Dehydration in Older People: A Public Health Issue

This report investigates public health issues related to dehydration in people over 65 years of age. It explores the consequences of dehydration, illnesses that may arise, and preventative measures. It also examines the impact of social inequalities and analyzes relevant policies and existing dehydration campaigns.

CONTEMPORARY
PUBLIC HEALTH
ISSUE

INTRODUCTION...............................................................................................................................3
MAIN BODY.......................................................................................................................................6
CONCLUSION..................................................................................................................................10
REFERENCES..................................................................................................................................11

INTRODUCTION
Dehydration is when your body loses more fluid than you take in (NHS, 2020).
Dehydration occurs when one does not drink enough fluids, this often leads to a number of
illnesses (NHS, 2020). Dehydration affects men, women and children however, certain
people are at greater risk (Mayoclinic, 2019). This report will attempt to recognise and
investigate public health issues related to dehydration in people over 65 years of age. The
report will investigate the consequences of dehydration and illnesses which might transpire as
a result of dehydration also, highlighting preventative measures. In addition, it will look at
how social inequalities have an impact in dehydration when it comes to people who are 65+
years. Relevant policies, strategies and guidelines will be critically analysed as well as
comparing and contrasting existing dehydration campaigns.
Older people are more vulnerable to dehydrations this is due to physiological changes in the
ageing process. Kidneys produce a hormone which stimulates thirst, in older people the
kidneys become less efficient as a result they are less effective at producing this hormone,
this leads to older people having a reduced sensation of thirst (British Nutrition Foundation
(BNF), 2019. In addition, physical and mental frailty can put a further increase risk of
dehydration (Mayoclinic, 2019).
This study will focus on looking at dehydration in older people. The reason for this is because
there are many factors to explore as to why older people are more prone to dehydration it also
links in with age related illnesses and body anatomy. A study conducted by Hooper et al
(2016) found that 20% of UK residents in long term care were found to be dehydrated. In
addition, another study carried out by Royal Society of Medicine (RSM) found that people
living with dementia are six times more likely to be dehydrated. according to BAPEN (2017),
over 3 million people in the UK are living with malnutrition and from the 3 million, 1.3
million (11%) are aged 65 and over.
Due to the severity of dehydration in the elderly and the general public, dehydration has
become a public health issue. ‘Nutrition and Hydration week’ is an annual event held every
March, its main purpose is to educate and highlight to people the value to maintaining health
and well-being in health and social care. It looks at de/hydration and other nutritional issues
and improvements in the provision of nutrition globally and nationally (N&H week, 2018).

Global
In developing countries dehydration if a major issue and it is usually due to poor
infrastructure. As a result, people are forced to utilise the same water for different purposes
resulting to diseases and illnesses (Mosier, 2017). According to Mosier (2017), dehydration
has claimed the lives of 760,000 children in developing countries. Africa faces trials with
numerous issues affecting public health, there is a lack of clean water in both urban and rural
places (The water project, 2016). In addition, there is lack of accessibility to drinking water
as well as a risk of water contamination due to a number of factors where water is available.
Contaminated water results in individuals suffering from diarrheal diseases majority of the
time children and adults over 65 years are the ones worst impacted (The Water Project,
2016). According to Tamlin (2017), 75% of Americans are dehydrated or at risk of being
dehydrated with 54.5% of children going to school dehydrated.
Figure…Percentage of population
dehydrated (Water logic, 2017)

