Hydration health literacy in the elderly

Abstract

Background: Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly.

Methods: We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge.

Results: About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death.

Conclusions: Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.

Keywords: Dehydration; aged; health literacy; hypernatremia; hyponatremia.

Fig.1

Hydration questionnaire utilized in the study. Demographic questions have not been included in this figure.

Fig.2

Self-reported A) amounts and B) types of fluids the survey respondents consumed per day. Most respondents consumed 4–9 glasses of fluid per day, and the most popular drinks were water and coffee. “Other” drinks included milk, fruit and vegetable juices, and alcoholic beverages (e.g. beer or wine).

Fig.3

Survey respondents were asked about A) The importance of adequate fluid intake for bodily function. About 60–80% displayed sufficient hydration literacy regarding specific body functions requiring adequate fluid intake. B) Only 34% of respondents were able to correctly answer at what percentage of fluid loss dehydration signs and symptoms would begin to appear. ^*P-value <0.05.

Fig.4

The survey included questions asking about A) Conditions that cause excess fluid loss and B) Conditions that cause excess fluid retention. Only ∼60% percent of respondents were able to correctly identify conditions associated with excess fluid loss (diarrhea and vomiting) and excess fluid retention (heart failure and kidney failure). ^*P-value<0.05.

Fig.5

Survey respondents were asked about how reduced or increased fluid intake would affect sodium levels in the blood. A small majority of the subjects believed that there was increase in sodium level with reduced fluid intake, while a minority of the subjects believed that sodium level increased with increased fluid intake. Yes vs No; ^*P-value<0.05.

Fig.6

Signs and symptoms of A) reduced body fluid and B) excess body fluid were addressed by the survey. A significant number of respondents were hydration literate for one symptom each in regards to reduced and excess body fluid. For the other signs and symptoms, there was a knowledge deficit, for which certain symptoms was significant. ^*P-value<0.05.