Question
Why is dehydration a common problem with aging patients?
Answer
Dehydration is a very common diagnosis in elderly patients. There is a significant amount of water in the blood (83%) brain (74%) and bones (22%). If a person does not drink enough water, the body will find it wherever it can – from organs, joints, discs – in order to lubricate the brain. Therefore, it is imperative that we educate patients and their families on the importance of hydration. That can be very difficult because so many patients are unable to drink independently. Additionally, their aging kidneys cannot deal with the urine and the concentration. But the body needs that water to help with the elimination of body waste and medications.
Water is important for regulating body temperature and maintaining blood pressure. The room temperature of many patients often creates or contributes to dehydration. Some patients will wear multiple sweaters and be covered in several blankets in order to stay warm. Because older individuals lose that layer of fat under the skin, they have difficult regulating their body temperature and can often feel cold.
Consequences of dehydration include thick, ropey saliva which will require doing oral care before a meal. That thick ropey saliva is probably laden with bacteria and swallowing it should be avoided. Dehydration causes constipation. The patient will then need to take laxatives which draws the fluids out of their system. Dehydration creates problems with heartburn. Swallowing saliva helps to push acid back down. If the patient isn’t creating saliva then they will have a problem with acid clearance in the esophagus. That, in turn, can actually contribute to heartburn. We need to be very careful with the potential of reflux with our clients.
Patients typically avoid liquids if they are thickened, especially a pudding thick consistency. It is very difficult to stay hydrated if a patient is given thickened liquids. It is important to recognize that food provides at least 20% of our fluid intake. If we have a client that is not drinking, we need to collaborate with a dietitian to give them foods that have high water content so that they are getting some water from their food rather than just drinking all the time.
Finally, it is important to know that a person who is dehydrated will die sooner than if they are malnourished.
