Case Study

Mrs. Johnson is an 82-year-old woman living independently in her home. Her daughter visits to check on her and notices Mrs. Johnson seems more confused and lethargic than usual. Upon questioning, Mrs. Johnson reports her hands have been tingling lately. Her daughter offers her a glass of water, but Mrs. Johnson refuses the water as she “just doesn’t feel thirsty.” Her daughter also observes that Mrs. Johnson’s lips are dry and her tongue has grooves on it. Concerned, she brings her mother to the emergency department for evaluation.

Lab results show

• Elevated BUN/creatinine ratio
• Elevated serum sodium of 148 mEq/L
• Elevated serum osmolality of 310 mOsm/kg
• Elevated hematocrit of 48%

Mrs. Johnson is diagnosed with moderate dehydration and admitted for IV fluid repletion and monitoring.

Rationale for Dehydration in Older Adults

Several physiological changes and risk factors make older adults more susceptible to dehydration:

1. Decreased thirst sensation: The thirst response becomes blunted with age, leading to reduced fluid intake (Hooper et al., 2016).
2. Reduced total body water: Total body water decreases by about 10-15% between ages 20 and 80, leaving less reserve when fluid losses occur (Bak et al., 2017).
3. Declining kidney function: The aging kidney has a reduced ability to concentrate urine and conserve water (Begg, 2017).
4. Medications: Many common medications in older adults, such as diuretics and laxatives, can increase fluid losses (Volkert et al., 2019).
5. Chronic illnesses: Conditions like diabetes and heart failure can affect fluid balance (Hooper et al., 2016).

Common Signs and Symptoms

As seen in Mrs. Johnson’s case, typical signs and symptoms of dehydration in older adults include:

• Dry mouth and mucous membranes
• Decreased skin turgor
• Sunken eyes
• Orthostatic hypotension
• Tachycardia
• Decreased urine output
• Confusion or altered mental status
• Weakness and fatigue
• Tingling in hands

Preventative Treatment

To prevent dehydration in older adults like Mrs. Johnson, the following strategies are recommended:

1. Regular fluid intake: Encourage consistent fluid intake throughout the day, aiming for at least 1.5 L daily for most older adults (Volkert et al., 2019).
2. Variety of fluids: Offer a range of beverages, including water, herbal teas, low-fat milk, high water content fruits and vegetables to improve palatability and adherence (Begg, 2017).
3. Fluid-rich foods: Incorporate foods with high water content, such as fruits, vegetables, and soups, into the diet (Bak et al., 2017).
4. Environmental modifications: Ensure easy access to fluids, use visual cues, and assist those with mobility issues in obtaining drinks (Hooper et al., 2016).
5. Medication review: Regularly review medications and adjust doses or alternatives to minimize dehydration risk (Volkert et al., 2019).
6. Education: Provide education to older adults and caregivers about the importance of hydration and signs of dehydration (Begg, 2017).
7. Monitoring: Implement regular weight checks and urine color monitoring as simple tools to assess hydration status (Hooper et al., 2016).

By implementing these preventative measures, the risk of dehydration in older adults like Mrs. Johnson can be significantly reduced, promoting better health outcomes and quality of life.

References:

Bak, A., Tsiami, A., & Greene, C. (2017). Methods of Assessment of Hydration Status and their Usefulness in Detecting Dehydration in the Elderly. Current Research in Nutrition and Food Science Journal, 5(2), 43-54.

Begg, D. P. (2017). Disturbances of thirst and fluid balance associated with aging. Physiology & Behavior, 178, 28-34.

Hooper, L., Abdelhamid, A., Attreed, N. J., Campbell, W. W., Channell, A. M., Chassagne, P., … & Hunter, P. (2016). Clinical symptoms, signs and tests for identification of impending and current water‐loss dehydration in older people. Cochrane Database of Systematic Reviews, (4).

Lacey, J., Corbett, J., Forni, L., Hooper, L., Hughes, F., Minto, G., … & Whyte, G. (2019). A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Annals of Medicine, 51(3-4), 232-251.

Schols, J. M., De Groot, C. P., van der Cammen, T. J., & Olde Rikkert, M. G. (2009). Preventing and treating dehydration in the elderly during periods of illness and warm weather. The Journal of Nutrition, Health & Aging, 13(2), 150-157.

Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., … & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47.