Dehydration in older adults Flashcards
Dehydration
- A “loss or removal of fluid” from the body and occurs when fluid intake fails to fully
replace fluid losses in the body - Dehydration is one form of fluid or electrolyte imbalance
Why dehydration is hard to operationalize
• In older adults who reside in facilities: there is a “lack of universally agreed-on operationalization” and “a strong need to develop a uniform and reliable method for detecting dehydration in this population.”
- Compared to pediatrics where there are clinical guidelines to guide practice and medical care, no such operationalization exists in the frailest older adults
Risk factors of dehydration in older adults
- Gender (females)
- Cognitive impairment
- Malnutrition
- Functional: Decreased mobility, reduced swallowing
- Environmental: lack of access to clean drinking water, warm temperatures
- Medications: laxatives, diuretics, high and new fiber meds, opiods
- Pain:
- Social: lack of attention to drink preferences, inability of residents to communicate with staff, and lack of social support
- Institutional factors (untrained and unsupervised staff)
Age related:
- Kidney function – decline
- Reduced thirst response
- Reduced body water
- Fear of incontinence
- Reduced lean mass
Concerns with dehydration increasing with aging
Older adults (USA) not meeting recommendations for fluid intake from beverages and food
- 63% aged 65-74
- 73% aged 75-84
- 81% aged 85+
Water in vs water out
Water in
- Metabolism (10%)
- Foods (30%)
- Beverages (60%)
Water out
- Feces (4%)
- Sweat (8%)
- Insensible loss via skin and lungs (28%)
- Urine (60%)
Why it’s important to regulate water in/out
Causes (too much fluid out):
- Diarrhea
- Fever
- Vomiting
- Exudation (from burns or other raw areas)
- Increased sweating
- Polyuria (frequent urination)
- Bleeding
Causes (too little fluid in):
- Inadequate fluid intake
Effects:
- The resultant hypovolemia
(decrease in blood plasma volume) is accompanied by electrolyte balance disruption
Consequences:
- Medical emergency
- Hypovolemic shock
- Delirium
- Severe dehydration
- Trauma: falls, lead to fractures
- Death
Too little fluid in
Inadequate fluid intake
- Can drink
- Can’t drink
- Won’t drink
- End of life
Risk assessment: ask yourself, is my patient at risk?
Health consequences dehydration
- Heart disease
- Confusion
- Constipation
- Kidney failure
- Pressure ulcers, poor wound healing
- Suboptimal rehabilitation outcomes
- Infections
- Seizures
- Drug toxicity
- Reduced quality of life
Constipation
- A potentially very serious consequence of dehydration
- Categorized as <3 defecations per week
- Constipation impacts 50% of older adults
- In impacted, needs to be removed via enema or digital removal
Why does hydration matter?
- Fluid balance is essential to health
- OAs have a reduces water body content compared to younger adults
- 30yr (70kg) has 41L water content
- 70ye (70kg) has 35L water content
- Meaning 6L loss (15%) of water content in body
Signs and symptoms to identify dehydration
Three stand alone tests that were sensitive and specific:
- Missed some drinks between meals
- Expressed fatigue
- Blood labs showing high sodium or glucose
Traditional stand-alone tests and indicators often used to assess dehydration in older people should NOT be relied on individually :
- Fluid intake,
- Urine specific gravity
- Urine colour
- Urine volume
- Heart rate
- Dry mouth
- Feeling thirsty
What is the context? Assess the patient. Ask questions.
Severity of dehydration
- Mild dehydration: headache; fatigue; weakness; dizziness; leg cramps; lethargy – exhaustion and mood changes
- Moderate dehydration: sticky or dry mouth; decreased skin elasticity; pallor
- Severe dehydration: fever; confusion (delirium); kidney failure and UTI’s; low BP; convulsions; severe cramping
Labs and medical treatment of dehydration
• Serum sodium or glucose levels are raised when someone is dehydrated
Treatments: Fluid replacement therapy
• Drinking water is the simplest method – But water alone does not replace electrolytes
• Intravenous (IV) is the most common in medical cases or in people who cannot drink/swallow
IV fluids for dehydration
- Excessive blood loss is sometimes countered by quickly giving normal saline (isotonic, 0.9% NaCl)
- Hypotonic
- Raises blood volume while maintaining normal osmolarity • Rates or bolus will depend on the patient
Correct pH imbalances
• Acidosis treated with Ringer’s lactate
• Alkalosis treated with potassium chloride
Isotonic 5% dextrose (glucose) solutions
• Patients who cannot eat
• Has protein-sparing effect: fasting patients lose as much as 70 to 85 g of protein per day
The best defence against dehydration
PREVENTION
This can be best accomplished by identifying patients at high risk for dehydration and teaching them and their caregivers about the risk factors for dehydration
What to keep in mind during care to prevent dehydration
• Notice how much your patient is eating, drinking
• How often do they use of the washroom?
• What are the drinking habits of the patient?
What is their preference?
• Diuretic medications changed?
• Offer higher water content foods (grapes, watermelon), soups, jellos, etc first
• Have longer meals to encourage more intake
• Promote access to water
• A cup they can see; labelled cup, light weight
• Straw
Suggestions to the client to prevent dehydration
- Drink a glass of water AM
- Drink full glass with medication
- Water should be half of your fluids daily
- Watch for caffeinated drinks and alcohol
- Eat fruit and vegetables
- Drink water throughout the day
Dehydration: H2O
H = Identify those at HIGH RISK for dehydration
2 = Watch for the 2 causes:
- Inadequate fluid intake
- Excessive fluid loss
O = Offer fluids
- Small amounts of fluids each time you enter the room
- Put fluids within reach
- Preferred beverages at preferred temperatures
What is dehydration
- Defined as “loss or removal of fluid” from the body
- can either be water-loss dehydration or salt-loss dehydration
- Evidence that water-loss dehydration is common in older adults
- associated with causes of morbidity and mortality
- falls, fractures, heart disease, delirium, kidney failure, infections, seizures, etc.
- in water-loss dehydration, either sodium or glucose levels are raised
Why does dehydration get worse with older age
- decreased thirst response
- ability to retain salt and fluid decreases with decreased kidney function
- total body fluid decreases
- different medications
- having to rely on others to provide drinks
Interventions to prevent dehydration in care homes
- education and involvement of staff
- use of social times
- drink carts/water jugs
- monitor urine colour
- be aware of medications
Why do we want to identify a valid, simple, non-invasive screening test for dehydration in OAs
- identify older adults with impending water-loss dehydration so we can improve fluid status
- monitor progress of these older people
- identify older adults with likely water-loss dehydration to we can do further testing
- identify settings/populations where there is a high risk of dehydration to put public health measures in place
- assessment of effects of interventions to improve hydration
