Hydration and the Elderly


Dehydration is a significant issue amongst the elderly, is under-diagnosed, and can often go unnoticed. The consequences of dehydration, however, can be serious.

For those working with the elderly, it’s important to understand:

  • why the elderly have a greater risk of dehydration
  • the common signs to help you identify dehydration; and
  • how to encourage the elderly to drink more


Why do the elderly have a greater risk of dehydration?

  • Reduced sense of thirst with age
  • Reduced ability to see or reach for fluids; and more spillages
  • Reliance on others to provide fluids
  • Being in rooms that are overly heated
  • Dementia and forgetting to drink
  • Wanting to drink less because of incontinence or reducing the number of visits to the toilet
  • Increased loss of fluid through dribbling
  • Chronic illness
  • Oral and swallowing problems and the need for thickened fluids
  • Reduced ability to overcome the effects of vomiting, diarrhoea, or fever
  • Regular use of some medications
  • More rapid breathing with respiratory infections causing increased fluid loss
  • Where the range of fluids available is limited and does not match a person’s food and fluid preferences

 What are the consequences of dehydration?

Every part of the human body needs water to function properly – it helps to maintain body temperature, carry nutrients around the body, and remove waste. Dehydration occurs when a person loses more water from their body than is supplied.

Consequences of dehydration may include:

  • Headaches, drowsiness
  • Reduced reaction time
  • Reduced kidney function
  • Loss of muscle tone
  • Postural hypotension (dizziness upon standing)
  • Delayed wound healing


Common signs of dehydration

  • Strong smelling, dark urine
  • Constipation
  • Dry mouth, lips & tongue
  • No pool of saliva under the tongue
  • Confusion and irritability
  • Poor skin elasticity
  • Hollow sunken eyes


How do I encourage the elderly to drink more?

 It’s important to identify those at risk of dehydration and encourage and support fluid intake.  The following tips may be useful in encouraging people to increase their fluid intake:

  • Have fluid within reach day and night
  • Offer small amounts of fluid more often, rather than larger amounts less often
  • Be aware of feeding difficulties and provide fluids appropriately, e.g. with a straw, in a special cup, or a squeeze bottle. Even soup may be better offered in a mug for residents who find using a spoon difficult
  • Provide fluids at the temperature that residents prefer
  • Encourage family and friends to drink fluids socially with the resident
  • Provide fluids that residents prefer e.g. if a resident doesn’t like water, offer alternatives like weak cordial or flavour water with lemon slices or mint leaves
  • Have fluids available during activity and therapy sessions
  • Offer a wide range of beverages, especially for those on thickened fluids
  • Remember those requiring thickened fluids are at high risk of dehydration, be patient and persistent in encouraging fluid intakeProvide extra fluids between meals according to a set fluid schedule — e.g. three times a day or every 1.5 hours. In Aged Care Facilities, you may want to assign a staff member to carry out the “hydration round”
  • Encourage additional fluid intake during existing procedures and activities e.g.:
    • With medications
    • After a resident returns from the toilet. Put signs in bathrooms to remind staff of this procedure
    • Before and after physiotherapy sessions
  • Offer high fluid foods e.g. fruit (whole or pureed), soup, jelly, custard, yoghurt, ice-cream, ice blocks (especially popular in hot weather), and ice chips
  • Be direct when offering fluids e.g. instead of asking “Do you want to have a drink?” which allows a choice not to drink, it may be better to say “I would like you to have a drink of water with me” or “lets have a drink of water together”