Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review

Abstract

The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.

Narrative Review of Low-Intake Dehydration in Older Adults

“…Regarding how much older people should drink, the literature search identified no more recent guidelines that addressed low-intake dehydration, but one critical review: Masot and co-authors [ 23 ] performed a review about fluid intake recommendations (in published articles and guidelines) for older adults. A literature search was conducted using PUBMED, Scopus, Cochrane, and Google Scholar until April 2020, focusing on people aged 65 years or older and on different care levels [ 23 ]. The authors suggest that most recommendations of international organizations do not consider the physiology of ageing or typical health problems of older adults.…”

“…The authors suggest that most recommendations of international organizations do not consider the physiology of ageing or typical health problems of older adults. However, Masot and co-authors [ 23 ] concluded that older people should drink between 1.5 and 2.0 L/day. More specifically, they recommended to follow the ESPEN and EFSA guidelines, with ESPEN ( Table 1 ) following EFSA recommendations.…”

Proteomic analysis reveals that aging rabbit vocal folds are more vulnerable to changes caused by systemic dehydration

“…Total body water decreases with age [ 14 , 16 , 17 ]; in humans, the water body changes range from 75% in infants to 55% in the elderly [ 13 ] and 45% in older women, making older individuals more prone to developing dehydration [ 14 ]. There are multiple factors contributing to the development of dehydration as we age [ 13 , 14 ], including the increased proportion of body fat over lean body mass [ 14 , 17 ], decreased renal function impairing efficient water conservation [ 14 , 17 ], decreased sense of thirst [ 18 ], and the presence of comorbidities [ 14 , 19 ]. Although several studies have focused on fluid homeostasis, dehydration, and contributing factors in the aging process, the impact of systemic dehydration on older subjects in the context of vocal fold biology has not yet been investigated.…”

Examining the Utility of Bioelectrical Impedance Analysis for Detecting Low-Intake Dehydration in Older Adults in Clinical Care Settings: A Systematic Review

“…However, the abovementioned de nitions or categories/subtypes of dehydration have done little to assist academics and clinicians in understanding and recognising the extent of the problem of low water or uid intake in older adults, which can be a marked and protracted cause of dehydration and related complications, such as acute renal injury and electrolyte imbalances [10]. The recent European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for hydration in the eld of geriatrics state that dehydration in older adults is due to either low uid intake, excess uid loss, or a combination of both; practice guidance remains the mainstay for hydration care in this population group worldwide [13,14]. The ESPEN guidelines speci cally de ne low-intake dehydration as a shortage of body water that leads to reductions in intracellular and extracellular uid and, subsequently, increased osmolality across both cellular compartments.…”