By Harriet Smith, Registered Dietitian

This warmer summertime weather is a cause for celebration; however it can be accompanied by nutritional challenges. In this article we offer our top tips for helping older adults to stay healthy and hydrated during the summer months.

Introduction

As the temperature outside increases, so too does the amount of body water lost through sweat. A loss of just 2% of body weight from fluid losses can result in increased risk of heat exhaustion (1). If these fluid losses are not replenished, dehydration can occur.

Reasons for Dehydration

In the UK, it’s estimated that 20% of older adults (aged > 65 years) in long-term care are dehydrated (2). Older people may experience physical and physiological challenges which can increase their susceptibility to dehydration. These may include (3, 4, 5):

• Decreased ability to detect and respond to thirst (especially in those with Alzheimer’s Disease)
• Problems with swallowing (i.e. dysphagia)
• Poor motility resulting in increased reliance on others to provide drinks
• Reduced renal function resulting in impaired hormonal response to dehydration
• Use of medications which promote fluid loss (e.g. diuretics and laxatives)
• Fear of incontinence resulting in reduced fluid intake

Consequences of Dehydration

Adequate hydration is essential for good health at all ages, but the effects of dehydration can be especially serious for the elderly. Common consequences of dehydration in elderly people may include (6):

• Low blood pressure
• Delayed wound healing
• Weakness, confusion, and disorientation, leading to increased risk of falls
• Urinary tract infections

If it’s not addressed, dehydration can cause a rapid deterioration in health, exacerbating existing comorbidities, and increasing the chances of death. Thus, in warmer weather, it’s important to ensure that an older person’s fluid requirements are met.

Fluid Requirements

An individual’s fluid requirements are likely to differ depending on a variety of factors such as climate, health status, gender and physical activity level. Therefore, fluid requirements should ideally be assessed on a case-by-case basis by a suitably qualified healthcare professional.

As a rule-of-thumb, healthy adults over the age of 60 require at least 30ml of fluid per kilogram of body weight each day (7). For a 60kg individual, this is equivalent to 1,800ml fluid per day (approximately nine (200ml) glasses of fluid).

Encouraging Adequate Hydration During Summer

Try to offer a range of drinks which are different flavours and temperatures. You could experiment with plain or sparkling water, fruit squash or cordial, juices and smoothies, milkshakes and tea and coffee.

• Ensure drinks are fresh and aesthetically appealing. Try adding slices of fruit, straws, ice or even a dusting of cocoa powder to milky drinks.
• Offer drinks at regular intervals, and with every meal.
• If appropriate, provide a jug of water in a visible and accessible place to prompt independent drinking.
• Offer hydrating foods such as freshly sliced fruits and vegetables, soups, stews, ice lollies and ice cream, yoghurts, and smoothies. Hydrating foods count towards our daily fluid intake too.
• Provide assistance and/or drinking aids, if required.
• Educate the older person and/or carers on the signs of dehydration (e.g. thirst, dry lips and mouth, dark urine, and infrequent urination.)

Staying Nourished During Summer

Older adults, especially those in hospital or residential care, are at increased risk of malnutrition. In the UK, it is estimated that 1.3 million people over 65 suffer from malnutrition (8). Malnutrition affects every system of the body and can have severe consequences for health, reducing physical and cognitive functional status in the elderly (9).

Malnutrition Risk Factors

Physical effects of ageing such as diminished sense of smell and taste, impaired ability to swallow, and limited motility, as well as social factors such as isolation and poverty can contribute towards malnutrition risk. However, hot weather can also exacerbate this risk. It is commonly reported that during hot weather, appetite declines and hot foods are less tempting, resulting in reduced food intake (10).

Top Tips

When looking after an older person, the following tips may be useful for encouraging them to eat enough during the summer months:

• Offer food little and often – consuming smaller and more frequent meals rather than several large meals may seem more manageable.
• Tailor the food offered to the weather – if it’s especially hot, offer cold dishes such as sandwiches or salads with energy-dense fillings. Remember to include a source of protein, carbohydrate and fats with every meal. Examples include: coronation chicken salad with new potatoes and avocado or egg mayonnaise sandwich with crisps and a yoghurt.
• Serve foods which meet their dietary preferences – you could involve the older person in the menu planning or meal preparation, if appropriate.
• Encourage light exercise such as walking or stretching before mealtimes to help stimulate appetite.
• Where possible, make mealtimes a social activity – encourage dining with friends, neighbours, or family, or use the television or radio to simulate social activity.

A Food-First Approach

Using a food-first approach is useful for individuals with poor appetite and reduced food intake. It increases the energy and nutrient density of meals and snacks without increasing the volume of food consumed (11). You could consider:

• Offering full-fat varieties of dairy products like milk and yoghurts.
• Boosting the energy content of a meal by adding butter, oils, cream, cheese, or syrups.
• Offering nourishing drinks such as milky coffees, malted milk drinks, smoothies, milkshakes, or fruit juices.
• Providing frequent access to high-protein snacks like mini sausages, boiled eggs, yoghurt, or cheese and crackers.

Oral Nutrition Supplements

For those who are unable to meet their nutritional requirements through an oral diet alone, oral nutritional supplements (ONS) can offer a convenient way to increase nutritional intake.

To increase compliance with ONS usage during the summer months, you could:

• Store ONS products in the fridge or add ice cubes when serving.
• Use ONS products in homemade nourishing drinks – here are some recipes.
• Get creative – juice-based supplements can be frozen into ice lollies and milk-based supplements can be used to make iced coffee.