Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration?
A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.
Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.
Now how to actually do this? Studies — and practical experience — suggest that the best approaches include:
- Frequently offering the older person a drink, preferably on a schedule,
- Offering beverages the person seems to prefer,
- Not expecting older adults to drink a large quantity at a single sitting,
- Addressing any urinary incontinence issues that might be making the person reluctant to drink often.
But your question brings up other issues in my mind. Has frequent dehydration been confirmed? (Dehydration can be hard to correctly diagnose.) Have you been able to measure how much your mother drinks, and how does this amount compare to the recommended daily fluid intake for older adults?
Also, is the real goal to prevent or manage frequent urinary infections, and is increasing her hydration likely to achieve this?
So let’s review the basics of dehydration in older adults, and what’s known about helping older adults stay hydrated. I will then share some additional tips on helping your mother maintain hydration.
The Basics of Dehydration
What is dehydration and what causes it?
Dehydration means the body doesn’t have as much fluid within the cells and blood vessels as it should.
Normally, the body constantly gains fluid through what we eat and drink, and loses fluid through urination, sweating, and other bodily functions. But if we keep losing more fluid than we take in, we can become dehydrated.
If a person starts to become dehydrated, the body is designed to signal thirst to the brain. The kidneys are also supposed to start concentrating the urine, so that less water is lost that way.
Why are older adults at higher risk for dehydration?
Unfortunately, the body’s mechanisms meant to protect us from dehydration work less well as we age. Older adults have reduced thirst signals and also become less able to concentrate their urine.
Other factors that put older adults at risk include:
- Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids
- Memory problems, which can cause older adults to forget to drink often, or forget to ask others for something to drink
- Mobility problems, which can make it harder for older adults to get something to drink
- Living in nursing homes, because access to fluids often depends on the availability and attentiveness of staff
- Swallowing difficulties
Dehydration can also be brought on by an acute illness or other event. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated. And of course, hot weather always increases the risk of dehydration.
Last but not least, older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure.
A UK study of older adults in residential care found that 46% had impending or current dehydration, as diagnosed by blood tests.
How is dehydration diagnosed?
For frail older adults, a simple preliminary check, if you’re concerned about dehydration, is to get the older person to drink some fluids and see if they perk up or improve noticeably. (This often happens within 5-10 minutes.)
This is not a clinically-proven method, but it’s easy to try. If drinking some fluids does noticeably improve things, that does suggest that the older person was mildly dehydrated.
For a truly accurate diagnosis in older adults, the most accurate way to diagnose dehydration is through laboratory testing of the blood. Dehydration generally causes abnormal laboratory results such as:
- Elevated plasma serum osmolality: this measurement relates to how concentrated certain particles are in the blood plasma
- Elevated creatinine and blood urea nitrogen: these tests relate to kidney function
- Electrolyte imbalances, such as abnormal levels of blood sodium
- Low urine sodium concentration (unless the person is on diuretics)
(Doctors often sub-classify dehydration based on whether blood sodium levels are high, normal, or low.)
Dehydration can also cause increased concentration of the urine — this is measured as the “specific gravity” on a dipstick urine test. However, this is not an accurate way to test for dehydration in older adults, since we tend to lose the ability to concentrate urine as we get older. This was confirmed by a 2016 study, which found that the diagnostic accuracy of urine dehydration tests in older adults is “too low to be useful.“
There are also a number of physical symptoms associated with dehydration. However, a 2015 study of older adults found that the presence or absence of dehydration symptoms is not an accurate way to diagnose dehydration.
Physical signs of dehydration may include:
- dry mouth and/or dry skin in the armpit
- high heartrate (usually over 100 beats per minute)
- low systolic blood pressure
- dizziness
- weakness
- delirium (new or worse-than-usual confusion)
- sunken eyes
- less frequent urination
- dark-colored urine
But as noted above: the presence or absence of these physical signs are not reliable ways to detect dehydration. Furthermore, the physical symptoms above can easily be caused by health problems other than dehydration.
This study published in 2019 confirmed that commonly used symptoms do not accurately detect dehydration in frail older adults: Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study.
So if you are concerned about clinically significant dehydration — or about the symptoms above — blood tests results may be needed. A medical evaluation for possible dehydration should also include an interview and a physical examination.
What are the consequences of dehydration?
The consequences depend on how severe the dehydration is, and perhaps also on how long the dehydration has been going on.
In the short-term, dehydration can cause the physical symptoms listed above. Especially in older adults, weakness and dizziness can provoke falls. And in people with Alzheimer’s or other forms of dementia, even mild dehydration can cause noticeable worsening in confusion or thinking skills.
Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure.
The consequences of frequent mild dehydration — meaning dehydration that would show up as abnormal laboratory tests but otherwise doesn’t cause obvious symptoms — are less clear.
Chronic mild dehydration can make constipation worse. Otherwise, a 2012 review found that the only health problem that has been consistently associated with low daily water intake is kidney stones.
A 2013 review on fluid intake and urinary system diseases concluded that it’s plausible that dehydration increases the risk of urinary tract infections, but not definitely proven.
