Introduction
If you aren’t up on your preventive care and suffer from chronic or acute urinary issues, it can be difficult to manage the symptoms of severe dehydration in elderly adults. Dehydration can be caused by a number of conditions including: Kidney Disease, Diabetes, Neurogenic Bladder Issues and more. Dehydration is a common disorder that can have a wide variety of causes. In elderly adults, dehydration can be related to many different conditions including renal failure, diabetes mellitus, and traumatic brain injury.
In order to make an appropriate diagnosis for dehydration in an elderly adult there are several considerations. In this article we will discuss the diagnostic approach to dehydration in the elderly population with primary care providers in mind. The other articles on this site will focus on other possible causes for diarrhea and vomiting which are not included here but may also cause a need for IV fluids or hospitalization.
Causes of Dehydration In Elderly Adults
1. Kidney Disease
Elderly adults with renal failure are at constant risk of dehydration, especially if they have a history of renal failure or if they are on dialysis. In addition to this one should consider the medications that may cause or result in dehydration and watch the patient closely for signs of dehydration.
Treatment: Don’t wait for things to get worse! A case can be made for starting IV fluid therapy before the first signs of kidney problems become apparent. Patients suffering from kidney disease are also more susceptible to crushing injuries such as falls and can easily lose half their body weight quickly as well as developing electrolyte abnormalities very quickly. Also see our article on Kidney Disease Causes and Treatment .
2. Diabetes
Diabetes is one of the more common causes of dehydration in elderly adults. Diabetes can cause dehydration either by itself or it can occur secondary to other causes such as infections, trauma, or medications. Since the prevalence of diabetes is higher among the elderly population and since so many types of diabetes are now being diagnosed at younger ages, it is important for primary care practitioners to watch for signs of dehydration in diabetic patients.
Treatment: Assess your patient carefully! Patients with diabetes may also be on a number of medications such as Metformin, ACE Inhibitors and diuretics which can all contribute to dehydration.
3. Neurogenic Bladder Issues
Neurogenic bladder problems can sometimes cause dehydration due to increased urinary output or decreased intake. Patients who have neurogenic bladder issues should be assessed for signs of dehydration including weight loss and pale skin, but it is also important to address their symptoms such as urgency, incontinence and pain.
Treatment: If your patient is showing signs of both a urinary tract infection and dehydration (i.e., weight loss, fast heart rate, fever) then consider prescribing an antibiotic to help them flush the bacteria out and rehydrate your patient in the morning.
4. Trauma
Trauma can also cause dehydration. It is important for primary care practitioners to monitor the signs and symptoms of dehydration in the veteran patient. Dehydration can be caused by a number of traumatic conditions including: Fracture, spinal injury, and brain injury.
Treatment: You should be concerned if your patient seems dehydrated and dehydrated rapidly because they are frequently very ill as well. Treat with IV fluids to rehydrate them and prevent complications such as infection. Treat with antibiotics if needed.
5. Gastrointestinal or Liver Disease
Gastrointestinal or Liver Disease can also cause dehydration either alone or in combination with another condition. Diarrhea, vomiting and abdominal pain can also cause dehydration. Constipation can also cause dehydration in elderly adults, but it is a much less common condition than the others mentioned here.
Treatment: IV fluids may be needed to rehydrate your patient or they may just need some laxatives to address their constipation and take care of the diarrhea or vomiting. However, you should always consider alternate diagnoses such as infections before prescribing laxatives.
Bipolar disorder has been found to be one of the main causes of dehydration in elderly adults.
6. Infections
Any kind of infection can sometimes cause dehydration. The most common causes of dehydration related to infection in elderly adults are urinary tract infections and gastroenteritis or “stomach flu”. These are also two of the more common infectious causes of diarrhea and vomiting in elderly adults.
Treatment: In general, once an infection is diagnosed, you should begin a course of antibiotics. Treat for the infection and address the dehydration. Often the antibiotics alone will rehydrate your patient but be sure to address other symptoms such as pain, fever, swelling etc.
7. Medications
Many types of medications can cause dehydration as a side effect or main effect including diuretics, antibiotics, medications for heart disease and hypertension among others.
Treatment: Reassess your patient for dehydration if you have prescribed a medication that is known to cause dehydration. Monitor for symptoms of dehydration and treat with IV fluids if needed. Also see our article on medication side effects and how they can be managed.
8. Eating Disorders
Eating disorders such as anorexia and bulimia can cause dehydration in elderly adults. These patients should be monitored very carefully, especially if they are on medications that can alter their appetite or have systemic illnesses such as cancer which could result in weight loss, hair loss, etc.
Treatment: Monitor your patient carefully for signs of dehydration and treat with IV fluids if need be, but treatment for the eating disorder is also needed.
9. Depression
Another common cause of dehydration in elderly adults is depression. Depression is a frequent cause of weight loss and pain in older adults who may not be eating enough or drinking enough fluids to compensate for it, or they may be experiencing other symptoms such as anxiety which could make them afraid to drink or eat even if they are thirsty or hungry.
Treatment: Anytime an older adult develops any type of psychiatric symptom such as mood swings, anxiety attacks, crying spells etc.
10. Alcoholism
Alcohol abuse is an important cause of dehydration in elderly adults. Signs and symptoms of dehydration due to alcohol abuse include: Frequent urination, excessive thirst, muscle cramps and weakness, etc.
Treatment: Treat any other problems that are currently present. If you suspect alcoholism then treat it. The easiest way to do this is to use a urine toxicology screen which requires your patient to bring a urine specimen randomly when they go in for their other health visit or doctor’s appointment. These are not expensive and will give you a clue as to whether your patient has developed the problem or if it is new.
Conclusion
As you can see, dehydration is pretty common in elderly adults as well. However, it can also be a symptom of many other diseases and conditions. Dehydration should always be considered as a potential problem that your older adult patient could have.