Staying Hydrated: A Vital Guide for Older Adults During the Summer Heat

While it may be ‘hot girl summer’ everywhere else you look, here over at Healthy Aging, we’re entering ‘hot patient summer’ season. Last week, as temperatures climbed, I challenged my Parkinson’s class to a drinking contest - except instead of chugging beers, we tried to finish a bottle of water between exercises. While for most people, summer heat brings thoughts of bathing suits, pool parties and barbeques, for me, and most of my home health colleagues, we go to thoughts of dehydration, low blood pressures and passing out. So, as the summer heat approaches, I want to talk to you today about staying hydrated. Hydration over the summer is crucial for everyone, but especially older adults. Dehydration can lead to serious health complications, but with a few simple strategies, it’s easy to stay hydrated and healthy throughout the season. 

Why Are Older Adults More Prone to Dehydration?

Several factors make older adults more susceptible to dehydration. Older adults tend to have a reduced thirst sensation combined with lower kidney function. With aging kidneys becoming less efficient at conserving water, while we lose more water, we also have less drive to replace it. Older adults also often take medications that impact hydration like diuretics that lead to increased urination, or anticholinergic drugs that lead to reduced sweat production. Many older adults have mobility limitations, and try to avoid the ‘extra walks’ or nighttime waking to use the bathroom that they fear may come with increased hydration. Lastly, you may also notice that you sweat less when you get older. It’s not all in your head! Older adults sweat less as they age due to reduced sweat gland function and impaired thermoregulation - this means that on top of reduced hydration, they are less able to internally cool themselves down! All these factors combined make dehydration one of the most common causes for hospitalizations in older adults - especially in the summer months.

How do I know if I’m dehydrated?

While younger adults may be able to quickly identify the signs of worsening dehydration and take quick action, the signs in older adults can be a little tricker, often leading to delayed treatment. The most common signs we see when we suspect a patient may be dehydrated are dizziness, especially when coming to stand, and confusion. Orthostatic hypotension, a drop in blood pressure related to changing position when coming from laying down to sitting, or from sitting to standing, can happen at any time, but dehydration can make this worse. Confusion or irritability, or any other changes in mental status can also be a confusing symptom especially in an older adult who may already have some form of dementia, but look for worsening confusion from their norm. Other common signs of dehydration in older adults include reduced urine output, increased muscle cramping, dry skin and a rapid heart beat.

How do I prevent dehydration?

The easiest way to treat dehydration is to PREVENT IT! Try to drink 8 glasses of water a day, choose fluid-rich fruits like watermelon and oranges, veggies like cucumbers and other foods like soup and smoothies that can give you a little extra hydration throughout the day. Keep an eye on drinks that make you LOSE fluid and avoid excessive caffeine, soda and alcohol - or at least pair them with a glass of water to off-set the fluid loss. Stay cool by dressing in light, ‘flowy’ clothes and carry a bottle of water with you wherever you go to sip on throughout the day. Try to drink BEFORE you feel thirsty, even if it’s just a few sips at a time. Prevention can make a world of difference.

How do I treat dehydration?

If you are already feeling the signs of dehydration, don’t panic! Try to move to somewhere cool and rehydrate. Rest for 30-60 minutes and see if you start to feel better. If the symptoms don’t improve, or you experience any fainting, fevers, changes in heart rate or chest pain, nausea, vomiting or diarrhea, it’s time to get some help. Call your PCP for further instruction or go to your local urgent care or emergency department. While mild dehydration may be easy to treat at home, severe or ongoing dehydration can lead to serious medical complications like kidney failure, urinary tract infections and heat stroke. The faster you get the proper care, the better!

Challenge a friend to a drinking contest!

