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Fluid in the Balance: Hydration and Nutrition Recommendations for Older Adults

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By Andie Lee Gonzalez

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Health & Well-being

With summer temperatures on the rise and heat waves headlining the news, it’s an important time to focus on hydration. Dehydration reportedly occurs in up to a quarter or more of older adults and is a frequent cause of hospital admission. Most importantly, dehydration is a significant health risk, often intensified by conditions that can come with age, including chronic diseases and related medications, less total body water, reduced kidney function, and the diminished ability to perceive thirst.

Fluid intake directly influences hydration and nutrition, and for older adults the risk factors for poor fluid intake and malnutrition overlap. This short article explores these aspects, guided by current guidelines and recommendations for managing hydration and nutrition to support better health of older adults.

The Role of Water and Signs of Dehydration

Everybody needs water for essential functions like regulating body temperature, blood pressure maintenance, transporting nutrients, helping rid the body of wastes, and lubricating joints. Insufficient fluids can lead to dehydration, which can cause constipation, electrolyte imbalances, urinary tract infections, renal stones, kidney problems and loss of balance. Serious dehydration requires immediate attention—see the signs and symptoms in the chart below.

Dehydration Warning Signs and Symptoms

Dehydration

Severe Dehydration

Dry mouth, dry, pale skin

Rapid heart rate

Tiredness

Extreme fatigue

Dizziness

Fainting, disorientation

Decreased urination, dark colored urine

Vomiting and/or diarrhea lasting > 24 hours

Muscle cramps

Trouble walking

Sunken eyes

For severe dehydration SEEK HELP RIGHT AWAY

 

The Impact of Nutrition on Hydration

The relationship between nutrition and hydration is complex, as various nutrients can influence fluid retention and electrolyte balance. For example, a diet high in protein can increase renal load and fluid requirements, whereas sodium influences fluid retention. Fruits and vegetables—which are high in water content—can contribute significantly to hydration. These food sources are particularly important because they provide essential nutrients and fluids and may be easier for older adults to consume than drinking large volumes of liquid.

In older adults, there often are overlapping risk factors impacting adequate nutrition and fluids, which can increase the likelihood of malnutrition and dehydration. These overlapping risk factors are age-related and can include:

  • Less muscle tissue and body water
  • Chewing and swallowing problems
  • Decreased functional abilities
  • Decreased cognitive abilities
  • Reduced social contact
  • Limited offering of foods/beverages by caregivers.

Current Guidelines and Recommendations

Current guidelines underscore the importance of monitoring fluid intake among older adults. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends a daily water intake of 2.0 liters (more than 8 cups) for older men and 1.6 liters (nearly 7 cups) for older women, from all sources, including food. The U.S. National Academies of Sciences, Engineering, and Medicine recommendations are even higher, 3.7 liters (more than 15 cups) for men and 2.7 liters (more than 11 cups) for women of daily water, from all sources.

Practical Ways to Increase Fluids in the Diet

Getting adequate fluids is especially important for older adults when temperatures climb during the summer and the risk of dehydration increases because of increased sweat loss of water. Below are practical tips for helping older adults increase their fluids to stay hydrated.

 

Focus

Recommendation

Beverages
  • Encourage regular fluid intake, including drinking fluids at each meal and between meals
  • Offer more water throughout the day and urge older adults not to wait until they’re thirsty to drink—that’s too late
    • Set a reminder on a phone or with a timer to help older adults remember to drink fluids
  • Provide a variety of cold beverage options like fruit-infused water, fruit juices, herbal teas
  • Offer an oral rehydration solution to help restore electrolyte balance and prevent dehydration

Diet
  • Serve hydrating foods like fresh fruits and vegetables, including those with high water content such as cucumbers, lettuce, celery, tomatoes, oranges, strawberries, and watermelon
  • Monitor high sodium diets, which can promote dehydration and high blood pressure; consider reducing salt intake

Education
  • Educate older adults, caregivers and healthcare providers about the signs of dehydration/severe dehydration and the importance of regularly providing fluids/monitoring intake to improve patient outcomes and prevent dehydration
  • Share information like this dehydration infographic with older adults, caregivers, and staff

 

Conclusion

Hydration is a critical but often overlooked aspect of nutrition and health in older adults. By integrating hydration into diet planning, leveraging nutrient-rich and hydrating foods, and following established fluid intake guidelines, the risk of dehydration can be decreased. Ensuring older adults receive adequate hydration is a collaborative effort that requires awareness, education and proactive management strategies. Maintaining hydration improves overall health and reduces risk for complications and can help enhance the quality of life for older adults.

Andie Lee Gonzalez, PhD, MPH, RDN, LD, FAND, is a medical science liaison for Pediatric Nutrition Scientific and Medical Affairs with the Abbott Nutrition Products Division of Abbott in Columbus, Ohio.

Photo credit: kungfu01

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