Watch Out: Signs of Dehydration & Malnutrition in the Senior Living Population

By Natalie Smith, MA, CCC-SLP

Speech-language pathologist

An important step to helping prevent and treat malnutrition and dehydration begins with being able to identify the signs and symptoms of each across individuals, as well as knowing common diseases that may increase the risk of obtaining each diagnosis. Malnutrition and dehydration are unfortunately commonly observed by healthcare professionals as either a primary diagnosis or co-morbidity in the aging population.  Staff working in senior living communities plays a huge role in identifying these symptoms and initiating a plan of action to manage these conditions.  The residents in these communities benefit greatly from the care and compassion of all the staff in SLCs, including nurses, CNAs, caregivers, activity staff as well as business staff.  Everyone can play a role in maintaining the safety of the residents, preventing the exacerbation of current medical conditions, cognitive status, orientation, physical well-being and improving the resident’s overall quality of life.

According to the World Health Organization, malnutrition is defined as “deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients.” Approximately 1.9 billion adults around the world are overweight and approximately 492 million are underweight.

Dehydration is a dangerous condition impacting many adults, which may ultimately lead to hospitalization. The Mayo Clinic defines dehydration as “when you use or lose more fluid than you take in, and your body does not have enough water and other fluids to carry out its normal functions.” The risk of dehydration increases in older adults because the elderly have a lower volume of water throughout the body, their sensation of thirst decreases and they’re more likely to have an increase in medications or medical conditions.

HOW TO IDENTIFY THE TELLTALE SIGNS OF MALNUTRITION

Malnutrition can be broken into two different categories: undernutrition or overweight. Undernutrition is the stunting, wasting, underweight, and micronutrient deficiencies or insufficiencies. Overweight malnutrition is obesity and diet-related non-communicable diseases, such as heart disease, stroke, diabetes, and cancer. With poor nutritional education and poor food choices during mealtimes, the rate of obesity only continues to rise in the adult population.

Signs of undernutrition may include:

• decreased appetite
• weight loss
• loss of fat or muscle mass
• hollowed cheeks or eyes
• a distended stomach
• dry hair or skin
• slowed healing of wounds
• fatigue
• attention deficits
• irritability as well as mood changes, including anxiety or depression

Adults who place in this category have nutrient and vitamin deficiencies that impact overall healing and maintenance of healthy functioning.

Overweight malnutrition may be identified by:

• weight gain
• obesity
• low measures of vitamins and minerals
• onset of diabetes
• decreased exercise

Methods used to assess malnutrition may include completing a body mass index (BMI), blood tests and physical exams, which can all be completed by an adults’ primary care physician. Should malnutrition progress, long-term effects maybe include the development of chronic health conditions such as obesity, heart disease, diabetes, or high blood pressure.

To prevent or help eradicate the prevalence of malnutrition, healthcare providers can monitor several factors when working with older adults. For instance, you may provide assistance to access and prepare appropriate and affordable food either in the home or a senior living community, explore the possibility of digestive problems, monitor alcohol consumption and manage mental health disorders. It is also important to educate older adults on healthy food choices, the importance of consistent and safe physical activity, and the addition of supplemental vitamins and minerals approved via a dietician, food specialist and/or physician.

HOW TO START ADDRESSING DEHYDRATION THROUGH AWARENESS

When determining whether an adult is experiencing dehydration, common symptoms may include extreme thirst, less frequent urination, dark-colored urine, dizziness, fatigue, increased confusion and disorientation, diarrhea, and increased irritability.

Common causes of dehydration are decreased liquid consumption, diarrhea, vomiting, fever, excessive sweating, and increased urination.

If these symptoms of dehydration go untreated, you may witness (or encounter) more severe results like heat injury, urinary tract infections, kidney problems or seizures.

To help prevent dehydration from occurring, it is crucial to encourage older adults to consume enough liquids throughout the day as well as limiting caffeine consumption, which in turn, dehydrates the body. According to the Mayo Clinic, it is recommended women consume 11-12 cups of fluids a day, which is approximately 92 ounces, and men consume 15-16 cups of fluid per day, which is approximately 124 ounces.

However, these numbers also include amounts of liquids contributed by solids, which on average is about 20 percent of daily liquid consumption. The amount of liquid consumption will vary from day to day, depending on someone’s level of physical activity, types of medications, types of food consumed (including foods high in sodium, which are foods we are likely to see in our pantry’s at home: canned soups, frozen foods, nuts or even instant pudding) as well as the surrounding environment such as walking outside in the heat, or sitting in a hot apartment.

EDUCATE TO ERADICATE DEHYDRATION AND MALNUTRITION

Healthcare providers must not be the only ones ready to observe these signs and symptoms of aspiration and malnutrition in elderly adults. It is also imperative to educate and train family members and friends regarding these issues. If these adults are still living at home, the first observation is likely going to be a spouse, child or another family member.

The same goes for all staff in SLCs, including nursing staff, caregivers, dining staff, and the director.  Anyone who comes in direct contact with the residents should be educated and trained in the warning signs indicating malnutrition and dehydration.  This group should first be capable of identifying these signs and symptoms and secondly be able to relay that information to their family physician as well as follow through with the appropriate strategies and treatment methods to not only reverse the effects of malnutrition and dehydration but also prevent further issues from arising. Malnutrition and dehydration are conditions that are often products of habit and routine, so it will take time, patience and perseverance to change these behaviors for lasting effects.

A BROADER LOOK AT DEHYDRATION AND MALNUTRITION

Malnutrition includes overweight and underweight individuals, caused by poor diet, inability to receive or prepare appropriate sources of nutrition, reduced physical activity, and current health conditions. Dehydration is a condition resulting from lack of fluid intake, an increase in sweating, vomiting or diarrhea, or prescribed medications which increase the risk of dehydration.

Both of these conditions have specific, and in many scenarios, blatant signs and symptoms to be identified by healthcare professionals, neighbors, friends, and family members, which initiates quicker, more effective treatment and prevention of further compromise.   If any of the above signs and symptoms are identified, an individual’s physician should be notified and appropriate measures will be taken to assess the severity of the condition.

Much of the aging population demonstrates slower rates of healing and recovery after trauma; therefore, it is important to take initiative and address a problem even if seemingly minor. Use these signs and symptoms to implement a better diet plan, incorporate appropriate exercise into daily routines and advocate for increasing liquid consumption to continue positively impacting the lives of the elderly and consistently improving their quality of life.