A 2020 review on the effect of increasing fluid intake to prevent UTIs also noted that “Patients with UTI are often advised by clinicians to keep adequately hydrated or drink more fluids. However, the evidence base for this recommendation remains unclear.”
Speaking of urinary tract infections (UTIs), if you are concerned about frequent bacteria in the urine, you should make sure this reflects real UTIs and not simply a sign of the older person’s bladder being colonized with bacteria.
This is a very common condition known as asymptomatic bacteriuria, and incorrectly diagnosing this as a UTI can lead to pointless overtreatment with antibiotics. (More on this issue below, or see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.)
How is dehydration treated?
The treatment of dehydration depends on:
- Whether the dehydration appears to be mild, moderate, or severe
- What type of electrolyte imbalances (such as high/low levels of sodium and potassium) appear on laboratory testing
- If known, the cause of the dehydration
Mild dehydration can usually be treated by having the person take more fluids by mouth. Generally, it’s best to have the person drink something with some electrolytes, such as a commercial rehydration solution, a sports drink, juice, or even bouillon. But in most cases, even drinking water or tea will help.
Mildly dehydrated older adults will often perk up noticeably after they drink some fluids, usually within 5-10 minutes.
Moderate dehydration is often treated with intravenous hydration in urgent care, the emergency room, or even the hospital. Some nursing homes can also treat dehydration with a subcutaneous infusion, which means providing fluid through a small IV needle placed into the skin of the belly or thigh. This is called hypodermoclysis, and this is actually safer and more comfortable for older adults than traditional IV hydration.
Severe dehydration may require additional intervention to support the kidneys, and sometimes even requires short-term dialysis.
How to prevent dehydration in older adults?
Experts generally recommend that older adults consume at least 1.7 liters of fluid per 24 hours. This corresponds to 57.5 fluid ounces, or 7.1 cups.
What are the best fluids to prevent dehydration?
I was unable to find research or guidelines clarifying which fluids are best to drink. This is probably because clinical research hasn’t compared different fluids to each other.
As to whether certain fluids are dehydrating: probably the main fluid to be concerned about in this respect is alcohol, which exerts a definite diuretic effect on people.
The effect of caffeine on causing people to lose excess water is debatable. Technically caffeine is a weak diuretic. But real-world studies suggest that people who are used to drinking coffee don’t experience much diuretic effect.
Now, caffeine may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine. But as best I can tell, coffee and tea are not proven to be particularly dehydrating in people who drink them regularly.
The safest approach would still be to drink decaffeinated drinks. But if an older person particularly loves her morning cup of (caffeinated) coffee, I’d say to consider accommodating her if at all possible.
How to help older adults to stay hydrated?
A 2015 review of nursing home interventions intended to reduce dehydration risk concluded that “the efficacy of many strategies remains unproven.” Still, here are some approaches that are reasonable to try:
- Offer fluids often throughout the day; consider doing so on a schedule.
- Offer smaller quantities of fluid more often; older adults may be reluctant to drink larger quantities less often.
- Be sure to provide a beverage that is appealing to the older person.
- See if the older person seems to prefer drinking through a straw.
- Supplement fluids with water-rich fruit (e.g. watermelon) or other foods with high water content.
- Identify any continence concerns that may be making the older person reluctant to drink. Keeping a log of urination and incontinence episodes can help.
- Consider a timed toileting approach, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties.
- Track your efforts in a journal. You’ll want to track how much the person is drinking; be sure to note when you try something new to improve fluid intake.
- Offer extra fluids when it’s hot, or when the person is ill.
Practical tips for family caregivers
Let’s now return to the issues brought up in the question.
Family caregivers are often concerned about whether an older person is drinking enough. Since dehydration is indeed very common among older adults, this concern if very important.
However, before expending a lot of energy trying to get your mother to drink more, I would encourage you to consider these four suggestions:
1.Measure how much your mother is actually drinking most days.
This can require a little extra effort. But it’s very helpful to get at least an estimate of how much the person drinks. This can confirm a family’s — or doctor’s — hunch that the person isn’t taking in enough fluid, and can help the care team figure out how much more fluid is required.
Again, the recommendation for older adults is to consume at least 1.7 liters/day, which corresponds to at least 57.5 fluid ounces. In the US, where a measuring cup = 8 ounces, this is equivalent to 7.1 cups/day.
Keep a journal to record how much fluid your older parent is drinking. It’s generally important to track anything you want to improve.
2. Confirm that your mother is, in fact, often dehydrated.
As noted above in the section on diagnosing dehydration: physical symptoms and urine tests are not enough to either diagnose dehydration or rule it out.
Instead, consider these two approaches to confirming clinical dehydration. One is to see if her energy and mental state perk up when she drinks more. The other is to talk to the doctor and request blood tests to confirm dehydration.
Now, you don’t necessarily want to request blood tests every time you suspect mild dehydration. But especially if your mother’s dehydration has never been confirmed by a serum osmolality test, it would probably be useful to do this at least once.
