December 11, 2016

Our December Meeting

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. 

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