Age-related factors affecting Fluid and

Electrolyte Balance among ELDERLY CLIENTS

Review of Concept:
What again are the factors affecting normal
fluid balance???
• Fluid Intake
• Oral fluids
• Water in foods
• By-product of food metabolism
• Fluid Output
• Urine
• Insensible Fluid Loss
• Feces
Think!
Question #1:
What makes the elderly adults more at
risk for fluid imbalance?

Answer:
They have decreased fluid intake and
increased fluid loss.

Dehydration is the most common cause of

fluid and electrolyte imbalance among
elderly clients.
Think!
Question #2:
When an elderly client is suspected of
dehydration, what possible early
manifestations should the nurse note for?

a)Poor skin turgor

b)Dry oral mucosa and tongue furrows
c)Change in mental status, memory or
attention
d)Orthostatic Vital Signs
Think!
Question #2:
When an elderly client is suspected of
dehydration, what possible early
manifestations should the nurse note for?
Answer:
C ; A change in mental status, memory, or
attention may be an early sign of DHN in elders.
Skin turgor is a less reliable indicator of DHN. Dry
oral mucosa and tongue furrows indicate DHN while
orthostatic VS may not demonstrate typical changes
in a dehydrated elderly client. (M/S by Lemone, p.
Related Concept:
What about the regulatory mechanisms of
the body responsible for maintaining
HOMEOSTASIS???

• Thirst
• Kidneys
• Antidiuretic Hormone (ADH)
• Renin-Angiotensin-Aldosterone System
(RAAS)
• Atrial Natriuretic Factor (ANF)
Thirst Mechanism↑ OSMOLALITY OF

↓ ECF VOLUME
ECF

STIMULATES THE ↓ SALIVA SECRETION

OSMORECEPTORS IN
HYPOTHALAMIC THIRST
CENTER DRY MOUTH

THIR
ST
WATER ABSORBED
FROM G.I. ↓ OSMOLALITY OF

↑ ECF VOLUME ECF

The Kidneys
 The adult kidney reaches its maximum size of 150 to 300 grams around
30 years of age.
 A gradual decrease in renal size and volume occurs during the decades,
and by 90 years of age the renal mass has fallen by 30% to 40%.
 As kidney size dwindles, so does renal blood flow and glomerular filtration
rate (GFR).
 Normal GRF in the healthy young adult is estimated at 100 to 125 mL per
minute. With time, GFR diminishes approximately 1 mL per minute after
40 years of age.
 Other changes observed in the aging kidney include the decreased ability
to concentrate urine, the inability to conserve sodium, and the decreased
excretion of potassium. Exogenous factors such as illness, volume
depletion, or medication can further exacerbate these changes, thus
making the elder at greater risk for renal failure
Antidiuretic Hormone
(ADH)
Atrial Natriuretic Factor
(ANF)
A hormone released by atrial muscle cells in
response to distention from fluid overload
Affects several body systems including the CV,
renal, GI, and endocrine systems, but primarily
affects the Renin-Angiotensin-Aldosterone-System
(RAAS).
Function: to oppose the RAAS by inhibiting renin
secretion and blocking the secretion and Na+-
retaining effects of aldosterone consequently,
promoting Na+ wasting, diuresis (increased urine
output) and causes vasodilation.
The Normal Elderly
Clients…

lean body mass ----

body fat--------------
total body water---
The Normal Elderly
Clients…

Perception of thirst
Kidney function-----
Thermoregulation-
The Elderly Clients…
Other Factors which may influence F&E balance in
elders are:
 Increased use of diuretics for HTN and heart disease
 Decreased intake of food and water, especially in
clients with dementia or who are dependent on others
to feed them and offer them fluids.
 Preparations for certain diagnostic tests that require
the client on NPO for long periods of time or cause
diarrhea from laxative preps.
 Clients with impaired renal function, such as elders
with DM.
 Fever, influenza, surgery or heat exposure
Possible Nursing
Diagnoses
Fluid Volume Deficit
Risk for Fluid Volume Deficit
Ineffective Tissue Perfusion
Risk for Injury
Risk for Imbalanced Body Temperature
Ineffective Breathing Pattern
Decreased Cardiac output
Excess Fluid Volume
Impaired Gas Exchange
Summary
Normal aging is often described as a continuous process characterized by
a decrease in lean body mass, an increase in fat, and a decrease in total
body water. However, it has been pointed out that many older people,
especially those aged 75 years and over, may feel healthy in spite of a
chronic illness. Thus, both nutrition and hydration may be altered by
chronic diseases, infection, as well as by changes in functional status,
mobility disorders, confusion, impaired sensory perception, medication
effects and difficulties in drinking, swallowing and eating because of the
absence of teeth or ill-fitting dentures. For water balance, two factors
place the elderly at risk for dehydration: a decreased fluid intake and an
increased fluid loss. In the human, the normal pattern of drinking is
intermittent while water is continuously lost by various routes so that
dehydration occurs. Dehydration is the most common cause of fluid and
electrolyte imbalance and is frequently reported in residents, hospitalized
and community-dwelling elderly people. It has been stated that one of the
greatest threats to the survival of any terrestrial animal, including man, is
that of dehydration.

SOURCE:
Nutrition and Aging:
I.H. Rosenberg; A. Sastre (eds),
Nestl´e Nutrition Workshop Series Clinical & Performance Program, Vol. 6, pp. 193–206,
Nestec Ltd.; Vevey/S. Karger AG, Basel,  2002.
That’s all, Thank You! 

Prepared by:

Benjamin Vera Cruz

LPU-Manila