3. If frequent urinary tract infections (UTIs) are a concern, learn about asymptomatic bacteriuria and try to determine whether these are real UTIs versus a colonized bladder.
Sometimes I’ve seen families hellbent on increasing hydration or taking other measures, because they are concerned about repeated or persisting urinary tract infections (UTIs).
But UTIs are a bit like dehydration. A UTI is a common problem in older adults and is potentially very serious. But it’s also easily misdiagnosed, even by professionals.
Sometimes, when an older person keeps being diagnosed with a UTI repeatedly, the problem is actually that the older person has asymptomatic bacteriuria. This is a very common condition in which an older person’s bladder becomes colonized with bacteria. It probably happens because people’s immune systems get weaker as they age.
So how is this different from a UTI? Both conditions will cause a positive urine culture, meaning that bacteria is in the urine. The main difference is that in asymptomatic bacteriuria, the older person doesn’t experience pain, inflammation, increased confusion, or other symptoms of infection.
In a young person, bacteria in the urine is very uncommon and almost always corresponds to a clinically significant infection. But in an older person, bacteria in the urine is common.
So you cannot diagnose a UTI in an older person just on the basis of a positive urine culture. Instead, the family and clinician must note other signs of infection, such as pain or delirium.
Families are often surprised to learn that clinical trials have repeatedly found that it is not helpful to treat asymptomatic bacteriuria, but it’s true. In fact, a 2015 study found that treating asymptomatic bacteriuria with antibiotics increased the likelihood of later having a real UTI, and that the real UTI was more likely to be antibiotic-resistant.
For more on this topic, see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.
4. Talk to your mother to get her perspective on drinking more (and to find out if continence issues are a concern for her).
Before you keep pressuring her to drink more: have you spent some time talking to her to learn more about her perspective on drinking more, and on avoiding dehydration?
The more we learn about how an older person sees a situation, the better equipped we are to try to assist them.
In particular, inquiring about how an older adult feels about drinking sometimes reveals that they are concerned about worsening their urinary continence symptoms. (Learn more about managing these here: Urinary Incontinence in Aging: What to know when you can’t wait to go.)
5. Pay attention to figure out which fluids your mother prefers to drink and try scheduling frequent small drinks.
Ultimately, there’s no substitute for paying close attention, keeping track of your observations, and doing some trial and error to figure out what seems to improve things.
No doctor has a magic formula to get an older person to drink more. So identify the drinks your mother prefers, start tracking how much she drinks, and then start experimenting to figure out what works.
Usually, a combination of the following three approaches will improve fluid intake:
- Offer a beverage the person likes,
- Offer small-to-moderate quantities of the beverage on schedule,
- Address any urinary incontinence concerns.
You can also increase fluid intake by offering foods that contain a lot of water, such as watermelon, or perhaps soups.
Do you have any additional questions regarding the prevention of dehydration in older adults?
Post them below and I’ll see how I can help.
This article was reviewed and updated in July 2021.
drink at least 1.7 liters/day, which corresponds to at least 57.5 fluid ounces. In the US, where a measuring cup = 8 ounces, this is equivalent to 7.1 cups/day.
After reading this, I poured 7.1 cups of water in a bowl. There is no way this is the correct amount to DRINK in a day. It has to be way too much. Maybe if one counts the moisture in ALL the food one eats as well. This reminds me of the “urban myth” that has been debunked that one should drink 8 cups of water a day. Everyone repeated this because they thought it was backed up by research but, it wasn’t and turned out to be an interesting case study in how directives enter into commonly accepted wisdom.
Thanks for bringing up this point. When I researched the post it was a bit unclear to me whether the daily fluid recommendation was supposed to include food or not. Also true that many medical myths are out there, and the “8 glasses of water per day” one was thoroughly debunked by Dr. Aaron Carroll in the NYT in 2015.
In terms of research, as far as I know, no one has randomized older adults to receive more than 1.7L/day versus less, and seen what happened.
But this study did randomize men aged 55-75 to drink an extra 1.5L/day; this extra intake did not improve outcomes. The full article (behind a firewall, sorry) reports that at baseline, participants had a daily fluid turnover of 3 liters/day. (They used a fancy “deuterium-labeled water method” to measure fluid turnover, so this measurement should be fairly accurate.) So this might be consistent with drinking 1.5/L and getting the other 1.5L through food.
What we DO know is that many older adults ARE at least mildly dehydrated, especially those who are older, frailer, or cognitively impaired. (The NYT’s Dr. Carroll is very smart but he is a pediatrician, which colors his clinical expertise, plus most clinical research is not conducted in people like the questioner’s mother.) Those older people likely would benefit from an increase in daily fluid intake. The true answer to how much they should drink is “however much usually keeps them from being dehydrated per their labs.” But since this is not feasible to measure for everyone, it seems reasonable to keep the guideline of 1.7L/day in mind.
Hints to get an elderly mother to drink when she had drinking problems I.e. she will start coughing when sipping mote than 1.5 to 2 gulps?