Figure… daily water consumption (Water logic, 2017)
The European Hydration institute are one of the world’s leading organisations on human
hydration. The main aim of The European Hydration Institute is to raise awareness of the
importance of wellness, health and hydration (European Hydration Institute (EHI), 2018).
The public health agenda needs to ensure that hydration is well understood
National
Malnutrition and dehydration in the UK are an ongoing public health issues, previous
literature and government publications found that older people living in nursing homes are at
a high risk of malnutrition and dehydration (Bunn et al, 2018). A report by the CQC (2017)
identified that between 2014-2017 roughly 50 enforcement actions were taken against care
homes for breaching hydration and nutrition regulations.
Eat well programme
Figure… Eatwell Guide (British Nutrition Foundation, 2018).
The balance of good health by UK’s National food guide was launched in 1994, its main
purpose was to define the governments advice on a balanced and healthy diet. In addition, it

was revised by the Foods Standards Agency and retitled ‘the Eatwell plate’. The refreshed
Eatwell guide policy was introduced by Public Health England March 2017 and has been
used by the government to recommend on achieving a balanced diet and reinforcing fluid
recommendations (Public Health England, 2016). In the UK climate it is recommended by
the NHS (2019) that we should drink 2 litres or 6-8 glasses per day in order to keep us from
being dehydrated. However, in hotter countries it might be required to have more glasses of
water to prevent dehydration.
MAIN BODY
Dehydration is one of the common issues which founded in every age group people of 65+
years. Main reason behind this is less fluid in body of person. In addition to this, Dehydration
occurs when one does not drink enough fluids, this often leads to a number of illnesses.
Dehydration affects men, women and children however, certain people are at greater risk The
body loses water through urination and sweating on a regular basis, an individual can become
dehydrated if the water is not replaced (Kahn, 2019).
Symptoms - In older adults many symptoms of dehydration go unrecognised as they
could be caused by medication side effects or other health conditions (NHS, 2019).
Dehydration symptoms listed by the NHS (2019) can be but not limited to:
 Feeling thirsty – It is one of the major symptoms which required to be taken seriously
and when individual feel thirsty it is important for them to take water plain or flavour
when feel thirsty.
 Feeling tired – This is also another symptom and when individual feel tired it is
essential for them to take something by which they feel energetic (Wu and et. al.,
2019). For removing tiredness individual have to take food through which they feel
energetic as well as have to take rest also.
 Dry mouth, lips or eyes – When fluid get less in body of individual then mouth, lips
and eyes get dry. If an individual feel so then they should have to drink water for
reducing level of dehydration from body of particular person.
 Strong smelling or dark yellow wee – Fluid get reduce from body then wee get dark
yellow or start smelling as it is important for individual to consume proper amount of
water. Because main reason behind this is dehydration so to overcome with this issue
it is important to proper intake liquid.

These are major symptoms which individual have to consider because they are major
symptoms of dehydration and required to be manage in effective manner (Jyothi and et. al.,
2019). In addition to this, when individual face such symptoms they have to ensure that
dehydrated patient is taking proper water.
Health risks - Some people can tell if they are dehydrated and act on it. However, this is
not always the case with older people or younger children. Body organs can fail to function
as they should if too much water is lost from the body (Kahn, 2019). In older people
dehydration can lead to harming your health and in rare cases it can be life threatening
(Mayoclinic, 2019). In addition, older people are more at risk as they might already have
underlying health condition so dehydration will have a negative impact on their health. A
person over 65 years is at risk of getting pressure ulcers if they are dehydrated. Kahn (2019)
states that untreated dehydration can lead to complications such as
 Heatstroke - Heatstroke is a condition brought about by your body overheating,
typically because of delayed presentation to or physical effort in high temperatures
(Cadiau and et. al., 2017). This most genuine type of warmth injury, heatstroke, can
happen if your internal heat level ascents to 104 F (40 C) or higher.
 Seizures - A seizure is an unexpected, uncontrolled electrical unsettling influence in
the mind. It can cause changes in your conduct, developments or sentiments, and in
levels of awareness. In the event that you have at least two seizures or a propensity to
have repetitive seizures, you have epilepsy.
 low blood volume - Hypovolemic stun is a risky condition that happens when you
abruptly lose a great deal of blood or liquids from your body. This drops your blood
volume, the measure of blood circling in your body. That is the reason it's otherwise
called low-volume stun.
 Coma - A trance like state is a condition of delayed obviousness that can be brought
about by an assortment of issues — horrible head injury, stroke, cerebrum tumour,
medication or liquor inebriation, or even a basic sickness, for example, diabetes or a
disease. In addition to this, coma is medical emergency.
 heat exhaustion - Warmth weariness is a condition whose side effects may incorporate
hefty perspiring and a quick heartbeat, an aftereffect of your body overheating (Zha
and et. al., 2018). It's one of three warmth related disorder, with heat cramps being the
mildest and heatstroke being the most extreme. Reasons for heat fatigue incorporate

