Navigating Health and Aging: Hydration important for everyone, particularly the elderly

In my last column, I discussed brain health and ways to keep the brain healthy. One of the most overlooked ways is hydration. It is also one of the easiest things to do! Our bodies are made up of two-thirds water and our brains 77-78 percent water. When we take in less water than we lose, we become dehydrated.

During these summer days of high temperatures and high humidity, our bodies lose water even when we are inactive. We lose water through sweating, through our skin, urination, vomiting, diarrhea and even breathing.


When we do not replace fluids lost through normal body functions or in times of illness or extreme heat, we can become dehydrated. Dehydration can disrupt normal functioning and can be extremely dangerous and even life- threatening in the very young, aging and in those who are working or exercising in extreme heat and not replacing fluids.

The aging population is especially susceptible to dehydration. In fact dehydration is one of the 10 most frequent diagnoses reported for hospitalizations of persons over 65 in the United States. Reasons for the high incidence of dehydration vary.


As we age, our kidneys are less efficient at concentrating urine in order to store water during times of dehydration. Also, as we age we experience decreased thirst sensation causing us to drink less. Add decreased mobility and the desire to not be interrupted to urinate frequently and it is a set-up for chronic dehydration. Those taking diuretics, such as Lasix (Furosemide), to control congestive heart failure or fluid retention are at risk for dehydration when not balancing fluid intake.

The following information about dehydration comes from the Mayo Clinic.

Mild to moderate dehydration is likely to cause:

•Dry, sticky mouth


•Sleepiness or tiredness — children are likely to be less active than usual


•Decreased urine output

•No wet diapers for three hours for infants

•Few or no tears when crying

•Dry skin



•Dizziness or lightheadedness

Severe dehydration, a medical emergency, can cause:

•Extreme thirst (often altered and diminished in the older population)

•Extreme fussiness or sleepiness in infants and children; irritability and confusion in adults

•Very dry mouth, skin and mucous membranes

•Little or no urination — any urine that is produced will be darker than normal

•Sunken eyes

•Shriveled and dry skin that lacks elasticity and doesn't "bounce back" when pinched into a fold

•In infants, sunken fontanels — the soft spots on the top of a baby's head

•Low blood pressure

•Rapid heartbeat

•Rapid breathing

•No tears when crying


•In the most serious cases, delirium or unconsciousness

In the aging population — which in my experience is notoriously under-hydrated — dehydration can cause confusion, delirium and even renal failure. Dehydration is often the cause of a change in mental status.

It is common for me to see aging people who do not like water, and barely drink any fluids. It is also common for me to see aging individuals in assisted living and nursing facilities with water cups across the room where they cannot reach them. Research has shown that more than 30 percent of the elderly are dehydrated and that as many as 50-90 percent of nursing home residents are dehydrated.

What are some simple rules of thumb that you can follow to assure proper hydration?

First, be sure to drink plenty of fluids even when you are not thirsty. Do not wait for thirst to guide your fluid consumption. While water is best under normal situations, flavoring water or drinking a beverage that you like is better than not drinking at all. Keep in mind that drinks with caffeine cause you to lose water, so consider adding extra water to account for those losses. Recommendations for fluid consumption are at least 57 ounces to 91 ounces per day for women, and more for men.

Exercise and sweating cause water loss, and as a result there may be a loss of sodium and electrolytes. In times of extreme heat, water and sodium are lost through the skin even with little exertion. Dr. Rengen, a kidney specialist, reminds us to hydrate and replace electrolytes with liquids such as Gatorade or G2, in the case of diabetes. Be aware that replacement with drinks high in sugar should be avoided when experiencing diarrhea or loose stools, as they will make it worse.

Eat fruits and vegetables! They have high water concentrations and help keep you hydrated. Watermelon, cucumbers and lettuce are excellent sources of additional fluids.

Check your urine for color and odor to assess hydration. The lighter the color the better hydrated you are. If your urine is dark yellow, or even amber, it is time to start drinking. Look at your tongue, is it dry or moist? Pinch the skin on the back of your hand, if it bounces back quickly, great. If it stays pinched appearing and takes time to bounce back then hydrate!

It's amazing how much better you will feel if you are hydrated. At first you may not notice the difference. However, if you hydrate consistently, you will begin to notice more energy, less lethargy, mental clarity, more regular bowel habits, better skin and many other benefits!

It is important to discuss fluid intake parameters with your physician especially if you have conditions such as congestive heart failure, kidney problems or fluid retention. There may be limitations on your intake in order to create a healthy balance for you.

And finally, remember that hydrating is important all year long … not just during hot weather!

Jill Rosner is a registered nurse, certified geriatric care manager and owner of Rosner Healthcare Navigation. She provides patient advocacy and care management services to clients with health and aging issues. Contact her at JillRosnerRN@aol.com.