Symptoms of Dehydration in Elderly People | Dangers of Dehydration & How it May Be Nursing Home Neglect

Dehydration in seniors is a common and dangerous problem. It’s estimated that 40% of older adults are chronically under-hydrated which increases the risk of falls, UTIs, and more severe consequences like organ damage. Seniors in nursing homes are at an even higher risk of moderate to severe dehydration.

Family members should be aware of the symptoms of dehydration in elderly adults, especially if a loved one is in a long-term care facility. Because dehydration can be prevented or treated before it worsens, signs of dehydration in elderly residents can be a warning of neglect.

Symptoms of Dehydration in Elderly People

The symptoms of dehydration in seniors can be difficult to recognize, especially in early stages. Dehydration in elderly people may cause:

• Dry mouth
• Sunken eyes
• Decreased urination
• Dark urine
• Fatigue
• Lightheadedness or fainting, especially when standing
• Muscle cramps
• Headache
• Nausea
• Skin that is loose or does not return to its normal position after it is pinched
• Constipation

Mild and reversible dehydration can quickly advance to severe dehydration in older people. Symptoms of severe dehydration in elderly people may include:

• Confusion or disorientation
• Fainting
• Rapid heart rate
• Low blood pressure
• Difficulty walking or moving
• Vomiting or diarrhea lasting over 24 hours

Does dehydration cause confusion?

The brain is especially susceptible to the effects of dehydration and confusion is one of the most common symptoms in older adults. It may be mistaken for the effects of dementia, even in seniors who do not have cognitive impairment.

Dangers of Dehydration in the Elderly

How dangerous is dehydration in the elderly? It can lead to falls, health complications, organ damage, and even coma or death if it is not treated quickly.
Side effects of dehydration in the elderly may include UTIs and kidney stones as well as an increased risk of falls due to lightheadedness, dizziness, low blood pressure, and confusion.

The most serious dangers of dehydration in elderly people can include:

• Falls
• Kidney and urinary issues such as kidney stones and urinary tract infections (UTIs)
• Increased risk of infections like pneumonia, respiratory illness, and UTI when exposed to viruses and bacteria
• Organ damage, particularly to the kidneys, liver, and brain
• Hypovolemic shock, a life-threatening complication of dehydration that causes low oxygen and blood pressure due to a low volume of blood
• Seizures caused by imbalanced electrolytes
• Coma
• Death

Recovery from Dehydration in Elderly People

Dehydration in the elderly can be difficult to reverse as it advances. Treatment for dehydration in elderly people can require only water or electrolyte drinks while it is very mild. Just remember that electrolyte drinks for elderly people should have no sugar, hydrogenated oils, or high-fructose corn syrup.

If dehydration is moderate, it may require medical attention such as IV fluids or subcutaneous infusions. Severe dehydration in seniors is a medical emergency that usually requires hospitalization and interventions like short-term dialysis.

The average hospital stay for dehydration for adults is 4-5 days, but seniors with severe dehydration and complications may be hospitalized for even longer. Many older adults require almost a week in the hospital to stabilize their hydration and improve kidney function enough for release. They may also require short-term dialysis for several weeks afterward.

An older study in 1999 found an average hospital stay of 4.6 days for dehydration in seniors with an average age of 80.4 years and a total cost of $7,440.

A 2015 study examined how common dehydration is in older adults admitted to the hospital and the outcome. It found 37% of seniors admitted to the hospital were dehydrated, and 62% were still dehydrated after 48 hours in the hospital. Of the 7% of seniors in the study who died in the hospital, 79% were dehydrated when they were admitted.

Severe dehydration in the elderly can be fatal on its own and complicate other medical conditions. One study found a dehydration fatality rate in the elderly as high as 50%.

Causes of Dehydration in Elderly Adults

Anyone can develop dehydration, but it’s most common in very young children and older people. There are many factors that increase the risk of developing moderate to severe dehydration in seniors.