Now that you know the signs, symptoms and treatment of dehydration - let’s have some fun. Challenge the next person (or patient) you see to a drinking contest! Suggest you both take sips of water between conversation, exercises or along a walk and see who can empty their bottles first. Try flavoring water with hydration tabs or fresh fruit or make it fun by using a special glass, straw or turning it into a summer mocktail. Want a fun recipe to try? Here’s my favorite thirst-quenching mocktail: Fill half your glass with coconut water, and top it off with a flavored seltzer or fruit juice. The cool coconut flavors will take you to a warm, sandy beach in your mind - and your body will be hydrated. Win-win:)

5 Things to Know about Exercise and Depression in Older Adults

May is Mental Health Awareness Month! In this blog post, we delve into the critical relationship between exercise and depression in older adults. Discover five essential insights to empower seniors in managing their mental health through physical activity.

1. Depression is common in older adults and can have a profound impact on daily function.

It is estimated that around 7% of adults over age 65 experience some form of depression, though this number is likely much higher in reality. Depression in older adults can stem from neurological changes and drops in neurotransmitter levels, but can also be related to the many changes older adults face as they age. Older adults face the loss of friends and family, and also experience changes like retirement that can significantly impact their perception of their place and role in society. Chronic illness and disability can lead to stress and lead to a loss of independence and a greater reliance on others for support. Depression can impact sleep and motivation and be also related to an increase in anxiety. Older adults facing depression frequently withdraw from activities they once found meaningful and engaging and this can further exacerbate the issue. Depression is linked to an increased risk of falls - as are the medications people take to manage this condition! All in all, depression is more than a sense of ‘sadness’ in older adults - it can have a wide-spread impact on health, wellness and overall quality of life especially in the aging population. 

2. Depression in older adults doesn’t always look like depression.

Depression in older adults may present with a range of signs beyond sadness, including persistent physical symptoms like aches and pains, changes in appetite or weight, sleep disturbances, fatigue, irritability, and agitation. Additionally, they may experience a loss of interest in previously enjoyable activities, difficulty concentrating or making decisions, feelings of worthlessness or guilt, and thoughts of death or suicide. Recognizing these varied symptoms is crucial, as depression in older adults can often go undiagnosed or be mistaken for other age-related changes, highlighting the importance of early identification and intervention to ensure optimal mental health and well-being.

3. Exercise can have a significant impact on depression.

Exercise and depression has been well-researched. Regular participation in aerobic exercise has been shown to reduce depressive symptoms by 30-47% in randomized control studies as compared to control groups. Exercise improves brain health, and reduces depressive symptoms in a variety of ways. Exercise stimulates blood flow to the brain, which improves energy and motivation, and encourages neurogenesis and synaptogenesis (fancy words for more neurons and more neural connections = faster brain speed and better brain health!). It also promotes release of endorphins, neurotransmitters that act as natural mood elevators, and helps to regulate stress, reduce inflammation and improve sleep quality - all factors that contribute to improved well-being and reduce depressive symptoms. In fact, it has been demonstrated (in randomized control studies like the SMILE trial), that exercise is AS EFFECTIVE as antidepressant medications at treating major depressive symptoms - with NONE of the side effects.

4. Exercise can reduce pain (and pain is linked to depression!)

Upwards to 50% of older adults report they struggle with chronic pain. Exercise is the GOLD STANDARD for treatment for chronic pain. Aerobic exercise in particular manages chronic pain well by improving circulation, releasing endorphins, improving management of arthritis and improving muscle health, and by promoting the normalization of neural circuits that have become maladaptive due to long term exposure to the pain cycle (story for another blog post..). Pain also keeps older adults from participating in social experiences and in the community, further increasing isolation and encouraging depression. Less pain = less depression!

5. The best exercise for depression is…

While the research points towards aerobic exercise as the most effective exercise to manage depression, I personally think the exercise that you ENJOY is the one to choose if you are hoping to use exercise to improve your mental health. If you enjoy what you are doing, you are more likely to be CONSISTENT with your exercise, and it is the consistency that will make the most impact. Take a walk each morning, try a zumba class at your local senior center or work with a therapist or trainor to develop a strength training routine. Whatever exercise you choose (and bonus points for doing it all!), you can feel secure that any steps you take to improve your activity level WILL have a positive influence on your mental health. 

