More Caregiving Summer Tips

Summer is officially here! Because dehydration can have such serious consequences in our older clients, you, as a caregiver, need to make prevention of dehydration a priority. Use the following information to assess your clients for dehydration for problems and intervene appropriately.

Why is dehydration threatening to the elderly?

Changes related to the aging process make an elderly adult especially prone to dehydration. She has about 10% less body fluid than a younger adult, so she has less fluid reserve to start with.

Because her sense of taste diminishes with age, food may become unappetizing. Consequently, she may eat less and use more salt, raising her body's need for water. At the same time, however, her thirst response can diminish, so she may not recognize the need to drink more.

For these reasons, an elderly adult may become severely dehydrated very quickly, before she feels thirsty or anyone notices symptoms.

Very often, the signs of dehydration are mild and vague. They are more or less similar to dementia and Alzheimer's symptoms. Confusion and disorientation, which aren't normal at any age, may have been your first clues.

Signs and symptoms of dehydration in the elderly include:

  •  Irritability
  • Confusion (Dehydration in the elderly can often be misdiagnosed, as symptoms can mimic those of dementia. Confusion and disorientation, which aren’t normal at any age, may be the first clues. And it’s a common problem — one of the 10 most frequent admitting diagnoses for Medicare hospitalization. Certain common medications like diuretics or laxatives can make dehydration worse.)
  •  Disorientation
  • Low urine output (may be concentrated)
  • Constipation
  • Dizziness
  •  Hypotension (low blood pressure and/or dizziness when getting up from bed or a chair),
  • Skin breakdown.
  • Weight loss
  • Dry and poor elasticity skin
  • Less urine output
  • Increased heart rate
  • Urinary Tract Infections

Dehydration in the elderly can be caused due to side effects of medications (e.g. diuretics and laxatives) and other medical problems like high blood sugar (hyperglycemia), diarrhea, vomiting, heat exhaustion (increased core body temperature) and infections.

 Many elderly deliberately reduce their fluid intake to decrease incontinence and eliminate embarrassment. Women are more likely to avoid fluids then men. Inadequate fluid intake, which often results in dehydration, makes the elderly more susceptible to urinary tract infection, pneumonia, pressure ulcers, hypotension (low blood pressure), confusion and disorientation.

Fluid replacement is the key!

This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.). Try Crystal Lite, flavored seltzer waters, water mixed with juices, etc. Spark the flavor!

If your client like the taste of water, dress it up with lemon slices, fruit juice, or any flavor your client enjoys. Be creative! Buy flavored seltzer water if they like a bubbly treat or flavor up plain seltzer with cranberry juice, peach nectar, or whatever kind of juice they like.

  • Try to reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated).  1-2 cups of a caffeinated beverage will not be enough to cause dehydration in a person. However, large amounts of caffeine could trigger the diuretic properties of the substance Beware of alcohol intake too.
  •  Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  • Eat lots of fruits and vegetables. Most have a high water content. Some fruits and vegetables which are comprised of 90% or more water are: cooked asparagus, raw bell peppers, cooked or raw broccoli, raw cabbage, cantaloupe, cooked or raw cauliflower, raw celery, raw cucumbers, grapefruit, honeydew, raw lettuce, raw strawberries, raw tomatoes, and watermelon. Adding one or two of these items to every meal provides more fluid in the diet and satisfied the daily recommended serving of fruits and vegetables, which also provides vitamins and minerals the body needs.
  • Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.

 Follow up to make sure that he or she is getting their fluids, either through meals or making sure that liquids are available during the day and perhaps by the bedside at night.

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