Why are older adults prone to dehydration? Risk factors for dehydration in elderly people include:

• Reduced body fluid. The amount of bodily fluid reduces with age as the amount of body fat increases. With reduced water in the body, older adults become dehydrated more easily.
• Reduced kidney function. Kidney function decreases with age. This results in more water lost through urination.
• Side effects of medications. Older adults often take medications to manage chronic health conditions that may cause dehydration as a side effect. Seniors taking diuretics must increase fluid intake.
• Chronic illnesses or health conditions. This can include dysphagia or incontinence. Even the fear of incontinence can prevent older adults from drinking enough fluids.
• Acute illnesses. Diarrhea is frequently a trigger for severe dehydration in older people.
• Inability to recognize thirst. As we get older, the body’s ability to signal when it does not have enough fluids gets weaker. Older adults may not feel thirsty and realize when they need fluids. A study found seniors underestimate their thirst because the body cannot communicate effectively with the brain as we age and loses the sensation of thirst. This study identified a brain malfunction in older adults in which the mid cingu-late cortex is turned off sooner by drinking lower volumes of fluids.
• Dementia. People with dementia may not recognize they are thirsty, forget to drink fluids, or be unable to communicate thirst.
  Functional impairment or mobility issues. This can prevent older adults from physically drinking fluids without assistance.

In a nursing home or long-term care facility, there may be additional risk factors and causes of elderly dehydration:

• Inability to speak English
• Poor attention to the resident’s preferences for beverages
• Lack of friends or family to assist at meals
• Nursing home understaffing
• Poor supervision

Preventing Dehydration in Elderly People

Dehydration can come quickly, especially in seniors. Because mild to moderate dehydration can still be reversed without hospitalization, severe dehydration in elderly patients is almost always preventable.

There are many ways caregivers and nursing home staff can ensure older adults receive adequate hydration:

• Offering residents the beverages they prefer frequently
• Providing foods with a high water content including celery, cucumber, watermelon, and low sodium soups and broths
• Ensuring adequate staffing to supervise residents and assist with drinking in the proper position
• Screening residents for dysphagia
• Ensuring pain is managed properly
• Treating underlying conditions that contribute to dehydration such as incontinence
• Recognizing signs of dehydration in older adults so it can be treated while it is still mild
• Identifying and addressing incontinence fears
• Monitoring urine output

How Much Water Should Seniors Drink?

It’s a myth that people should drink 8 glasses of water per day. According to the National Council on Aging, optimal water intake depends on age, body weight, climate, activity, diet, medications, and more. There is no one-size-fits-all rule, and that is why you should not rely on using a water intake chart by age.
Here is what you should keep in mind to ensure adequate hydration for elderly loved ones.

• A good rule of thumb is drinking one-third of your body weight in ounces of fluid every day. A senior who weighs 150 pounds should aim for 50 fluid ounces a day. This can be increased if needed due to diuretics and other medications.
• The average person gets about 20% of their fluid intake through food alone. This share may be increased for older adults who do not feel thirsty or have trouble drinking fluids. Focus on high water content food and offer it frequently throughout the day.
• Daily fluid intake does not need to come from plain water. Coffee can count toward a senior’s fluid intake as it is a myth that coffee is dehydrating. If a loved one doesn’t want regular water, try adding lemon juice, cucumber, or juice diluted 50% with water.
• Hydration drops for elderly people with dementia may be a good solution. Options like Jelly Drops are like a treat or candy but contain 95% water with electrolytes and no sugar.

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Nursing Home Dehydration – A Common Issue that May Indicate Neglect

Dehydration in the elderly is already a common problem, but nursing home residents are at an even higher risk. Seniors living in nursing homes may not be able to drink enough fluid on their own, especially if they require assistance with daily activities, and they are more likely to suffer from multiple chronic health conditions that increase the risk of dehydration.

A 2014 study involving UK patients admitted to hospitals found that nursing home residents were more likely to be admitted to the hospital for dehydration than older adults living in the community.

An older study in 1999 was conducted to specifically investigate factors contributing to elderly dehydration in nursing homes. This study found a lack of professional supervision and inadequate staffing were major factors.

Nursing homes have an obligation to provide proper medical care and supervision to residents. This includes recognizing risk factors for dehydration, providing enough supervision and support, and promptly treating dehydration in seniors in their care.

Contact a California Nursing Home Neglect Attorney

No one should experience serious dehydration while living in a nursing home. If your loved one has suffered severe dehydration and you suspect neglect, an experienced nursing home neglect attorney in California can help.

Based in San Diego, Berman & Riedel, LLP specializes in nursing home abuse and neglect and handles cases throughout California. Our case results speak for themselves. Contact Berman & Riedel, LLP today for a free consultation with a California nursing home neglect lawyer to discuss your case.