Hydration in the Older Adult
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Learn the body’s hydration needs specific to the older adul, the signs or symptoms of dehydration, the three consequences of dehydration in the older adult and the strategies for maintaining hydration status and/or preventing dehydration in the older adult.
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Hydration in the Older Adult
- 1. Hydration in Older Adults Margaret Roche, MS, RD, CSG, FAND, Corporate Dietitian & Sara Casey, RD, CSG, LDN, Director of Nutrition, Dining Services
- 2. Following this presentation the participant will be able to: • Discuss the body’s hydration needs specific to the older adult. • Name the signs or symptoms of dehydration. • Identify three consequences of dehydration in the older adult. • Articulate strategies for maintaining hydration status and/or preventing dehydration in the older adult. 2 Learning Objectives
- 3. Dehydration
- 4. Importance of Hydration in the Older Adult Population
- 6. 6 What happens as we age? Total body water Thirst sensation Kidney function
- 7. 7 Thirst Mechanism • Plasma osmolality • Low blood volume • Low blood pressure • Climate • Temperature • Humidity • Hormones • Medication • Medical issues
- 8. *Graphic Source: Nestle Nutrition Institute 8
- 9. Risk Factors for Dehydration in the Older Adult
- 10. 10 Risk Factors for Dehydration Swallowing disorders Obesity Bedridden or immobility Diarrhea Excessive sweating Vomiting Incontinence Polypharmacy (>4) Chronic diseases (>4) >85 years old Laxatives or diuretics abuse Fever Infection Institutionalization Dementia Comprehension/communicat ion disorders
- 11. Physical Signs and Symptoms of Dehydration
- 12. 12 Signs and Symptoms of Dehydration Thirst Fatigue and muscle weakness Headache Decreased skin turgor Sunken eyeballs Dark urine Swollen tongue Cramping Longitudinal tongue furrows Weight loss Decreased urination Decreased functional ability
- 16. 16 Consequences of Dehydration Inappropriate dosage of medication Constipation Hypotension (low blood pressure) Mucosal dryness (mouth, eyes) Nausea and vomiting Mental confusion Decreased urinary output Elevated body temperature Electrolyte disturbances Acute renal failure Increased heart rate
- 17. Hydration Needs
- 19. 19 Requirements
- 20. • 1500 mL or 1.5 L per day minimum on average • 6-8 glasses of 8 fluid ounces 20 Requirements
- 21. 21 Requirements
- 22. Case Study #1: Introduction
- 23. Case Study #1 Armando
- 24. Armando is a 93 year old man who worked for 45 years as a carpenter. He is a resident of a dementia care community (Assisted Living). He is widowed and has 3 daughters who live near the community and visit frequently. His diagnoses include: dementia, DM, HTN, constipation. Armando’s physician has ordered a Puree Diet with a liquid supplement at 8 pm related to poor dentition and difficulty swallowing. Recently Armando has been sleeping more and not wanting to get out of his easy chair. 24 Case Study #1 Armando
- 25. Armando typically eats well but has recently been refusing meals and is asleep when it is time for his supplement. His monthly weights reveal a 5% weight loss over the past 30 days. His daughters are concerned that his dementia is worsening. 25 Case Study #1 Armando
- 26. 26 Case Study #1 Armando Dehydration Risk Factors Diagnoses: Dementia, DM, Constipation, Swallowing disorder Age Restrictive Therapeutic Diet: Puree Poor food intake
- 27. 27 Case Study #1 Armando Dehydration Signs & Symptoms Weight loss Muscle weakness Fatigue Confusion Nutrition focused physical exam
- 28. 28 Nutrition Focused Physical Exam
- 29. • Sunken eyes • Skin turgor • Edema • Dry, cracked lips • Swollen tongue • Dry tongue and mucous membranes • Longitudinal tongue furrows 29 Nutrition Focused Physical Exam
- 30. 30 Nutrition Focused Physical Exam
- 31. 31 Nutrition Focused Physical Exam
- 32. 32 Anthropometrics Current Weight Status • 5’10’’ • 166 lbs Ideal Body Weight • Male: 106 lbs for first 5 feet, 6 lbs per inch • 106 lbs + 66 lbs = 172 lbs • 96% IBW Usual Body Weight • 175 lbs 30 days ago • 175-166 = 9 lbs/173 = 5% weight change
- 33. Calculating Fluid Requirements 33 Hydration Needs • 166 lb man or 75 kg x 30 mL = 2263 mL/day • *Most accurate for institutionalized elderly 30mL/kg body weight* • Example: 2200 kcal x 1 mL = 2200 mL 1 mL/kcal consumed • Then: 50mL/kg for the next 10kg and 15mL/kg for remaining 100mL/kg for first 10kg actual weight
- 34. • Tube feeding dependent individuals should have free water provisioned at ~25% total formula volume • Adjust to 35mL/kg for dehydration, diarrhea, draining wounds, fever, ostomy losses – 166 lb man or 75 kg x 35 mL = 2640mL/day • Adjust to 25mL/kg for ascites, 2-3+edema, SIADH, CHF without diuretic • Adjust for obesity • Adjust for fluid restrictions (CHF, CKD) 34 Additional Considerations
- 36. 36 What are your challenges to adequate hydration?
