Symptoms of dehydration in older people

Signs and symptoms of dehydration in elderly people.

Dehydration can be a common problem for older adults, so if you are providing care to an older relative you may be concerned about recognising the signs of dehydration to ensure your loved one is always sufficiently hydrated and healthy. 

Here, we are taking a look at why older adults tend to experience dehydration, the signs and symptoms to watch out for, the causes and risk factors for older people, how to prevent dehydration in an older person you care for, and when you should seek medical assistance. 

At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global home care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about home care services, we can help. 

What is dehydration?

Many of us will have experienced the feeling of dehydration, when we crave fluids to alleviate symptoms like a dry mouth, excessive body heat or a headache. It is characterised by an inadequate intake of fluids, or excessive loss of fluids from the body, and can disrupt the body’s balance of electrolytes which are necessary for typical bodily functions. 

For most of us, dehydration will cause us to feel thirsty, at which point we can start to drink more. However, dehydration can cause issues for anyone if not addressed, and severe dehydration can actually be life-threatening as it can impair organ function and lead to organ failure – older adults are particularly susceptible to these dangers.

Why is dehydration a problem for older people specifically?

Dehydration is an issue that older adults and their carers should be aware of, even if it has never been a problem in the past. This is because ageing tends to diminish the body’s ability to conserve water and regulate the sensation of thirst, which can lead to older people being unaware that they are becoming dehydrated. There are several reasons why older people specifically could be affected by this:

  • Chronic medical conditions like diabetes, kidney disease, or dementia can exacerbate the risk of dehydration
  • Issues like incontinence can cause older people to deliberately limit their fluid intake without being aware of the potential consequences 
  • Reduced kidney function can make older adults more susceptible to fluid loss
  • Medications like diuretics can increase urine production, leading to more fluid loss 
  • Mobility issues or requiring assistance when eating or drinking can impact their access to fluids
  • Cognitive impairment can interfere with the recognition of thirst cues
  • Age-related changes in skin can lead to increased water loss through perspiration, as the total water in the body is reduced by up to 15% as we age 
  • Age-related loss of appetite in older adults is very common, with an estimated 20% of older people seeing a notable loss of appetite as they age due to things like a general lack of interest in food, health problems that make eating uncomfortable, hormone changes, digestive issues, dental issues, dry mouth, changes in smell and taste, dietary changes, becoming less active, mobility challenges, and more. You can read more in our guide: Handling Loss Of Appetite In Older Adults
symptoms of dehydration in elderly

What are the signs and symptoms of dehydration?

If you work as a carer or are caring for an older loved one, being aware of the subtle signs and symptoms of dehydration in older individuals is so important in order to catch any dehydration issues before they cause severe consequences. 

Some of the visible signs of dehydration in older people include:

  • A dry mouth or tongue 
  • Cracked or dry lips
  • Sunken eyes 
  • Dry skin 
  • Confusion or disorientation
  • Dizziness or drowsiness 
  • Visible weakness or fatigue 
  • Irritability

Some signs you may need to ask your relative about, or check for, include:

  • If they are feeling thirsty 
  • If there is a decreased urine output
  • If they are experiencing blurred vision or dry eyes 
  • If their urine is dark in colour or strong smelling 
  • If they feel fatigued or have weak muscles
  • If their blood pressure is low
  • If they have a rapid heart rate
  • If they are constipated
  • If they are unable to sweat  

Important: Keep in mind some of the symptoms listed above may be due to dehydration, but they could also be due to another medical condition – if you are concerned about a loved one’s health do not hesitate to contact the medical professional in charge of their care, or book a GP appointment to ensure there are no underlying issues. 

What causes dehydration in older adults?

According to Age UK, older people should aim to drink around 6-8 cups of fluid per day, which is around 1.5 to 2 litres. When an individual drinks significantly less than this, or experiences other factors causing them to lose more fluid than they gain, this can cause dehydration.  

Typically the cause is due to inadequate fluid intake coupled with factors such as heat or humidity causing excessive sweating, illnesses that cause a fever, vomiting or diarrhoea, mobility issues making it difficult for older adults to get a drink by themselves, underlying health conditions like diabetes, or increased urination due to certain medications or illnesses. 

Also, changes in kidney function as we age can eventually compromise the body’s ability to conserve water, which further contributes to dehydration. 

What are the risks of dehydration?

