior citizens that become dehydrated, including higher
risk of coronary heart disease. Age-related changes make older adults
more vulnerable to shifts in water balance that can result in
over-hydration or, more frequently, dehydration.
Author Janet Mentes, PhD, APRN, BC, found in a
study of long-term care residents that 31 percent were dehydrated.
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She also reports in her article, "Oral Hydration in
Older Adults," on another study that found 48 percent of older adults
admitted to the hospital from Emergency Departments had laboratory
values indicative of dehydration.
She writes that "greater awareness is needed in
preventing, recognizing and treating dehydration."
With sufficient fluid consumption older people tend
to have fewer falls, less constipation and laxative use, improved
rehabilitation in orthopedic patients and a reduction in bladder cancer
(among men).
Drinking five or more 8-oz. glasses of water a day
is also associated with lower rates of fatal coronary heart disease in
middle-age and older adults, reports Mentes.
She warns that the body's thirst response becomes
blunted with age. As a consequence, many of older patients may be
dehydrated – a condition that leads to severe consequences if not
identified and treated.
Dehydration in the elderly is not just caused by
inadequate fluid intake. Other causes include diarrhea, excessive
sweating, blood loss, fluid accumulation and fever. Illnesses that
entail excessive urination, such as diabetes and hypercalcemia, may also
put people at risk for dehydration.
With aging, it becomes more difficult for the body
to maintain fluid balance. There are several reasons, says Mentes.
The thirst response, which is the body’s primary
mechanism of signaling the need for fluid, becomes blunted with age.
This was apparent in a 2002 trial that compared men 51 to 60 years of
age with those 20 to 28 years of age. During a strenuous 10-day
hill-walking excursion, the older men had less thirst and became
progressively dehydrated; younger participants had no dehydration.
An earlier study found that in older men, the serum
markers of dehydration (serum osmolality and sodium level) took longer
to return to normal after an episode of dehydration than they did in
younger men.
Total body fluid
From puberty to 39 years of age, total body fluid
is about 60% of body weight in men and 52% in women; after age 60, total
body fluid decreases to about 52% of body weight in men and 46% in
women. Women have a higher percentage of body fat and less muscle mass
than men do and therefore less total body fluid.
In addition, muscle mass is lost with age,
increasing the proportion of fat cells, which contain less water than
muscle cells do, resulting in a decrease in intracellular fluid volume.
Decline in kidney function
Creatinine clearance, an indicator of the kidney’s
efficiency in filtering toxins from the blood, can decline with age. In
one study, researchers found that in “normal” patients, the “mean
decrease in (creatinine clearance) was 0.75 mL/min/year” after age 40.
“Normal” patients were those who didn’t have renal
or urinary tract disease or use diuretics or anti-hypertensives.
(However, the authors also noted that “one-third of all subjects
followed had no absolute decrease in renal function.”) This decline in
function means that the kidneys are less able to concentrate urine, so
water is lost that in a younger person wouldn’t be.
This newest article in the American Journal of
Nursing New Look at the Old series provides current research about the
hydration status of older adults across care settings and in the
community, as well as a range of tools to improve your assessment
skills, including a "Dehydration Risk Appraisal Checklist."
This study and all in the series are presented free
online by the American Journal of Nursing and most are accompanied by
videos.
Editor's Notes:
This and previous articles in the "New Look at
the Old" print series can be accessed free of charge. Links to videos
based on articles in the print series can also be found at:
www.NursingCenter.com/AJNolderadults. Reprints of previous articles
are available at no cost.
This project is funded in part by Atlantic
Philanthropies. The venture is a collaborative effort between The
American Journal of Nursing, The Gerontological Society of America, and
Trinity Healthforce Learning.
Janet Mentes is an assistant professor at the
University of California–Los Angeles School of Nursing. Contact author:
jmentes@sonnet.ucla.edu. This article is 12th in a series that’s
supported in part by a grant from the Atlantic Philanthropies to the
Gerontological Society of America. Nancy A. Stotts, EdD, RN, FAAN (nancy.stotts@nursing.ucsf.edu),
a John A. Hartford scholar, and Carole E. Deitrich, MS, GNP, RN (carole.deitrich@nursing.ucsf.edu),
are the series editors. The author of this article has no significant
ties, financial or otherwise, to any company that might have an interest
in the publication of this educational activity.
Follow this link to access this article:
www.NursingCenter.com/AJNolderadults
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