- 37. • Set a daily fluid goal. • Schedule when to drink water and beverages. • Drink water or beverage with meals, snacks, and medications. • Keep a glass of water nearby for frequent sips. • Small, frequent consumption. 37 Strategies and Tips
- 38. 38 Tips *Graphic Source: Nestle Nutrition Institute
- 39. • Be proactive – hand resident a drink instead of asking. • Incorporate foods high in water content in daily activities (popsicles, gelatin, watermelon). 39 Strategies and Tips
- 40. 40 Palatability
- 41. • Warm in winter, cool in summer. • Add flavor to water such as lemon, cucumber or mint. • Provide sugar free flavored beverages. • Limit or avoid alcohol, coffee and high protein drinks. 41 Palatability
- 43. Case Study #1: Intervention
- 44. Case Study # 1 Armando
- 46. • Fruits and vegetables • Soup • Tomato sauce • Ice cream • Pudding • Gelatin • Yogurt • Popsicles • Cottage cheese 46 Fluid Containing Foods
- 47. 47
- 48. 48 Daily Intake Example 6 oz orange juice, 4 oz milk, 6 oz decaf coffee, ½ cup strawberries 6 oz broth soup, 8 oz water, 1 cup watermelon, ½ cup tomato salad ½ cup gelatin, ½ cup cantaloupe, 6 oz flavored water x2, 2 .oz water x2 8 .oz flavored water, ½ cup lettuce salad, ½ cup zucchini, ½ cup ice cream
- 49. 49 Daily Intake Example 540 mL 600 mL 660 mL 420 mL
- 50. Case Study #2 Gwen
- 51. Gwen is an 89 year old woman with a recent hip fracture admitted to a skilled nursing community for rehabilitation. Diagnoses include HTN, s/p CVA, CAD. Gwen resides in an assisted living community. She values her independence and is looking forward to returning to her activities including knitting blankets for veterans. Gwen had a UTI in the hospital which is resolved. PT is going well and Gwen is expected to be able to walk with a walker soon. 51 Case Study #2 Gwen
- 52. Gwen’s physician prescribed a 2gm Sodium diet because of her diagnosis of HTN. Gwen typically eats small meals, she reports to the dietary manager that she has an “OK” appetite. Her favorite meal is soup and sandwich, she enjoys sweets. Since admission Gwen’s food intake has been variable, she refuses between meal liquids. Her hospital weight 1 month ago was 110 lbs. 52 Case Study #2 Gwen
- 53. 53 Case Study #2 Gwen Dehydration Risk Factors Age Diagnoses: Hip fracture s/p CVA Restrictive Therapeutic Diet: 2 g Sodium Limited mobility Fear of incontinence
- 54. 54 Case Study #2 Gwen Dehydration Signs & Symptoms Weight loss Nutrition focused physical exam
- 55. 55 Anthropometrics Current Weight Status • 5’3’’ • 106 lbs Ideal Body Weight • Female: 100 lbs for first 5 feet, 5 lbs per inch • 100 lbs + 15 lb = 115 lbs • 92% IBW Usual Body Weight • 115 lbs 30 days ago • 115-106 = 9 lbs/173 = 8% weight loss
- 56. Calculating Fluid Requirements 56 Hydration Needs • 106 lb woman or 48 kg x 30 mL = 1445mL/day • 106 lb woman or 48 kg x 35 mL = 1686mL/day • *Most accurate for institutionalized elderly 30mL/kg body weight* • Example: 1800 kcal x 1 mL = 1800 mL 1 mL/kcal consumed • Then: 50mL/kg for the next 10kg and 15mL/kg for remaining 100mL/kg for first 10kg actual weight
- 57. Case Study #2 Intervention
- 58. Case Study # 2 Gwen
- 59. References 1. Chernoff, Ronnie. Geriatric Nutrition, The Health Professional’s Handbook, 4th Edition, Jones and Bartlett Learning, 2014 2. Ventura Marra, M. Warren, AL. Hollingsworth, EK, et al. Body Mass Index Does Not Protect Long Term Care Residents from Impaired Hydration Status, Inadequate Fluid Intake or Dehydration Risk. Journal of the Academy of Nutrition and Dietetics, Vol. 115, Issue 9, A16, September 2015 3. Position of the American Dietetic Association: Nutrition, Aging and the Continuum of Care. Journal of the American Dietetic Association, Vol. 100, Issue 5, 580-595, May 2000. 4. USDA National Nutrient Database for Standard Reference : USDA ARS. Web. 04 Jan. 2017.
Editor's Notes
- GRAPHICS NOTE: Title font should be Georgia 37 point in black, text 1. The presenter’s name is set in Segoe UI, 24 pt. The presenter’s job title, 18 point Segoe UI italic. Adjust font size and position on all text as needed.
- Obesity adjusted: (10kg x 100mL) + (10kg x 50mL) + (resident’s wt in kg 1 20kg x 15mL)
- GRAPHICS NOTE: This is a final slide to be used at your discretion or preference. No text should be on this page.