I’m sorry to heat that your mother is having trouble getting enough fluid. Coughing when drinking liquids could be a sign of a swallowing problem. I made a video about that, which you can watch here: https://youtu.be/Tv7GsowTL1o
Sometimes a thickened fluid texture can be easier to swallow, and offering very small amounts (30-50 ml) several times a day can make it easier to get the fluids in over the course of a day. Remember that older adults can get fluid in their foods (like soups or smoothies) as well as in the form of liquid beverages.
I manage a home health agency and dehydration is, indeed, a very common challenge encountered by us. This is a wonderful and complete article. Thank you! I would add that sneaking watery foods into the diet may help, too. Watery fruits and soups (especially nice warm soup on a cold day) may help add needed water into the diet–just watch the sodium content. Also, people are more willing to take in extra water with medications if you tell them it is medically necessary. Anytime a medical professional says to do something, people are more inclined to do it.
Thank you for sharing these terrific practical suggestions. Agree that fruit and soups can be an excellent way to provide extra fluid to older adults.
would drinkin’ electrolyte water be effective in retention for mild dehydration??
For mild dehydration, drinking just about any kind of fluid — including plain water — will help. A fluid that contains electrolytes may be more effective, and would be more important if the dehydration is worse than mild.
The University of Arizona provides a recipe for making a home-made sport drink, they suggest:
“Dissolve ¼-1 teaspoon iodized salt into 12 ounces (1 ½ cups) boiling water. Mix in 20 ounces
(2.5 cups) 100% fruit juice and 2 ounces (¼ cup) lemon juice. Chill and drink. Makes four 8-ounce servings (1 liter).”
Will this be good for a 75 year old man to drink for bad dehydration, he had prostate cancerhad treatment radiation and had a injection hormones every 3 months he had his last injection in September, he constantly sweats alot, badly dehydrated, what can I do for him
If you are concerned about an older person being badly dehydrated, then I would definitely recommend getting a medical evaluation. It’s important to understand why he has become so dehydrated, and also it may take more than getting him to drink extra, to treat his dehydration. Good luck!
I have off & on for a number of years had Low sodium level:
* while drinking my (8 glasses per day)
I use mineral water which has sodium , 1 cup coffee & one cup tea per day Decaff.
& (2 Eight Oz glasses Gatorade each day).
However when July comes around my Blood sodium goes down.
My June sodium lever is 133. Very hard to get up to 136…
I eat fresh foods no Prepackaged food with added sodium.
My internist works with a nephrologists I visited several years ago.
I write down each glass on card spas I pour it out.
My urine color is very light as it should be which indicated good kidney functions.
*Both doctors are both puzzled.* ( both Emory System) (top doctors) great relationship w/ Both doctors 25 yr w/Internists.
I drink no alcohol.
It is very scary for me …I get tiny cramps in my legs & know low sodium.
I am age 80 but In Excellent health.
It sounds like you’ve been talking with your doctors about this issue which is a good idea. Low sodium levels can be related to fluid and salt intake as you mention, but can also be affected by medications and other health conditions.
For most people, a slightly lower than normal sodium level is not dangerous, and can be monitored with regular bloodwork.
My father, who is 91 years old, was just released from hospital. They could not find any cause for his dilirium but administered intravenous fluids as a precaution. After 3 days he returned to normal. We encouraged him to drink more water (which he did while we were there). This is not the first episode my father has had with dilirium and each time it happens the hospital has no prognosis but again administers intravenous fluids as a precaution. These episodes are far more serious than we were aware of, thank you for sharing your knowledge of these issues. We will continue encouraging my father to drink fluids more often. He is also taking Boost on a daily basis but I wonder just how much good this product does as opposed to drinking just plain old water.
Sorry that your father has been experiencing delirium. Yes, some older adults need a lot of encouragement in order to drink enough.
Boost is usually used for supplemental nutrition rather than just for hydration, but it’s often not even a good choice for that purpose, I address this issue in more detail here: Q&A: What to Do About Unintentional Weight Loss
I would recommend talking to your father’s doctor about what fluids might be right to keep him hydrated. Usually water or diluted juice should be fine. Good luck!
How much liquid is needed and how long will it take with the patient rceiving care at home to become hydrated?
As I say in the article, experts generally recommend older adults consume 1.7 liters of fluid per 24 hours.
If a person is actually dehydrated, how much liquid is needed and how long it takes to rehydrate depend on many things, including how significant is the dehydration, the underlying cause, and the person’s ability and willingness to drink fluids.
What can you do when your mother will not drink because she has to urinate frequently and thinks that she won’t have to go as often? I told her that it’s not uncommon to have more bathroom trips but she will not drink more than 3 small glasses per day.
That’s not uncommon, but it certainly can be challenging to work through. If her continence issues are the main concern, then I would recommend focusing on that and helping her address them.
First, she should be evaluated to determine what’s causing her frequent urination and to see if any medications or other health-related issues are aggravating her continence issues.
How to manage incontinence really depends on what the underlying causes are. But in general, timed toileting and bladder training are helpful in many circumstances.
Finding a suitable and comfortable incontinence pad can also help quite a lot, especially for trips out of the house or any other situation that creates worry about “what if I need to go?”
