The Risk of Chronic Dehydration in the Older Adult
The Risk of Chronic Dehydration in the Older Adult
Joy Stepinski, MSN, RN-BC
May 15, 2026
Did you know that older adults may be at a higher risk of dehydration than the general population? Dehydration is often thought of as a short-term problem caused by illness, intense exercise, or excessive heat [1]. However, chronic dehydration can be insidious, gradually developing over time, which can lead to serious health complications.
Dehydration puts people at risk for a wide range of health problems. Water makes up approximately 60% of the human body and plays a vital role in all of its functions. When the body does not receive enough water, even mild dehydration can affect overall health and well-being. With older adults, chronic dehydration can be gradual and often goes unnoticed. Yet, many problems can increase as a result, including constipation, urinary tract infections, confusion, delayed wound healing, kidney failure, respiratory infections, decreased muscle strength, falls, and medication toxicity, significantly affecting quality of life [2,3].
Older adults are at risk of dehydration for several reasons. Poor hydration habits and dietary patterns, chronic health conditions including functional and cognitive impairment, and multiple medication use may influence hydration status. These factors may affect the kidneys' ability to function efficiently. Certain medications, such as diuretics and laxatives, may also contribute to fluid loss and reductions in total body weight [4].
Inadequate fluid intake further increases the risk of dehydration. The sensation of thirst often decreases with age, causing some individuals to forget to drink fluids regularly. Others may intentionally limit fluid due to fear of frequent urination or of incontinence. In addition, some may have limited access to beverages or experience swallowing difficulties that make drinking challenging.
Research shows that many nursing home residents do not drink enough fluids each day. One study found that 52–90% of nursing home residents consumed less fluid than recommended levels [3], depending on the standard used. The outcome was determined by direct observation of food and fluid intake among 40 residents, applying three different intake criteria.
The authors raised several important points. The recommended intake for institutionalized adults is 1,500 – 2,000 mL per day to maintain proper hydration. While the intended meal pattern and non-meal feedings may have been sufficient to meet daily fluid needs, residents frequently did not consume 100% of their meals in this research. Many residents are dependent on caregivers for feeding. These residents are at risk of not receiving sufficient fluids, suggesting that caregivers need to be more aware and proactive about this issue.
According to a Cochrane review [5], common clinical signs of dehydration may be less reliable in older adults than in the general population. Indicators such as dry mouth, thirst, urine color and volume, and fluid intake may not accurately reflect hydration status in older individuals. Instead, older adults may present with fever, sunken eyes, difficulty swallowing, and bed sores [6]. These signs are commonly associated with underlying conditions, including stroke, diabetes, infections, kidney disease, and heart disease.
Medication use can be a big culprit of dehydration, especially with polypharmacy (taking 5 or more medications). Blood pressure medications, such as diuretics, β-blockers, and ACE inhibitors, can influence fluid and electrolyte balance [6]. Some clinical symptoms, such as dry mucous membranes or tongue furrows, may be related to side effects of medications, rather than dehydration.
In institutional settings, the health literature suggests many strategies to improve hydration. Fluid intake should be monitored each shift to ensure residents receive enough. With strong knowledge of their residents, nurses are in an important position to encourage fluids and monitor the amount taken. Dietary preferences, desired meal times, the dining environment, and being offered beverages outside of meals all may play a role. Some authors suggested a happy hour for residents to socialize and enjoy fresh beverages.
Hydration is fundamental to healthy aging and overall well-being. Many factors that influence hydration are closely related to lifestyle habits, including nutrition, mobility, medication use, and fluid intake. Drinking enough fluids can support physical function, strength, and cognitive health, while decreasing complications associated with dehydration. Because dehydration in older adults is often subtle, awareness among individuals, family members, and care providers is essential. Proper hydration may support physical and cognitive function, helping older adults maintain independence and quality of life.
References
Nagae, M., Umegaki, H., Onishi, J., Huang, C. H., Yamada, Y., Watanabe, K., ... & Kuzuya, M. (2020). Chronic dehydration in nursing home residents. Nutrients, 12(11), 3562.
Bruno, C., Collier, A., Holyday, M., & Lambert, K. (2021). Interventions to improve hydration in older adults: A systematic review and meta-analysis. Nutrients, 13(10), 3640. https://doi.org/10.3390/nu13103640
Wotton, K., Crannitch, K., & Munt, R. (2008). Prevalence, risk factors and strategies to prevent dehydration in older adults. Contemporary Nurse, 31(1), 44-56.
Beck, A. M., Seemer, J., Knudsen, A. W., & Munk, T. (2021). Narrative review of low-intake dehydration in older adults. Nutrients, 13(9), 3142. https://doi.org/10.3390/nu13093142
Hooper, L., Abdelhamid, A., Attreed, N. J., Campbell, W. W., Channell, A. M., Chassagne, P., ... & Hunter, P. (2015). Clinical symptoms, signs and tests for identification of impending and current water‐loss dehydration in older people. The Cochrane Database of Systematic Reviews, 2015(4), CD009647. https://doi.org/0.1002/14651858.CD009647.pub2