Dehydration in the Elderly

Dehydration in the Elderly

Dehydration is more common in older adults and can lead to confusion, urinary and respiratory tract infections, constipation, hospitalization, stroke, and death.

Risk Factors

■ Diminished feelings of thirst ■ Decreased total body water (TBW). In older adults, TBW represents 60% of weight; in younger adults, TBW is 70%. ■ Factors that contribute to high risk for dehydration include ■ Age >85 years ■ Nursing home resident ■ Recent weight loss >5% of body weight ■ Difficulties with feeding and eating, difficulty swallowing ■ Dementia ■ Fever ■ Multiple chronic conditions ■ Confined to bed ■ Multiple medications (four or more) ■ Limited opportunity to drink ■ Vomiting, diarrhea ■ Diuretic or laxative use ■ Self-restriction of fluids related to incontinence or increased frequency of nighttime voiding

Signs and Symptoms

■ Confusion, change in level of consciousness ■ Tachycardia, orthostatic hypotension, elevated temperature ■ Low urine output, dark yellow to brownish urine ■ Dry skin, poor skin turgor, dry mucous membranes ■ Constipation, fecal impaction ■ Dizziness ■ Infection ■ Weakness, fatigue ■ Signs of electrolyte imbalance ■ Muscle weakness, poor skin turgor over forehead or sternum (do not use hand or arm; it is unreliable) ■ Increased urine specific gravity ■ Increased hematocrit

Nursing Interventions

■ Evaluate hydration status by assessing ■ Vital signs ■ Urine specific gravity ■ BUN/creatinine/electrolytes ■ Complete blood count ■ Urine color ■ 24-hour fluid intake and urine output ■ NPO status, enteral/tube feedings ■ Usual pattern of fluid intake ■ To calculate the desired fluid intake per day ■ Start with the patient’s weight (kg) = 70 ■ Subtract 20 = 50 ■ Multiply by 15 = 750 ■ Add 1500 = 2250 ■ Multiply by 0.75 = 1688 is the fluid goal for a patient weighing 70 kg. ■ Provide 80% of desired fluid goal at meals (1350 mL for 70-kg patient). ■ Provide remaining 20% between meals (338 mL for 70-kg patient). ■ Offer a variety of fluids and have patient take sips throughout the day if he or she has trouble taking more at a time. ■ Document intake and output, difficulties drinking. ■ Assess weight daily and record. ■ Note urine specific gravity and urine color. ■ Post the volume of each container (cups, bowls, tea cup, etc.) in the patient’s room. ■ If patient requires test preparation (NPO or bowel cleansing), arrange timing so that test occurs as soon as possible. Offer fluids immediately after test is completed unless contraindicated. Consider IV hydration if NPO status is prolonged. ■ Notify physician or nurse practitioner immediately if signs or symptoms of dehydration are present. Dehydration can progress quickly and become severe, associated with a high mortality rate in elderly Pts.