Lastly, in terms of general strategy in persuading an older person, it’s important to try to avoid lecturing and power struggles. Try to start by inviting your mom to share her thoughts and concerns, ask her what she thinks might help, and be sure to use “I messages” when you voice your concerns, rather than “you should” messages. Good luck!
Best formula for water intake is 35mlperkgperday in summer
Add 500ml extra .this formula does not include congestive heart failure and ckd
Thanks for sharing this formula. This formula would suggest an intake of 1.9 liters for someone of my weight, which is about 8 cups of water and that’s just a cup more than the 1.7 liters/day suggestion in the article.
Dear Leslie, I have written to you before and am grateful for your site. Alimentary canal blocked today after drinking extra water. Had a yucky episode with severe reflux propelling body to the toilet. My chief concern has to do with the bowel. Last week I cancelled a colonoscopy. At nearly 85, COPD, problems with other (? Most) body systems, decided it was too risky. After the above episode was able to pass stools and eventually urine … lately have had fluid retention and mild constipation. At the end of las toilet visit there were, what looked like, dark grains ? from multi grain bread; now concerned they could be what some refer to as coffee grounds. I have no idea what the last things look like when connected to bowel cancer. Also for some weeks have post natal drip which is very annoying…thickish, clear, no odour. In Australia visits to the Doctor are ‘time rationed’, chipping into confidence. Thank you for your help.
Glad you find the site helpful. If you are concerned about potential blockage of the bowel sounds more like constipation than dehydration (although dehydration can certainly make constipation worse). More on constipation here: How to Evaluate, Prevent & Manage Constipation in Aging.
Re “coffee grounds”, there is a phenomenon called “coffee ground emesis”, it is something people vomit sometimes when they are having bleeding in the upper gastrointestinal tract. When blood from the upper part of the bowel eventually exits from below, it is called “melena” and it looks dark and tarry, due to the effect of the body’s digestion on the blood. “Dark grains” in the feces doesn’t ring any bells for me in terms of signs of bleeding or bowel cancer. It certainly is common for small bits of indigestible material (e.g. the outside of corn kernels) to show up in the feces.
You mentioned in a prior comment that you are “all alone.” I would say that a bigger issue to address in this case is how can you get extra help and support regarding your health concerns, and who could support you if you were unwell. I’m not sure what the options are in Australia. For someone in the US, I might suggest looking into local community groups for aging adults and local non-profits. Churches sometimes sponsor such groups. Some people also get a lot of benefit from connecting with others online, either people with a similar social situation or with similar health problems.
In the US, we also have privately paid services, such as patient advocates (for help sorting out a health concern) and in California, professional fiduciaries (for help overseeing general affairs and sometimes medical affairs as well).
I suppose what I am saying is that although it’s certainly valuable to use the internet to research specific health conditions and concerns, this can’t substitute for having support in navigating the medical experience, and eventually, in navigating other late-life challenges. So I would encourage you to research options for finding that support in your area. Good luck and take care!
I should have mentioned I have iron deficient anemia, Barrett’s Osophegus and ulcers in it too. Regards. I need a secretary!
Thank you for another clear, thorough, hugely helpful article!
When I trained as an EMT, we were taught a quick “test” for dehydration–gently pinching the skin of a person’s forearm between our thumb and first finger. If the skin subsides, the person is probably OK. If the skin stays in that puckered position, dehydration might be occurring.
Is this a reliable way to quickly check hydration?
Thanks again for all you do–and share!
Pam
Glad you found the article helpful.
The “skin pinch” test you describe is unfortunately not reliable in older adults, because the skin gets thinner and much less elastic with aging.
Honestly, I think a reasonable fast way to check hydration is to encourage the person to drink a glass of water and then see if they noticeably perk up within 10-15 minutes.
Hi Leslie, A member of my family had dementia. As things got worse they had to be cared for in a nursing home. They werent happy about this but there was no other option . Although they were still full of life and a good laugh. Loved by both staff and residents. After about 7/8,weeks they started to become dehydrated. So week later were given iv fluids for 3 days i think. It turns out when tested after the iv they were still badly dehydrated . A week later the doctor had to be got again and less they five days later they died. Why would the iv not have worked and how come they went down hill so quickly?
Sorry to hear of your relative’s decline and death. When it comes to more significant dehydration — or more significant illness, which can cause a need for IV fluids — there are all kinds of possibilities so it’s really not possible for me to say what happened. From what you describe, I think it’s quite possible that there was more going on than just a need for rehydration with normal saline.
To learn more about what happened, you could try asking the involved health providers to explain in a little more detail. Alternatively, your family might be able to request the medical records and have them reviewed by a medical expert, who could then perhaps explain.
I am a 69 year old woman. I had a lumpectomy 2 years ago and had problems with dehydration during my treatment. I had to go get routine blood work done yesterday and it took the tech quite a few tries using 4 different veins before getting even a drop of blood. Finally she was able to get a trickle out of one. She said I needed to drink at least 20 oz of water before having blood work. Since she couldn’t get any blood out of 3 veins, does this mean that I am dehydrated? Does this mean that the blood isn’t circulating through my body properly?
