Too Little Fluid in the Elderly

What do you do when you’re thirsty? Simple question, easy answer: drink something. But what if your body needs water without signaling it? This is the case for many older people – whether they live at home or in an elder care facility.

Lack of fluids in old age

Dry mouth, dry mucous membranes or sagging skin are signs of insufficient fluid intake. Other symptoms such as constipation, altered effect of a medication, confusion, weakness and dizziness, or increased susceptibility to infections are rarely associated with fluid deficiency, but may be consequences of dehydration. However, especially in the elderly, other causes such as heart disease or dementia are often mistakenly suspected. It becomes life-threatening in cases of unconsciousness, circulatory or renal failure. Hospitalization is often necessary. But it does not have to get that far.

Drinking enough: small effort, big effect

The German Nutrition Society (DGE) recommends a regular daily fluid intake of 2.25 liters for healthy older people. Of this, 1.5 liters should be taken in through drinks, and the remaining amount through food (vegetables, salads, fruit, dairy products, etc.). For people in need of care or living in homes, appropriate services must be provided and caregivers trained. For senior facilities and outpatient care services, the DGE has drawn up key points for practical implementation to improve the situation on site.

Elderly people often drink too little

Lack of habit, fear of going to the toilet at night, incontinence, or prostate disease (in men) can be important barriers to drinking. For those living alone, carrying heavy drinks – whether from the supermarket to home or from the basement to the top floor – can become an obstacle. People in need of care are sometimes unable to reach their drink, even if it is right next to them. An aggravating factor in old age is that the feeling of thirst often decreases. If the kidneys lose their ability to concentrate urine with increasing age, more water is excreted and the risk of dehydration increases further. The same applies in the case of increased protein and electrolyte intake, heavy sweating (for example, in summer, with fever, in overheated rooms, during physical exertion), but also in the case of diarrhea, vomiting and taking laxatives or dehydrating agents.

Drink more – how to do it?

If seniors live together with their family under one roof, children and grandchildren can help to train the right drinking behavior. It is more difficult in homes and in care for the elderly. Employees have a special responsibility here. It therefore makes sense for employees or sponsoring institutions of senior citizens’ facilities and outpatient care services to establish a beverage concept. Important cornerstones of the concept should be:

  1. Offer age-appropriate beverages: Drinking water, mineral water, still water, diluted fruit juices (spritzers), and fruit and herbal teas are particularly suitable. Alternate between different cold and hot drinks, the preferences and habits of the residents should be taken into account. If desired, can be additionally – in moderation – coffee, black tea and if necessary in the evening beer and wine (spritzers) are served.
  2. Soups, milk and buttermilk drinks, as well as fruit, vegetable and multivitamin juices also contribute to hydration. In this regard, the drinks should be offered and drunk throughout the day. It is important that they are available at all times. The range of drinks must be adapted to the metabolic situation and the state of health.
  3. Take structural measures in the facility: In addition to the question of which beverages are offered in nursing homes, the “how” is also crucial. A drinking plan accessible to all residents of the home reminds them to drink regularly at specific times. Drinking logs can be kept for individuals with unsatisfactory drinking patterns. Staff training and individual counseling of seniors improve acceptance and implementation.
  4. The establishment of self-service options for drinks (for example, beverage oasis) is helpful.
  5. Empty glasses and cups should always be refilled.
  6. The less someone eats, the more should be drunk: Low food intake, small meals or infrequent meal intake lacks the water contained in food.
  7. Seniors in need of assistance and care require adequate assistance and support when drinking. Special drinking vessels are recommended for the bedridden and the enrichment of drinks for the debilitated or reduced energy and nutrient intake.
  8. Pay attention to the fluid supply of (supposedly) independent residents.
  9. Dementia patients are more likely to reach for the cup if it contains a colored or colored liquid.

Drinking plan for seniors

Here’s what a possible daily drinking plan for seniors might look like:

Example of a daily drinking plan for seniors
Breakfast 2 cups of latte, tea or cocoa 250 ml
Snack 1 glass of fruit juice spritzer or buttermilk 200 ml
Lunch 1 glass of mineral water 200 ml
1 plate of soup 150 ml
Snack 1 large cup of tea or latte 200 ml
Dinner 2 cups of herbal tea 300 ml
Late evening 1 juice spritzer, mineral water or
1 glass of beer or wine (spritzer), if necessary
200 ml
Total amount (Add to this about 750 ml of fluid supplied by food).

1500 ml

When drinking too much can hurt

A limitation of the amount of fluid, if necessary even a balancing may be necessary in patients with (severe) heart failure or disorders of fluid excretion (for example, certain kidney damage). In such cases, consultation with the attending physician is essential.