If you are an older adult struggling with depression, or worried about a loved one who may be experience depression, I also want you to know there are some really helpful resources out there. For more information about depression in older adults, check out the links below:

Depression is Not a Normal Part of Getting Older:

https://www.cdc.gov/aging/depression/index.html

Older Adults and Depression PDF from the E4 Center:

https://e4center.org/wp-content/uploads/2021/04/Older-Adults-and-Depression.pdf

Caregiver Guide: Depression from HealthInAging:

https://www.healthinaging.org/tools-and-tips/caregiver-guide-depression

Older Adults and Depression Guide from the NIH:

https://e4center.org/wp-content/uploads/2021/09/Older-Adults-and-Depression.pdf

FAQ # 4: How Do I Know if I’m at ‘Fall Risk?’

As you know, I love to counter a question with another question, or in this case, three:

1 ) Have you fallen in the past year?

2) Do you feel unsteady with standing or walking?

3) Do you worry about falling?

If the answer to any of these is yes, research has shown that you are likely at an increased risk for falling. Now while this may seem like a short and sweet, the actual answer is a bit longer and more involved. This is where I come in. When I check to see if a patient of mine is at increased risk of falls, I’m like a detective on a trail. While I may start with these questions, their answers lead me down windy trails where I pick up clues that not only determine IF you are at fall risk, but more importantly, WHY. And it’s the WHY that allows me to help you prevent them. But that’s a story for a different post.

So, back to the question at hand. What do I look at to determine if you’re at risk for falls? 

1) I look at how you move. First and foremost, I look at your mobility, in your own home environment, sometimes when you don’t even think I’m watching (‘hey, can you give me a tour of your house?’). Without even doing another test, this would probably give me the most valuable information I can get. Do you stumble over thresholds? Reach for walls? Get distracted and lose balance with turning? Are there environmental hazards (small pets, throw rugs and more egads!) that could cause you trouble down the road? Is it dark? Is it too bright? Are you moving too fast, or too slow? Are you using assistive devices or may benefit from one? Do your movement patterns indicate an area of weakness or contracture? As therapists, this is our bread and butter. If you’re every hanging with a PT and feel like you’re being watched (or judged), you are! We can’t help ourselves, and we’re truly sorry:) 

2) I look at your balance. Obvi. Your very ability to stand upright, balanced over your base of support requires an intricate and functioning relationship between your feet, your inner ear, your eyes and your brain. This combination is lovingly referred to as your somatosensory integration. It allows you to stay upright, and then allows you to control your body as it moves both purposely outside your base of support - and unpurposely (is that a word?), as in the case of a loss of balance. By putting you in a series of different foot positions, with different degrees of challenge to each of these systems (somatosensory, vestibular, visual), I can identify which system is working and which system could work better - and then develop a plan of action to improve your balance over all. 

3) I look at aaaaallll other systems that are involved with your balance. Do you have pain that surprises you and knocks you off your feet? Limited range of motion in places that make your feet more likely to catch on the stair? Do you get tired easily or have impairments in cardiovascular function that make it more likely for you to pass out? Are you taking medicines that could make you dizzy, or confused or sleepy? Are you taking medicines that make it more likely to get injured from a fall like steroids that can make your bones more brittle or a blood thinner that could put you at risk for a head injury? Do you have other comorbidities that could play a role? Diabetes with fluctuating blood sugars? COPD with oxygen rates that drop when you move? Covid that has left you exhausted and uncertain on your feet? 

Before this FAQ becomes a book, I’ll stop there. As you can tell, there is a lot that goes into answering this seemingly simple question. Fortunately, there are Physical Therapists, like me, who train for years to become Fall Risk Detection experts and are happy to help you figure it out. If you’d like to learn more about fall risk, fall prevention and how I figure this all out, please join me Tuesday night for a Zoom webinar titled ‘So You’ve Been Told You’re UNSTEADI. Now What?’ During this one-hour seminar, I’ll dive deeper into the fall risk assessment process, explain the STEADI initiative, and how it is used by your medical team to determine fall risk and address modifiable risk factors and give you tools to make changes on your own to help you stay on your feet.

To register ahead, please click the link below and you’ll receive the zoom link from there.  

So You've Been Told You're UNSTEADI Zoom Registration