presentation to high temperatures, especially when joined with high mugginess, and
arduous physical movement. Without brief treatment, heat fatigue can prompt
heatstroke, a hazardous condition. Luckily, heat weariness is preventable.
 kidney failure - As a rule, kidney disappointment is brought about by other medical
conditions that have done lasting harm (hurt) to your kidneys gradually, after some
time. At the point when your kidneys are harmed, they may not fill in just as they
should (Scoffoni and et. al., 2017). On the off chance that the harm to your kidneys
keeps on deteriorating and your kidneys are less and less ready to carry out their
responsibility, you have constant kidney malady. Kidney disappointment is the last
(generally serious) phase of persistent kidney malady. This is the reason kidney
disappointment is additionally called end-stage renal infection, or ESRD for short.
Prevention - Dehydration can be easily prevented by drinking fluids when you feel
dehydrated or when you experience dehydration symptoms. An increase of fluid intake if one
is feeling ill and vomiting or having diarrhoea can prevent dehydration. Drinking the
recommended amount of fluids can also help prevent dehydration.
Target audience is of 65+ years because they are the one who suffering more with
dehydration issues and as this issue is increasing due to insufficient fluid in body of
individual. Thu, it is important for them to make sure that they have proper water intake and
in case they feel dehydrated then they should have to consume more liquid (Ban and et. al.,
2019). A person over 65 years is at risk of getting pressure ulcers if they are dehydrated as
well as cause several other health risks such as heatstroke, seizures, low blood volume, coma,
heat exhaustion, kidney failure as well as many others. Although, it is important for an
individual to take care and ensure that they have sufficient or required fluid in their body.
Apart from this, it is important to take care in this age group because one mistake and
carelessness related to health may result in causing numerous issues.
In addition to this, individual can include different flavours to water and other liquids
so that they will be able to drink enough fluid required by person (Blum and Tuberosa, 2018).
Moreover, dehydration may result in stroke and other heart related issues which will easily
not get recover in this age. Older people are more vulnerable to dehydrations this is due to
physiological changes in the ageing process. Kidneys produce a hormone which stimulates
thirst, in older people the kidneys become less efficient as a result they are less effective at
producing this hormone, this leads to older people having a reduced sensation of thirst (Zhou

and et. al., 2019). In addition, physical and mental frailty can put a further increase risk of
dehydration as well as dehydration can be control when individual take proper liquid in
appropriate manner.
There are several strategies, policies as well as guidelines which every health care
institution have to follow for conducting activities in effective manner as well as gain
outcomes in better manner. Along with this, it is important for health care practitioners to
provide equal treatment to each and every patient suffering from dehydration without
conducting any discrimination within them on the basis of numerous factors such as age,
gender, cast colour and several others. Because equal treatment is right of every individual if
medication will not provide to patient of dehydration then it may result in creating several
other risks such as heatstroke, seizures, low blood volume, coma, heat exhaustion, kidney
failure as well as many others (Armstrong and et. al., 2016). Along with this, health and
safety are another major act which has to be implement within working of health care
institutions. So, they will be able to conduct each and every activity in appropriate manner
without any risk. The Health and Safety Executive (HSE) is the administrative delegated
body that is answerable for upholding working environment wellbeing and security
enactment in the UK (Liu and et. al., 2017). Be that as it may, with regards to ordering
authorization, this obligation is commonly separated between the HSE and significant nearby
specialists.
Another policies and strategies is data protection which an play most important role
and it should be make sure by each and every healthcare professional and medical institution
that they will not discuss personal information of patient with anyone. Because sharing
personal data of particular person with others is not legal as they have to make sure that
information or data will not discuss with anyone else (Zhang and Bartels, 2018). Thus, it can
be said that there are numerous strategies, policies and regulation which health care
organisation and other professional have to implement in their working such as data
protection, health and safety act, anti-discrimination as well as many other. Older people are
more vulnerable to dehydrations this is due to physiological changes in the ageing process.
Kidneys produce a hormone which stimulates thirst, in older people the kidneys become less
efficient as a result they are less effective at producing this hormone, this leads to older
people having a reduced sensation of (Xu and et. al., 2018). In addition, physical and mental
frailty can put a further increase risk of dehydration.