As I mention in the article, clinical signs don’t necessarily correspond well to whether or not someone is dehydrated. If you are concerned about whether you are dehydrated, I would ask your usual health provider to help assess you for this. Good luck!
I am 82 y/o in good health but have had dehydration problems for about 8 months. I drink 30 oz of water with a “Hydration Multiplier” added each day. But, my urine is usually dark yellow at all times and I have balance issues and headaches which I believe are due to the dehydration, my skin is very very dry. What is the solution?
It’s possible to experience dehydration if you are drinking a lot of water, but mainly if something is malfunctioning with the kidneys or with the endocrine system. Your balance issues and headaches may or may not be related. I would recommend getting evaluated by a health provider. The “solution” will depend on what is causing your symptoms, and that can only be determined by an individualized encounter with a qualified health professional. Good luck!
My mother is 94 she has been diagnosed with dehydration and I’ve been treating her at home for a couple of years for it with electrolyte popsicles ( Pedialyte) and slowly training her to Drink more water from Water that you buy in the store in 8 ounce bottles. I give her 1/2 bottle at a time. Recently her symptoms have gotten worse. She becomes confused and delusional ( wants to go home to her real home doesn’t know where she is ). Her face becomes pink and a little puffy her eyes look puffy and slightly bloodshot and she is warm to the touch like she has a slight fever. I’m beginning to notice that this could be happening after excessive urination. Her doctor has already diagnosed her with dehydration. At what point do I call 911? Is the flushing a sign of extreme dehydration? The local emergency room is a little short of a nightmare. Mom is a bad patient so she needs to be taken by ambulance and even though she goes right into the emergency room sometimes it’s a long time before she’s seen. One time she was sent home without ever being seen by a doctor. Because of her age and her physical problems it is really difficult for her to get through a visit to the emergency room. So I use it as a very last resort.
Sorry to hear of your situation with your mother. I would not expect flushing with dehydration unless there was some kind of overheating related to it.
Becoming more confused and/or delusional than usual does sound like delirium, which can be brought on by a variety of physical illnesses or other stressors on the body or mind (e.g. medication side-effects). I suppose it could be brought on or worsened by dehydration, but it’s probably not safe to assume that dehydration is the problem; instead she should be medically evaluated if you think she’s delirious.
The emergency room is not ideal for someone her age; as you point out, there is often a long wait plus under some circumstance patients or families are charged some type of copay. You may want to contact your local Area on Agency, to find out if there are ways that you could get help transporting her to a PCP or urgent care facility. I would also recommend discussing goals of care with her usual health provider. Good luck!
Your article didn’t mention something that happened to me: I felt weird while gardening, and, having had three stents placed earlier in the year, ended up in the ER.
In HINDSIGHT, the fact that my veins were sticking out on the backs of my hands and that I was not able to produce any urine practically for their tests, told me that I had let myself get thoroughly dehydrated (a first time for everything – I was outside weeding on a hot and humid day, with no water next to me).
THEY WOULDN’T LET ME DRINK WATER. They insisted on analyzing what I told them was not a clear catch sample (and tiny). Then they came back insisting I had a very bad UTI and wanting to hang a bag of a powerful antibiotic. I refused the antibiotic, said I’d wait for a second test to confirm.
They admitted me, and I spent the first two hours in the room drinking icewater – and recovering quite nicely. The next morning’s tests – plenty of sample – showed no evidence of a UTI, and I was released.
A couple of simple questions at the very beginning would have caught the dehydration. Letting me drink plain water before I saw the doctor would have been prudent. And, as you said, had me perked up in a few minutes. They didn’t even CONSIDER dehydration.
I was not impressed. I am not going to let that one happen again. Really stupid waste of resources.
Thanks for sharing your story. I know most healthcare providers are well-intentioned, but things do sometimes slip through the cracks. So it’s good to inform oneself and be proactive when possible. When one is ill, it also helps to have a trusted family member or friend available to advocate.
So many articles, this one included, assume that the elderly person is living with someone who is there to offer water every hour or so.
My mom has ended up in the hospital twice because of dehydration. In her case her heart meds weren’t washing out of her system so it was like she was over dosing on her medications which slowed down her heart to the point where she was non responsive.
In my mother’s case, she does have memory issues, she doesn’t like to drink water, she probably has one cup of coffee in the morning and maybe a sip of water when she takes her meds.
I feel short of living with her, there’s really not much we can do to get her to drink more. I feel like we’ve tried everything from notes around the house to straws, water bottles, phone calls and I even told her that her wrinkles would plump up and go away if she drank more water lol. Nothing seems to work.
It can indeed be very difficult to get an older person living alone to drink enough water, especially if that person has any memory issues. It sounds like you’ve tried a lot of good ideas (notes, phone reminders, etc), I’m not sure I can think of anything more. Many older people with memory issues eventually are unable to keep living on their own without some form of daily assistance. You could see if she’s able to maintain hydration if someone stops by, or even comes to stay with her for a few hours a day. Some people also find that leaving the older person with a lot of cut up watermelon can help. As you know, there are often no easy answers. Good luck!
