According to the United States Environmental Protection Agency, NEPA and all of Pennsylvania is experiencing a change in climate as indicated by a half a degree (F) in temperature, more frequent and heavy rainstorms and the tidal portion of the Delaware River is rising one inch every eight years. Last summer was one of our hottest on record and this summer has produced a several heat waves with more expected. For those without air conditioning or access to a lake or pool, it will also be remembered as record setting warm temperatures. A local reader who cares for her elderly mother wrote to express her concern about dehydration in the elderly. Age, diet, illness and medications are some of the many reasons why elders suffer from dehydration not only in the summer heat, but year-round.
Next to oxygen, water is the nutrient most needed for life. A person can live without food for a month, but most can survive only three to four days without water. Even though proper hydration is essential for health, water gets overlooked as one of the six basic nutrients. Dehydration occurs when the amount of water taken into the body is less than the amount that is being lost. Dehydration can happen very rapidly (i.e. in less than eight hours); the consequences can be life threatening and the symptoms can be alarmingly swift.
In the body, water is needed to regulate body temperature, carry nutrients, remove toxins and waste materials, and provide the medium in which all cellular chemical reactions take place. Fluid balance is vital for body functions. A significant decrease in the total amount of body fluids leads to dehydration. Fluids can be lost through the urine, skin, or lungs. Along with fluids, essential electrolytes, such as sodium and potassium, are also perilously depleted in a dehydrated individual.
Dehydration is the most common fluid and electrolyte disorder of frail elders, both in long term care facilities and in the community! Elders aged 85 to 99 years are six times more likely to be hospitalized for dehydration than those aged 65 to 69 years. More than 18% of those hospitalized for dehydration will die within 30 days, and associated mortality increases with age. Men appear to dehydrate more often than women and dehydration is often masked by other conditions.
Elderly individuals are at heightened risk for dehydration for several reasons. Compared to younger individuals, their regulatory system (i.e. kidneys and hormones) does not work as well and their bodies have lower water contents. Older adults often have a depressed thirst drive due to a decrease in a particular hormone. They do not feel thirsty when they are dehydrated. This is especially true in hot, humid weather, when they have a fever, are taking medications, or have vomiting or diarrhea. They have decreased taste, smell, and appetite which contribute to the muted perception of thirst. Because of dementia, depression, visual deficits, or motor impairments, elderly persons may have difficulty getting fluids for themselves. Many elderly individuals limit their fluid intake in the belief that they will prevent incontinence and decrease the number of trips to the bathroom. The medications that they are taking (e.g. diuretics, laxatives, hypnotics) contribute to dehydration.
Elders may suffer headaches, fainting, disorientation, nausea, a seizure, a stroke, or a heart attack as a result of dehydration. The minimum daily requirement to avoid dehydration is between 1,500 (6.34 cups) and 2,000 ml of fluid intake per day. Six to eight good-sized glasses of water a day should provide this amount. Better hydration improves well-being and medications work more effectively when an individual is properly hydrated.
By the way, plain old tap water is a good way to replenish fluid loss. Keep in mind that some energy drinks not only have excess and unneeded calories but also contain sugar that slows down the rate at which water can be absorbed form the stomach. Consuming alcoholic and caffeinated beverages actually have an opposite, diuretic effect!
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician.
For further inquires related to this topic email: drpmackarey@msn.com Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.
For all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/
It is difficult to take care of a senior with many needs. The demands of care-giving can create situations in which abuse is more likely to occur. Even though many non-professional care-givers consider their role to be satisfying and enriching, the responsibilities can be extremely stressful. This stress can escalate, especially as the elder’s condition deteriorates, and can lead to mental and physical health problems causing caregivers to burn out, become impatient, and unable to restrain their frustration.
Even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. Nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities, are unsuited for care-giving, or work under poor conditions.
In many cases, elder abuse, though real, is unintentional. Caregivers may be pushed beyond their capabilities or psychological resources.
Elder abuse help-lines offer help for caregivers as well. Call a helpline if you think there is a possibility that you might cross the line into elder abuse. (REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)
If you suspect elder abuse, report it. Look at the elder’s medications to see if the amount left in the bottle is consistent with the dosing schedule and date of the prescription. Watch for possible financial abuse by asking the elder if you may scan financial documents for unauthorized transactions. Call and visit the elderly person as often as you can. Offer to stay with the elder so that the caregiver can have a break.
Many seniors do not report abuse. Many are ashamed, feel responsible or fear retaliation from the abuser. Others believe that if they turn on their abusers, no one else will take care of them. If you are an elder who is being abused, neglected, or exploited, tell at least one person: your doctor, a friend, or a family member whom you can trust. Every state has at least one toll-free elder abuse hotline or helpline for reporting elder abuse in the home, in the community, or in nursing homes and other long term care facilities. You can also call Eldercare Locator at 1-800-677-1116. For those over the age of 60, help is available through local Area Agencies on Aging (AAA).
One in seven senior citizens nationwide falls victim to some type of elder abuse, usually at the hands of a family member. The abuse can be financial, physical, or psychological and the consequences can be deadly. Statistics suggest that abused and exploited seniors die sooner than other seniors their age. Despite such devastating consequences, most elder abuse goes unreported because of fear or lack of knowledge. If you have been abused, you may be afraid of what might happen if you tell someone. If you suspect that an elderly neighbor or friend is being abused, you may not know where to turn for assistance.
(REPORT ELDER ABUSE: PA Dept of Aging 24 Hotline 1-800-490-8505)
Elder abuse is the use of power or control to affect the well-being and status of an older individual. The World Health Organization considers elder abuse as a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. The core feature of this definition focuses on harm which includes mistreatment by people the older person knows or with whom they have a relationship, such as spouse, partner, or family member, a friend or neighbor, or people that the older person relies on for services.
There are several types of elder abuse that are universally recognized:
Each different type of elder abuse has specific signs. Below are some indicators that you need to be aware of and may recognize when involved personally or professionally with an elderly person:
Read “Health & Exercise Forum” next week to discuss the risk factors and interventions for elder abuse.
Read “Health and Exercise Forum” by Dr. Paul J. Mackarey every Monday in The Scranton Times-Tribune.
Read all of Dr. Mackarey's articles at: https://mackareyphysicaltherapy.com/forum
Dr. Mackarey is a doctor of orthopedic and sports physical therapy with offices in downtown Scranton. He is an associate professor of clinical medicine at GCSOM.
