Too little fluid in the elderly

What do you do when you are thirsty? Simple question, easy answer: drink something. But what if the body needs water without signaling it? This is the case with many older people, regardless of whether they live at home or in a nursing home.

Dehydration in old age

Dry mouth, dry mucous membranes or loose skin are signs of inadequate hydration. Other symptoms such as constipation, altered drug effects, confusion, weakness and dizziness, or increased susceptibility to infection are rarely associated with dehydration, but can be the result of dehydration.

Especially in older people, however, falsely often other causes such as heart disease or dementia are suspected. It becomes life-threatening in case of unconsciousness, circulatory or renal failure. Often a hospitalization is required. But it does not have to come that far.

Drink enough: little effort, big effect

The German Society for Nutrition (DGE) recommends a regular daily hydration of 2.25 liters for healthy older people. Of these, 1.5 liters should be consumed over drinks, the remaining amount over the food (vegetables, salads, fruits, dairy products, etc.).

In the case of persons in need of care or living in homes, corresponding offers must be created and the caregivers trained. For senior citizen facilities and outpatient care services, the DGE has created key points for practical implementation in order to improve the situation on the ground.

Older people often drink too little

Lack of habit, fear of going to the toilet at night, incontinence or prostate (in men) can be important drinking restrictions. For those living alone, transporting heavy drinks - whether from the supermarket home or from the cellar to the upper floor - can become an obstacle. People in need of care are sometimes no longer able to reach their drink, even if it is right next to them. To make matters worse in old age is that the feeling of thirst often decreases.

If the kidney loses its ability to concentrate the urine with increasing age, more water is eliminated and the risk of dehydration increases. The same applies to increased protein and electrolyte intake, heavy sweating (eg in summer, fever, overheated rooms, physical exertion) as well as diarrhea, vomiting and ingestion of laxatives or dehydrating agents.

More drinking - how are you?

If seniors and their families are united under one roof, children and grandchildren can help to train the right drinking behavior. It is more difficult in homes and in the elderly care. The employees have a special responsibility here. It therefore makes sense for employees or institutions of senior institutions and outpatient care services to establish a beverage concept. Important cornerstones of the concept should be:

  • Provide age-appropriate drinks: Particularly suitable are drinking water, mineral water, still water, diluted fruit juices (spritzers) as well as fruit and herbal teas. Alternate between different cold and hot drinks, the preferences and habits of the residents should be considered. If desired, coffee, black tea and possibly evening beer and wine (spritzers) can be served - in moderation.
  • Soups, milk and buttermilk drinks as well as fruit, vegetable and multivitamin juices contribute to the supply of fluids. The drinks should be distributed and drunk throughout the day. It is important that they are available at all times. The beverage offer must be adapted to the metabolic situation and the state of health.
  • Structural measures in the institution meet: Besides the question, which beverages are offered in nursing homes, also the WIE is crucial. A drinking plan accessible to all residents reminds on regular drinking at certain times. For people with unsatisfactory drinking habits, drinking protocols can be kept. A training of the employees and an individual consultation of the seniors improve the acceptance and the implementation.
  • The establishment of self-serve drinks (eg beverage oasis) is helpful.
  • Empty glasses and cups should always be refilled.
  • The less you eat, the more you should drink. Low water intake, small meals, or infrequent meal intake may result in a lack of water in the food.
  • Elderly and dependent elderly need adequate help and support in drinking. Special drinking vessels are recommended for bedridden and the enrichment of the drinks in the weakened or with reduced energy and nutrient absorption.
  • Pay attention to the fluid supply of (supposedly) independent residents.
  • Dementia patients access the cup more often if there is a colored or colored liquid in it.
Example of a day drinking plan for seniors
breakfast2 cups of milk coffee, tea or cocoa250 ml
Snack1 glass of fruit juice spritzer or buttermilk200 ml
Having lunch1 glass of mineral water200 ml
1 bowl of soup150 ml
Snack1 large cup of tea or milk coffee200 ml
Dinner2 cups of herbal tea300 ml
Late evening1 juice spritzer, mineral water or
if necessary 1 glass of beer or wine (schorle)
200 ml
total quantity(plus about 750 ml of liquid, which are fed through the food)

1500 ml

Limiting the amount of fluid, or even accounting, may be required in patients with (severe) heart failure or fluid clearance disorders (eg, certain kidney damage). Here a consultation with the attending physician is essential.

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