Hydration and ageing
HOW TO KEEP FLUIDS UP WHEN INTEREST IS DOWN
“I’m not thirsty.” When someone says they aren’t thirsty but you’re pretty sure they need water – there could be several reasons for their resistance. Here, we look at why hydration is so important, how it changes as we age, and how to encourage more of it.
Water stores
Water makes up about 70% of our total weight. It regulates body temperature, eliminates toxins, carries nutrients and oxygen to cells, and provides a lubricating environment for joints, eyes, and intestines. As far as survival goes, our number one need is to get enough fluid to keep these bodily functions going. The feeling of thirst is our brain’s way of reminding us of that and it plays a crucial role in keeping us alive and well. Then, as we age, the amount of water our body contains goes down.
If we don’t keep our fluid levels up, we can get dehydrated. Dehydration is connected to a host of problems like constipation, confusion, low blood pressure when we stand up leading to dizziness, falling, problems producing saliva, poor control of sugar levels with diabetes, or hyperthermia (abnormally high body temperature) because of body temperature control being poor. Studies have shown that improving fluid levels is connected with good outcomes, like fewer falls, which is particularly important for older people. Staying hydrated is one of the simplest and most effective ways to help keep someone healthy.
What causes dehydration?
One big problem: people can actually lose their sense of thirst. The elderly in particular, due to changes in the brain, will often not feel thirsty, even when their bodies might be getting dangerously dehydrated. What can make this more of a problem is that when an older person has been dehydrated they often won’t drink enough to rehydrate.
Someone may develop an aversion to drinking fluids because they’re trying to manage incontinence, or they might be reluctant to get help with something as intimate as going to the toilet, for example when they have mobility issues, or due to medication, or illness.
Another way our bodies help keep fluid levels up is through the kidneys, by reabsorbing fluid from urine. But as we age, our bodies also lose kidney function and are less able to conserve fluid in this way.
Many of the illnesses that older people experience and medications they may take can increase their fluid needs too.
It’s no wonder that dehydration is one of the most common health problems as people get older.
How can I tell? Some symptoms of dehydration
Increase in confusion (over and above typical dementia symptoms)
Urine is dark and strong smelling
Skin may appear drier and more papery than usual
Lips are cracked and dry
Urinary tract infections (which can also cause thinking to get pretty haywire)
Headaches
Eyes become sunken
Blood pressure is lower/they are dizzy after getting up
Pulse is fast, weak and/or irregular
The trickiest symptom to work out is the increased confusion that can be a sign of dehydration. People with dementia will already have days where they seem confused and other days where they’re more lucid, so knowing when confusion might be dementia-related, versus dehydration, can be difficult. It helps to look for other symptoms like changes in urine colour or skin dryness to confirm whether they need extra fluids.
What to do / How much?
A general guideline for those over 65 years old is seven to nine glasses of fluid a day. If this feels overwhelming, try thinking of it in ‘real life’ moments instead:
1. Waking up drink / 2. & 3. Breakfast drinks (for example, juice and tea) 4. Morning tea drink / 5. & 6. Lunch drinks x 2 (juice and water) / 7. Afternoon tea drink / 8. Pre-dinner drink / 9. Dinner drink – with maybe a popsicle or fruit ice dessert.
Water is always best, but most liquids count! (As with anyone, it’s important to watch the sugar intake and keep alcohol consumption down).
Breaking hydration down into these moments where you offer things throughout the day is far easier than telling someone they have to drink a certain number of drinks. Instead, it can become: “Let’s have a cup of tea”, “Here’s an iced water with a slice of lemon”, or “I got us a popsicle for a treat”…
If you aren’t with them, then leave ‘triggers’ like a glass and a jug of water with slices of lemon next to where they sit – or make it even more appealing with other ‘extras’ like cucumber or orange slices, strawberries, or fresh mint leaves.
If they struggle to lift jugs or glasses then a lightweight water bottle or sipper cup can help. You can also put drinks in non-spill cups with sturdy bases, which help stop spills and keep dignity intact.
If their suction is weak, then ‘one-way’ straws, which let them suck fluid up without it falling back down, can be really useful.
Other sources of hydration:
Broth or soup – an excellent way to increase fluid and nutrients
Coffee with milk
Tea – caffeinated or herbal
Iced tea – black tea, fruit teas or herbal teas
Popsicles – natural, all fruit are best
Juice – 100% juice is best, but a small amount of something like cranberry mixed with water is great too
Smoothies – and you can add protein powder, yoghurt and fruit/vegetables for extra nutrition
Coconut water – a good way to get natural electrolytes; it also tastes sweeter and is enjoyable to alternate with water
Milk – chilled soy milk, rice milk, goat or cow’s milk. In colder months try hot milk with honey, or hot chocolate with cinnamon. (Be aware of not making it too hot so they can’t burn themselves accidentally.)
Many people worry that caffeine’s diuretic properties (it makes you wee more) mean tea and coffee aren’t appropriate for boosting hydration. However, some tea or coffee is fine as the amount of caffeine in a cup of tea or coffee is relatively small, so it will still hydrate to a degree.
And it’s not only fluids that can hydrate us – we get about 20% of our daily needs from food as well. Try offering some foods with a high percentage of water, like:
Cucumber, Watermelon, Spinach, Pineapple, Blueberries, Celery, Tomato, Grapefruit, Pumpkin and Pear.
How do you get someone who is not thirsty, or who is anxious about the impacts of drinking, to drink more?
A big challenge to keeping someone hydrated is when they are reluctant to drink. Tackling it head on is not ideal. Here are a few tips:
Simple reminders that make sense might work for some, such as: “Have a drink – let’s keep those kidneys happy.”
If they put a lot of store in “the Doctor” then use that – “It’s what the Doctor said we have to do…”
Make things fun. Try bubbly drinks or water that has colour with a small bit of fruit juice in it. Make fruit ices.
Be social and have a drink with them, or get the kids involved and all sit down for afternoon tea after school.
Sometimes simple trading can work too – “Just have that drink and then we’ll go for a walk/drive/watch that movie/listen to that music…”
If you are really getting stuck, then hydration products might help.
The bottom line is to do whatever you can to keep fluid levels up – it helps kidneys work better, the brain works better, and valuable nutrients will be better absorbed. It really is one of the easiest ways to help with overall health.
