Dehydration and Malnutrition Have Serious Consequeces in The Elderly

WHETHER YOU WORK in a hospital, long-term care, or home health care, you’ve undoubtedly encountered an elderly patient who’s dehydrated or malnourished. Confusion and disorientation, which aren’t normal at any age, may have been your first clues.

Because dehydration and malnutrition can have such serious consequences in older patients, make early recognition and treatment a priority. Use the following information and guidelines to assess for problems and intervene appropriately.

Why dehydration threatens:

More than one in three older Americans may not drink enough water:

Physiologic changes related to aging make an elderly adult especially prone to dehydration. She has about 10% less body fluid than a younger adult, so she has less fluid reserve to start with. Because her sense of taste diminishes with age, food may become unappetizing. Consequently, she may eat less and use more salt, raising her body’s need for water. At the same time, however, her thirst response can diminish, so she may not recognize the need to drink more. For these reasons, an elderly adult may become severely dehydrated very quickly, before she feels thirsty or anyone notices symptoms.

Fever can contribute to dehydration. Because an elderly adult’s normal body temperature may be lower than 98.6deg F (37deg C), a temperature increase may be undetected at first. Always check the patient’s temperature against her baseline. A temperature of 98deg F (36.7deg C) is a lowgrade fever for someone whose temperature is normally 97deg F (36.1deg C). Generally, 1 degree of fever increases total body water needs by 10%.

A fever can be a consequence of dehydration as well as a cause: A low-grade fever develops if the patient doesn’t have enough fluid to adequately cool her body. The result is a downward spiral of dehydration and increasing body temperature, further raising fluid needs and compounding dehydration.

Signs and symptoms of dehydration include irritability, confusion, tachycardia, low urine output, dry skin, constipation, fecal impaction, dizziness, hypotension, infection, bowel blockage, and skin breakdown. If allowed to continue unchecked, dehydration may lead to falls, stroke, renal failure, and death.