CONCLUSION
After going through overall discussion it has been summarised that, dehydration
mainly cause because of less fluid in individual body. So, it is important for individual person
to always remain hydrate which simply means that they must have to intake proper amount of
water on timely basis. According to the data it has determined that, mostly 65 and above the
age people are suffering with dehydration as well as for them it is important to take care of
things in appropriate manner because it may result in further several other issues also. A
person over 65 years is at risk of getting pressure ulcers if they are dehydrated as well as
cause several other health risks such as heatstroke, seizures, low blood volume, coma, heat
exhaustion, kidney failure as well as many others. Although, it is important for an individual
to take care and ensure that they have sufficient or required fluid in their body.

REFERENCES
Books and Journals
Hooper L, Bunn DK, Downing A, et al. Which Frail Older People Are Dehydrated? The UK
DRIE Study. J Gerontol A Biol Sci Med Sci. 2016;71(10):1341-1347.
doi:10.1093/gerona/glv205
Bunn D, Hooper L, Welch A. Dehydration and Malnutrition in Residential Care:
Recommendations for Strategies for Improving Practice Derived from a Scoping Review of
Existing Policies and Guidelines. Geriatrics (Basel). 2018;3(4):77. Published 2018 Nov 12.
doi:10.3390/geriatrics3040077
Wu, Y. and et. al., 2019. Two-dimensional MXene membrane for ethanol
dehydration. Journal of Membrane Science, 590, p.117300.
Jyothi, M. S. and et. al., 2019. Membranes for dehydration of alcohols via
pervaporation. Journal of environmental management, 242, pp.415-429.
Cadiau, A. and et. al., 2017. Hydrolytically stable fluorinated metal-organic frameworks for
energy-efficient dehydration. Science, 356(6339), pp.731-735.
Zha, G. F. and et. al., 2018. SO2F2-mediated oxidative dehydrogenation and dehydration of
alcohols to alkynes. Journal of the American Chemical Society, 140(50), pp.17666-17673.
Scoffoni, C. and et. al., 2017. Outside-xylem vulnerability, not xylem embolism, controls leaf
hydraulic decline during dehydration. Plant physiology, 173(2), pp.1197-1210.
Ban, Y. L. and et. al., 2019. Thiocyanate radical mediated dehydration of aldoximes with
visible light and air. Chemical Communications, 55(65), pp.9701-9704.
Zhou, Y. and et. al., 2019. Characteristics of dehydration during rice husk pyrolysis and
catalytic mechanism of dehydration reaction with NiO/γ-Al2O3 as catalyst. Fuel, 245,
pp.131-138.
Armstrong, L. E. and et. al., 2016. Diagnosing dehydration? Blend evidence with clinical
observations. Current Opinion in Clinical Nutrition & Metabolic Care, 19(6), pp.434-438.
Liu, X., Wang, C., Wang, B. and Li, K., 2017. Novel Organic‐Dehydration Membranes
Prepared from Zirconium Metal‐Organic Frameworks. Advanced Functional
Materials, 27(3), p.1604311.
Zhang, Q. and Bartels, D., 2018. Molecular responses to dehydration and desiccation in
desiccation-tolerant angiosperm plants. Journal of experimental botany, 69(13), pp.3211-
3222.
Xu, Z. and et. al., 2018. Two-dimensional MXene incorporated chitosan mixed-matrix
membranes for efficient solvent dehydration. Journal of membrane science, 563, pp.625-632.
Blum, A. and Tuberosa, R., 2018. Dehydration survival of crop plants and its
measurement. Journal of Experimental Botany, 69(5), pp.975-981.
Online
NHS.uk. 2020. Dehydration. [online] Available at:
<https://www.nhs.uk/conditions/dehydration/> [Accessed 21 September 2020].