Always amazes me how much controversy exists in medicine even on simple recommendations how much water to drink. A great website, Dr. Kernisan.
Thank you, glad you find it helpful!
I find the article very relevant especially during Summer because we do experience heat wave these days. It helps us to manage our very experience of dehydration based on the symptoms previously discussed. It was helpful for me.
Thank you!
Loved this article. It was very timely as my 97 year old mother, who lives with us just had another episode of dehydration. She had fallen in the bathroom, thankfully didn’t get hurt. When she complained about her very dry rough lips, I suspected we were dealing with a fluid deficit. By the end of the day, after a few added glasses of diluted juice, she was acting much better. A bigger concern for me is finding an appropriate internist for her. Is there a resource for finding a geriatrician for her?
Glad you found this article helpful.
I share some ideas on finding geriatric care here: How to find geriatric care — or a medication review — near you. Good luck!
Thank you, Doc. I was admitted to the ED with shortness of breath a couple of days ago. Turns out that I was “just” dehydrated. After an infusion of a liter of some solution and a meal, I felt much better.
Glad you are better. I hope you won’t need to go again to the ER any time soon. Stay well and take care!
Very helpful article. What are your thoughts on hydrating gels such as Gu and other brands for elderly dementia patients who struggle with swallowing fluids? I know some products have high levels of caffiene, but if they are no caffeinated and are contain primarily electrolytes and some sugar, are these encouraged?
Hi Kim. I’m glad you found the article helpful! Products like “GU” appear to be designed for fitness activities, and they can provide energy in the form of carbohydrates (including sugar) and some contain caffeine, but are not hydrating.
For those with trouble swallowing, there are thickeners available, usually in the form of starch or xanthan gum, which can be added to liquids. The drawbacks to thickeners is that they can sometimes make people feel full sooner, so they can decrease appetite, or can affect flavour and enjoyment of food. Here’s a little video about swallowing difficulties that you may enjoy.
I went to the emergency room11 days ago for severe muscle cramps, worst pain of my life. Blood work showed server hydration, thay gave me 3 bags of fluid through iv and felt good. Sence then I drink about 50 oz of Gatorade and a half gallon of water a day, 10 days later and I am starting to cramp up again i am starting to get nervous that something serious is going on with me! I am calling my Dr in the morning. I am 45 year old male. Can you please help me!!!
Sorry to hear about your ED visit. I usually work with older adults so I’m not sure what advice to give someone in their 40’s. In an older person I would start by reviewing medications and lifestyle patterns to see if there is some troubleshooting that can be done there. Good idea to call your doctor.
It is a big struggle to get my mom to drink enough liquids. However, she loves fruits, and in particular watermelon and grapes. She seems to do ok with this, no real instances of dehydration that I can point to – will fruits suffice as a partial substitute for liquids?
Fruits and vegetables, soups, juices,teas etc. can be great sources of fluid. In fact, if you’re on a fluid restriction, you should count those items into your daily fluid allowance. However, in the case of fruit especially, the content is not just liquid but also sugar (although natural fruit sugar), which can be dehydrating in large quantities. If your someone who consumes a lot of fruit is not having dehydration episodes, then that’s probably OK, but I would continue to encourage some water intake as well.
My mother has dementia and is 85 y/o. She has caregivers with her 24 hr/ every day. She gets up at noon time and goes to bed at 9:00 p.m., but doesn’t get a lot of fluid after 5:00 p.m. She gets around 51 oz of fluid each day within 5 hour period. Her nighttime caregivers have said she’s getting to much fluids in a short period of time and causing her to have a lot of output at night. Some nights she saturates her Depends, pj’s, and bedding and other nights she remains dry. Is this a problem for my mother?
A couple of things to keep in mind are that:
1. Fluid intake may include more than just beverages and need to take into account liquids that are in soups or other foods, and water used to swallow pills or take other medicines.
2. Fluid requirements vary according to a person’s medical issues and activity levels, among other things.
People who are living with dementia may have incontinence for multiple reasons, and fluid restriction is not always the answer. Often, a regular routine of being reminded, or assisted to use the toilet during the day can promote less wetting at night.
Look up night time nocturia. Happens in elderly females more often. Antidepressants and a lot of meds interact creating increase voids at night. They wake up in mornings soaked from head to toe. They have a history of getting up 2-3 x a night to void when younger.
Nocturia is nighttime urination, as you mention, and most older adults get up 1 – 2 times a night. It can be a big problem, and as you mention, medications and other medical conditions can make it worse. Dr. Kernisan has an excellent podcast about nocturia that you can listen to, here. I also have an article on the website about urinary incontinence. Hope that’s of interest to you, and thanks for your comment!
Very helpful article. I have a question regarding my father who is 77 and being bedridden from past 8 years. He got a brain stroke in the year 2014.
He eats food but not ready to drink any fluids. We tried giving milk and lemon juice as a substitute of water but its not working. I can see some confusion happing in speaking at times but not sure it is due to less fluid or due to his stroke history. Even his body is shrinking.