Besides the obvious discomfort dehydration can cause for anyone who experiences it, there are a number of potentially serious risks involved when hydration levels deplete in an older person. For example: 

  • Dehydration can exacerbate existing health conditions
  • A lack of sufficient fluids can lead to conditions such as urinary tract infections (UTIs), kidney stones, electrolyte imbalances and more
  • It can cause dizziness and falls, which can be extremely dangerous for older people due to a heightened risk of injuries such as fractures
  • Dehydration can cause confusion and delirium, which could be mistaken for cognitive decline or dementia symptoms, leading carers to seek incorrect treatment
  • Severe dehydration can lead to seizures, which is considered a medical emergency
  • Dehydration can alter the effectiveness of some medications, so it is important to be aware of this and seek medical help if you suspect there is interference  
  • If an older individual becomes dehydrated, they are more likely to be hospitalised which can lead to an increased risk of infections
symptoms of dehydration in elderly

What to do if an older person isn’t drinking enough

Being vigilant with an older person’s hydration needs is important, and both proactive and reactive intervention is required to protect their health and wellbeing and ensure complications do not develop as a result. Remember, thirst is the brain’s way of telling us that the body is already dehydrated, so don’t wait until an older person says they are thirsty – be proactive with their hydration needs. Here are a few ways you can help to prevent dehydration in an older loved one: 

  1. Encourage regular sips of water throughout the day (you can set a timer for every hour if you struggle to remember this).
  2. Offer them drinks they enjoy so they will drink more. For example, if they only like flavoured water, offer this instead of tap water.
  3. Pay attention to caffeine intake, as too much of this can further dehydrate the body due to increased urination. If your loved one is a keen tea or coffee drinker, consider switching them to decaffeinated options. 
  4. If they have mobility or dexterity issues, make sure they always have access to a drink when they want it, even if you are not around. For example, a flask or water bottle placed near their seat on the sofa, or a cup with a straw if they struggle with lids. This will remove any barriers between them and staying hydrated. 
  5. Pay attention to the fluid temperature they like best. Some people do not like ice cold water and so they will be less likely to drink it. 
  6. Add hydrating foods into their meals and snacks, such as fruit like watermelon or vegetables like cucumber. Liquid-based foods like soup, gravy, custard and ice cream are also helpful for increasing the water content in an older person’s diet, but keep in mind that the amounts should be halved when calculating fluid intake. For example, 100 mls of soup would be roughly 50 mls of liquid. 
  7. Keep track of everything they drink and their fluid output when they use the bathroom. You could also keep an eye on the frequency of their urination, and the colour of the urine as an indicator for dehydration.
  8. Speak to their doctor or nurse to find out if there is anything you can add to their drinks or food to help with hydration, such as electrolyte sachets or medications.
  9. If the weather is warm, try to increase their fluid intake to counteract any additional perspiration.
  10. If they are worried about needing to use the bathroom a lot during the night, and prefer to avoid fluids in the evening, ensure they are sufficiently hydrated during the day instead. 
  11. Make it clear to them that their hydration is important, and that they should not avoid drinking in order to limit the number of toilet visits they make – let them know you are there to help them get to the bathroom whenever they need to.
  12. Figure out (with a doctor’s help if required) the daily fluid intake goal to help you manage the situation and ensure there are no long stretches of time without fluids.
  13. If you are worried about a loved one who is not drinking enough throughout the day, you can seek the help of home carers – such as a Care Professional from Home Instead – who can provide encouragement and reminders, plan meals to include hydrating ingredients, and monitor their fluid intake and output throughout the day to pick up on any early signs of dehydration. You can read more about how this works in our guide: How To Choose & Arrange Home Care Services.

When is it time to seek medical attention for dehydration?

Older adults can become excessively dehydrated in a short space of time which, in some cases, can endanger their health and life. If for any reason your loved one is unable to or refuses to take fluids, you should seek medical attention as soon as possible so they do not become further dehydrated. This might be the case if the person is feeling sick or vomiting. 

If you notice symptoms such as confusion, disorientation, dizziness, drowsiness, decreased urine output, blurry vision, dark-coloured urine, low blood pressure, or a rapid heart rate, speak to your loved one’s doctor to ensure they are healthy, and take steps to rehydrate them. A doctor may be able to treat them within the surgery or will send them to hospital if symptoms are more severe. They may replenish their fluids and electrolytes through an IV or offer oral rehydration therapy. 

At Home Instead, we can provide everything you need to feel comfortable leaving your relative. If dehydration is a worry you regularly have, learn more about our domiciliary care services, from visiting companionship care to live-in care, can support you and your loved one. 

Home Instead is an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.

Michelle Tennant

Michelle Tennant, Clinical Governance Lead

I am a Registered Nurse of 20 years and have been in the care sector since I was 17 years old, I have had experience in every role that exists in a care company, including Registered Manager, care consultant, recruiter, scheduling, auditing, complaints, and networking! My role in the National office is Clinical Governance Lead, and most recently have been working with DHSC and Chief Nurse Deborah Sturdy to develop a clinical governance framework for the delegated healthcare activities in social care, I am continuing to take the lead on our Healthcare at Home service and drive this in the network. In addition to my nursing role, I’m 4 years into my PhD in Aging at Lancaster University, with a key focus on the retention of Care Professionals in the social care sector.