Hydration in older adults

Importance of Hydration

  • Hydration is maintained through homeostatic management of fluid intake and loss.

  • Key principle: The amount of water entering the body must equal the amount leaving through:

    • Urine output

    • Insensible losses (skin, mucous membranes, gastrointestinal tract, respiratory membranes)

Complications Related to Hydration

  • Common issues in older adults:

    • Hypovolemia or dehydration

    • Hypervolemia or fluid overload

  • These complications arise due to physiological changes associated with aging.

  • Increased complexity in managing hydration status in older persons.

Role of Nurses in Hydration Management

  • Awareness of hydration challenges is crucial for preventative care.

  • Responsibilities include:

    • Assessing deviations in hydration state

    • Planning and providing care for optimal hydration

    • Evaluating care effectiveness

Daily Fluid Intake and Loss

  • Average daily fluid intake: 2.5 liters

    • Ingested fluids: 1,500 mL

    • Water in foods: 700 mL

    • Water from oxidation of food: 200 mL

  • Average daily fluid loss: 2-2.5 liters

    • Skin: 300-400 mL per day

    • Respiratory tract: 300-400 mL per day

    • Gastrointestinal tract: 200 mL per day

Clinical Assessment of Hydration Status

Two types of hydration complications that older adults may experience are:

  • Hypovolemia or dehydration

  • Hypervolemia or fluid overload

Assessments to evaluate hydration status include:

  1. Medical condition review: Understanding any existing medical issues that could affect hydration.

  2. Neurological function alterations: Assessing cognitive and neurological conditions impacting hydration ability.

  3. Mobility and dexterity issues: Identifying any limitations that hinder fluid intake or management.

  4. Fasting periods during surgery/ investigations: Considering the effects of extended periods without fluid intake.

  5. Environmental factors: Evaluating heat and humidity that may increase fluid loss.

  6. Fluid balance charts and urine output review: Monitoring the quantity and quality of urine.

  7. Comprehensive cardiovascular assessment: Includes checking pulse, blood pressure, peripheral pulses, and capillary refill time.

  8. Skin assessments: Observing skin turgor, color, temperature, and looking for signs of dehydration or fluid overload (e.g., dry or cracked mucous membranes, oedema).

Special Considerations for Patients

  • Respiratory patients may experience increased fluid loss due to breathlessness.

  • Pathology results to review:

    • Alterations in hematocrit (red blood cells to total blood volume ratio)

    • Electrolyte imbalances:

      • Hypo or hypernatremia

      • Hypo or hyperkalemia