He wets bed more than five times in a day.
Can’t understand without having fluids how he is able to urinate.
Looking forward for your reply which might help me with some clarity.
I’m glad you enjoyed the article, and I’m sorry to hear about your dad’s stroke. Strokes can affect swallowing, and can also be a cause of cognitive impairment. Both of these conditions can make it more difficult for someone to consume thin fluids (as opposed to thickened fluids, which have a consistency like honey or nectar).
Fluid can enter the body through food intake as well, so even if someone doesn’t drink water or another liquid, they can still get some moisture through their food and can produce urine. Urine output alone isn’t necessarily a good sign of hydration in an older adult, so we often need to get additional bloodwork or tests, as mentioned in the article.
This has been the most educative article I have read this year.
Thank you very much.
My mum who is 77 recently fell I’ll and the diagnosis was mainly dehydration. It gave us a near scare. She also suffers from Dementia.
Though she is getting better thank God, she is still a bit weak and lost so much weight in 5 days. From your article I learnt fluid intake doesn’t always have to be just water. We could introduce a cordial such as Ribena and juices to encourage her drinking.
The weakness is still a bit of an issue, how can we help her.
Also, my mum loves cold water but we are constantly advised cold drinks are not good for the elderly, is this true?
I’m glad you’ve got a plan to help with your mom’s dehydration issue. Remember that juices can be high in sugar, so I often advise watering them down with plain water, which is more hydrating than a sugary beverage.
Dr. K has a good article about weight loss, which you can read, here.
I’m not aware of any reason to avoid cold drinks, especially if it encourages a person to drink more water!
Try adding aloe vera whole leaf fillet dietary supplement for a time.
Aloe vera is used by some as a dietary supplement, mostly to help with skin and hair, but I’m not aware that it can be useful for treatment or prevention of dehydration.
My mom is 96 and lives with me. She doesn’t drink much anymore without lots of encouragement. I’ll need to remind her over and over to drink and hand it to her to get her to actually drink anything. We are lucky to get her to drink 3 Ensure (24 Oz) and two water bottles. 32 Oz Most Times she won’t get that much down. She stopped eating regular food about 3 and half months ago and now only gets her nourishment through the Ensure. Up until a few months ago she would eat tiny amounts but now she puts food in her mouth and spits it out. She does know how to swallow and can easily swallow her medicine. She had gotten an iv last year and they had to go deep vein with an ultrasound to find a vein on her. Then iv came out. Was aweful for her. I’m interested to know more about the fluids under the skin in the stomach that was addressed in your article for elderly people. Is it something a home caregiver or family member could administer with training from a nurse? Desperately trying to get my mom to drink more. She has been on antibiotics due to UTI from Urine tests probably ten times since March. This past weekend she started getting rash on legs. Geriatric. Doc thought it might be from a new prophylaxis antibiotic we were trying. Didn’t think it was sepsis but prescribed levoquin and she seemingly is feeling a little better. I have been measuring output and input and the last few days we are lucky to have 30
Oz of each. I was sick yesterday and couldn’t offer the fluids every hour or so. My daughter came over and stayed and would offer my mom fluids. Can you also tell me what the fluid accelerators are that I read about. Such a great article and thank you so much
Thanks for sharing your experience and I’m sorry to hear about the difficulties your mom is having.
You don’t mention if she is living with dementia, but many of the older adults that I treat, who are in a more moderate to advanced stage of the dementia journey, have trouble maintaining an adequate intake of food and liquid. Often, it’s a lot of work to try to keep the person hydrated, and sometimes, the goals of care will change form trying to keep providing enough calories and fluid, to just keeping the person free from suffering, in a comfortable state.
Hypodermoclysis, or giving fluid under the skin can be used in the short term, but isn’t usually practical for more than a few days to weeks at most. It is often used in palliative care, and for short term rehydration. It’s possible that a port could be placed and a family could learn how to do it, depending on your region and skill set.
I’m not sure what a fluid accelerator is, so I can’t comment on that.
Your technique of having someone offer small sips of fluid frequently is often the most successful and least invasive way to go. Good luck.
I am a bit over 90 years old live along weigh about 160 lbs still drive take no prescriptions no known health problems walk a mile a day do a 45 minute workout stretch out. BuT….since my wife of 6o years passed away a year ago I feel so tired , slightly dizzy and generally worn out. After reading your article I realize I drink very little liquid and wonder if that can be part or a lot of my problem?
Hi David and congratulations on keeping up with those healthy habits! I’m so sorry to hear about the loss of your wife.
More fluids might help with dizziness, if there’s a mild dehydration. As a Geriatrician, I always think about medications too (although you mention that you take no prescriptions), salt intake, and other medical conditions (thyroid, diabetes, heart disease, etc). Even grief can cause fatigue and other symptoms.
If I saw someone like you in my office, I would do a full physical exam and maybe check a couple of basic blood tests, just to make sure we’re not missing anything that we could easily address.
Keep up your healthy habits, but see your doctor too! Thanks for checking out the website and leaving your comment!