Fluid operations

A co-ordinated effort can keep older residents hydrated, even in hot weather. 

Dehydration is one of the leading causes of hospitalisation in older Australians. Not only are older adults at greater risk of dehydration, they are also more vulnerable to its negative physiological effects. The good news is that the condition can easily be prevented with the support of healthcare professionals and food service staff.

Physiological changes that occur as part of the ageing process contribute to the prevalence of dehydration amongst older adults. Reduced kidney function impairs the body’s ability to concentrate urine and conserve sodium, resulting in greater water losses through urine. In addition to this, a decline in overall volume of body water, changing body composition and diminished thirst response will also greatly affect the hydration status of the older population.

Recognise risk factors

It is important to take into account factors that can influence hydration. For individuals with swallowing difficulties, transitioning to thickened fluids can be challenging and unnerving. This can place them at a greater risk of dehydration if they dislike thickened fluids or do not have access to many options.

Identifying barriers to optimal hydration is essential to putting an effective system in place. This includes recognising individuals who have:

• difficulties with fine motor skills, such as pouring a drink or holding a cup
• reduced mobility and capacity to access fluids
• an inability to communicate
• progressive dementia and are unable to comprehend their hydration needs.

Clinical considerations such as the use of laxatives or diuretics can also increase dehydration risk, as can incontinence and environmental factors such as warm weather.

Symptoms

The symptoms commonly displayed with mild dehydration include:

• dry mouth
• reduced saliva
• dark urine
• constipation
• fatigue
• poor skin elasticity.

As dehydration progresses, individuals are at greater risk of:

• impaired cognition
• acute confusion
• difficulties concentrating
• irritability
• headaches
• altered sleeping patterns.

This can lead to increased incidence of falls.

The decrease in overall water volume in the blood stream affects blood pressure. This results in reduced blood flow to organs and tissues. As a consequence, this can increase the risk of:

• pressure areas
• urinary tract infections
• reduced blood volume (with the potential to cause renal failure in cases of chronic dehydration).
• Prevention

In order to prevent these problems, each individual’s fluid requirements must be met. These will vary, and a range of factors, such as clinical status and weight, must be taken into account. The Australian Nutrient Reference Values suggest that men and women over 70 years old get 2.1–2.6 litres, about 8–10 cups, of fluids each day (from drinks and high-water foods such as fruit, jellies and custards). This can be achieved by making sure a variety of beverages are on hand, such as water, cordial, juice, milk, flavoured milk, Milo, milkshakes, tea, herbal tea, coffee, iced coffee, soft drinks and fruit smoothies.

Knowing whether people have access to water jugs or the ability to pour their own drinks will assist in tailoring an individual hydration plan for them. For residents living in the community, it can be helpful to set up a hydration tick sheet. This is a simple page with pictures of eight cups (to achieve more than 1500ml daily), which get ticked off when fluids are consumed. This can be done by the person or by a partner or carer. In the residential aged care home setting, more detailed charts can be kept by nursing staff to report on intake and output, making them more helpful at highlighting areas for improvement.

Support techniques

Older adults who have regular access to nursing or care staff and are at high risk of dehydration should be encouraged to consume a full cup of fluids when medication is administered. They should also be encouraged to take fluids at all meal and snack times. A schedule detailing amount and type of fluid that clearly outlines requirements throughout the day may be beneficial. This may include hydrating food options such as jelly, ice-cream, custard, icy-poles and soup. These all classify as fluids, given their liquid consistency at room temperature.

Other hydration support for older Australian residents:

• In residential care, foodservice staff could pour a glass of preferred fluid for residents attending the dining rooms at meal times.
• Carers and food service assistants could be trained to recognise when modified cups, such as sipper cups, are needed to help a resident maintain independence with hydration.
• Lifestyle co-coordinators could prompt fluid consumption during activities.
• Residents’ families can promote fluid intake by offering beverages when visiting.

Help in the heat

On days of extreme heat, extra caution is required and additional fluids should be consumed. Most residential care settings will offer an additional hydration round between lunch and the evening meal, along with afternoon tea, which is considered good practice. Fluids such as icy-poles, ice-cream in a cone and hot and cold beverages are generally offered. Some homes will have a lifestyle activity around making milkshakes, ice-cream spiders or freshly squeezed juices, which provides activity for residents as well as vital hydration. It tastes great, too!

For those cared for in their own homes, even a phone call on hot days as a reminder to take extra fluids can be effective. Alternatively, workers who provide only a couple of hours of in-home support in the mornings can leave a jug of cold fluids in the fridge and fill a glass and leave it within reach before they leave.

Early detection and prevention of dehydration will lead to better health outcomes for older adults. Adopt a broad approach that involves the individual, their family and carers.

Jenna Yeo is an accredited practising dietitian (APD) at Leading Nutrition, a national aged care dietetic provider. This article has been written on behalf of the Dietitians Association of Australia rehabilitation and aged care interest group.

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