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What is water imbalance in elderly?

Water is the main component of living cells and tissues. Water balance is very important for the normal functioning of various body systems. Even mild disturbance in the water balance of the body can lead to significant states of discomfort and deviation from normal health.

The water balance of the body is maintained by unique coordination among neural, endocrine, gastrointestinal and renal systems. As people age, the system becomes more and more prone to disturbances that can lead to significant clinical consequences.

Understanding water balance regulation

Maintenance of water balance and the mechanisms underlying the regulation of body water are attributed chiefly to the kidney. A number of neural mechanisms also regulate the input and output of water.

The role of the kidney is to excrete toxins as soluble products dissolved in water. This lost quantity of water is replaced through oral intake, that is direct drinking of water or water ingested along with various food preparations.

Intake of water is chiefly a neurally regulated phenomenon. As soon as the body water content starts depleting, a thirst mechanism is triggered. This makes the person want to drink water. The same mechanism also leads to increased absorption of water from the kidney, thereby reducing the loss of water in urine.

Maintaining water balance becomes difficult for elderly individuals, as they tend to retain less water than younger individuals. The usual 55 to 60% of total body water in young adult gradually declines to less than 50% by the age of 75 to 80 years. The reduction is even more marked in elderly women.

What changes occurring in body cause water imbalance in the elderly?

Kidney:

Impairment of water balance in elderly is also associated with decreased kidney mass, reduced blood flow to the kidney. Along with this reduced filtration and altered responsiveness to electrolyte balance also lead to water imbalance. All these individual changes are consequences of normal aging.

Fluid Balance:

Moreover, elderly individuals usually have the problem of urinary incontinence. Therefore they tend to drink less water to avoid frequent trips to the bathroom. Diarrhea, vomiting, gastrointestinal bleeding are also common ailments of old age and contribute to water imbalance in elderly individuals.

Neurological impairment:

Neurological disorders like dementia, anorexia, or depression can affect water intake and water imbalance in older individuals.

Other disease conditions:

Similarly, poor control of diabetes, disorders of breathing, infections, burns, or stroke can destabilize not only the water balance but also regulatory mechanisms in the elderly.

Thirst sensation:
The thirst sensation diminishes with age. The concentrating capability of the kidney also declines over the years. All these factors lead to a significantly reduced ability to maintain water and its balance which confers an increased risk of disease in elderly individuals.

Both dehydration and over-hydration are problems associated with old age. Dehydration is also linked to infection and it is associated with mortality in the elderly.

What are the signs and symptoms of water imbalance in the elderly?

Disorders of water imbalance will mainly present as reduced urine output or complete absence of urine output, or the passing of frequent, large volumes of dilute urine. Other associated complaints can be:

  • A burning sensation while passing urine
  • Urgency
  • Inability to hold back urine till appropriate washroom facilities available. This is known as incontinence.
  • Increased thirst
  • Decreased thirst
  • Dry skin, reduced sweating, dry mouth
  • Diarrhea, increased sweating, increased secretions in the mouth and eyes
  • Giddiness, the tendency of falls and tremors. Such symptoms indicate an underlying electrolyte imbalance besides water imbalance.

How is water imbalance treated?

Treatment of water imbalance in elderly mainly consists of correcting the fluid volume in the body.

  • Dehydration is treated by infusing appropriate quantities of normal saline.
  • Overhydration is corrected with the use of a class of drugs known as diuretics.
  • The associated infection needs treatment with appropriate antibiotics.
  • Underlying diseases like diabetes, hypertension, neurological conditions and endocrine diseases need appropriate management and long-term therapy.

Also Read: Kidney Health and Potassium Levels: How to Manage

How can water imbalance be prevented?

Maintenance of appropriate drinking hygiene, that is consumption of fluids as directed by the physician. The physician suggests the quantity of water intake in accordance with the patient’s requirements in their specific disease conditions. This helps in preventing an acute imbalance of water and electrolytes and precipitation of serious clinical outcomes.

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