December 10 was our last meeting of the
year. Brenda had her daughter present the topic of dehydration for
the elderly. Allison started by stating she was not a doctor and as
such she may not cover everything and may not be able to answer some
questions.
She asked for a show of hands of how
many may be concerned about becoming dehydrated. All hands went up
and she said she hoped what she had prepared would help. Next she
asked how many had read Bob's blog of the current week on this. Most
of the hands went up and then she asked how many had read the link he
had in the blog. Several hands were lowered. Allison said Bob has
many blogs on dehydration and I will mention a few of these at the
end.
Dehydration has medical consequences
and these depend on the severity of dehydration and how long it has
been developing or been in existence. In the elderly, 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 often causes the kidneys to
become inefficient, 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. Another health problem that has been
consistently associated with low daily water intake is kidney stones.
A review on fluid intake and urinary
system diseases concluded that it’s plausible that dehydration
increases the risk of urinary tract infections, but this is not
definitely proven.
Talking about 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 elderly 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.
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.
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 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
seniors than traditional IV hydration.
Severe dehydration may require
additional intervention to support the kidneys, and sometimes even
requires short-term dialysis.
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. Clinical research
hasn’t compared different fluids to each other to determine which
fluid is the best to treat dehydration.
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 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. However, 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 elderly person particularly
loves her morning cup of (caffeinated) coffee, I’d say to consider
accommodating her if at all possible.
Bob has written about hydration myths
here and here and these can be important. If you are having leg
cramps read about the causes here. Then please read about the 14
forgotten caused of dehydration. The last blog you should consider
is about low blood pressure.
Then Allison opened the discussion for
questions and answers and this lasted for longer than she had
expected and finally asked if another meeting would help. Yes, was
the answer and Brenda suggested the May 2017 meeting and this was
agreed.
Brenda asked for cleanup and Allison
came to thank me for all the material I had in my blogs to help her
with the discussion.
No comments:
Post a Comment