Mayo Clinic. 2019. Dehydration - Symptoms And Causes. [online] Available at:
<https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-
20354086#:~:text=Overview,fluids%2C%20you%20will%20get%20dehydrated.> [Accessed
24 September 2020].
2019. [online] Available at:
<https://www.nutrition.org.uk/nutritionscience/life/dehydrationelderly.html?
__cf_chl_jschl_tk__=b6f6c7e59edd0fb18f40e2ce354a894589706882-1600962092-0-
ASPYznsO3XMWhGxDZvunSiIR75m3KEO2lDleqos_0T6XSzY0B2Vx-
Xy5CT1zl7ZbwUzkBNbGBCb0XjaizhLeK7Yfh96Fhc4qDQp6gHDtQOjPRKevm-
5YIBs2BIQBpra0L8paeTqVuUzC-QwLUFqLFEB-
wgxvjh8PIDZmqtJ0laetvU4aUJonzBm4WcrG0DSvt4KOb55yzWwbpXvM1Rj0SmmorYuV
9wwzu_yngFEDx0zHnLKud9OO-Up-
c5ejkayh2njUsi1hAENDxC6MR4x7T8WNgrJHXr00wE2r2aPDWEB-
5_ZjWJnZI5jLt2sjyLbo6P3E0B9ky5mIvcxP4LFnSRqFNy_t9sGKx8vTtH9QFRgSMTBtX5
_nLrV0i0XNn3wqiWbyncFuQALKzMsQ8GbbCF0 > [Accessed 24 September 2020].
Nutritionandhydrationweek.co.uk. 2018. About Us | N&H Week. [online] Available at:
<https://nutritionandhydrationweek.co.uk/about-us/> [Accessed 24 September 2020].
BAPEN. 2017. Introduction to Malnutrition: What is the size of the problem in the UK?
BAPEN: The British Association for Parenteral and Enteral Nutrition. Available at:
http://www.bapen.org.uk/malnutrition-undernutrition/introduction-to-malnutrition?
showall=&limitstart=[ Accessed 24 September 2020].
Mosier, L., 2017. Wanderlust Global Dehydration: What It Is And Why It Matters. [online]
Wanderlust. Available at: <https://wanderlust.com/journal/global-dehydration-matters/>
[Accessed 28 September 2020].
Care Quality Commission The State of Adult Social Care Services, 2017 Available
online: http://www.cqc.org.uk/sites/default/files/20170703_ASC_end_of_programme_FINA
L2.pdf. [Ref list] [Accessed 24 September 2020].
2016. Public health englad Eatwell Guide. [ebook] Public Health England: Public Health
England. Available at:
<https://assets.publishing.service.gov.uk/government/uploads/system/uploads/
attachment_data/file/528201/Eatwell_guide_whats_changed_and_why.pdf> [Accessed 28
September 2020].
The Water Project. 2016. Water In Crisis - Spotlight Africa: Rural And Urban Issues.
[online] Available at: <https://thewaterproject.org/water-crisis/water-in-crisis-rural-urban-
africa> [Accessed 29 September 2020].
nhs.uk. 2019. Dehydration. [online] Available at:
<https://www.nhs.uk/conditions/dehydration/> [Accessed 29 September 2020].
Kahn, 2019. Dehydration: Causes, Symptoms, Treatment, And More. [online] Healthline.
Available at: <https://www.healthline.com/health/dehydration> [Accessed 29 September
2020].