Healthy Ageing: why is being well hydrated so important?
The number of seniors is reaching historically unforeseen
levels. In 1950, seniors between 45 and 75years old made
up 19% of the total population, whereas the United Nations
forecasts 32% by 20501.
Actually, beginning around 45 years old, the ageing process
begins sometimes earlier than we think. Thebody evolves
slowly. For example, nutritional needs change due to
physiological modifications that affect body composition,
water balance and bone health2 The body becomes less
efficient than before and starts to feel the first signs of
ageing.
All of these changes are of course unavoidable!
However, it is possible to take action in order to protect
oneself as much as possible against premature ageing.
1. EuroStat Datamonitor seniors are define as people aged 50 years old and over
2. Gille 2010. Overview of physiological changes and optimal diet in the golden age generation over 50. Eur Rev Aging Phys Act 2010; 7: 2736
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Healthy living can actually slow down and delay these slight
drawbacks, which on a daily basis, can become tiresome
and harm the well-being of seniors. 71% of seniors across
the world are willing to modify their diets to improve their
health status1. As health care professionals, you can help your
patients.
To do so, you can give them good advice to be followed on
a daily basis: practicing on a regular basis a physical activity
which is suitable for them, adopting a varied and balanced
diet which provides them adequate amounts of macro- and
micronutrients and drinking enough water to keep the body
properly hydrated.
Help ageing people preserve
their quality of life!
2 Healthy Ageing: why is being well hydrated so important?
With ageing, seniors are more
at risk of mild dehydration

Gradual ageing of the body is accompanied by several

changes, both physical and physiological.
For example, the decline in lean body mass is accompanied
by a decrease over time in the percentage of water in the
body. So, the percentage of body weight made up of water
falls from about 60% in adults to about 50 % in the elderly3,4.

A more troubling fact: seniors are more at risk of dehydration
as the sensation of thirst decreases with age, and their
kidneys have decreased ability toconcentrate urine.
1. Age and progressive reduction
of the sensation of thirst
The sensation of thirst is a rather complex biological
mechanism which allows the body to realise that it lacks
water. Thus, when we feel thirsty, our body is already slightly
dehydrated. In seniors, the sensation of thirst is decreasing,
and therefore they are more at risk of becoming dehydrated.
This is a well established physiological fact for seniors aged
65 and over5, but it is also true amongst younger seniors
as shown by two studies6,7. Indeed, in the Marzalek et al
study6, which examined men who were exposed to a hot
environment, levels of thirst in older men (aged 58-64 years)
were lower than amongst young people (aged 20-29 years).
Another study, carried out during a strenuous hill walk,
hasalso shown that the sensation of thirst was lower
for seniors (aged 56+/-3 years) than for younger adults
(aged24+/-3years)7.

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2. Age and impairment of kidney function
With age, the kidneys do not function as well and renal ability
to concentrate urine decreases.
In fact, between the ages of 30 and 80, there is often a 20 to
25% loss of renal mass8, most of which is from the cortex.
Other changes explain the difficulty which kidneys have in
adapting urine concentration. sticky mouth, muscle weakness, headache, sleepiness or
For example, the decrease of renal blood flow and of the tiredness.
glomerular filtration rate9.
Therefore, it is important to advise them to drink water
When seniors are slightly dehydrated, they can feel the onset regularly throughout the day, and to drink before they become
of some physical signs: thirst of course, but also a dry and thirsty10.

3. Jequier E et al. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr 2010; 64: 115-123
4. Mentes J. Oral hydration in older adults. AJN 2006; 106 (6): 40-49
5. Phillips PA et al. (1984): Reduced thirst after water deprivation in healthy elderly men. New England Journal of Medicine 1984; 311(12): 753-759
6. Marszalek A International journal of occupational safety and ergonomics (2000): Thirst and work capacity of older people in a hot environment. Int J Occup safety ergonomics, 2000; special
issue: 135-142
7. Ainslie PN et al. (2011): Energy balance, metabolism, hydration and performance during strenuous hill walking : the effect of age. J Appl 2002; 93: 714-723
8. Beck LH. The aging kidney. Defending a delicate balance of fluid and electrolytes. Geriatrics 2000; 55: 26-32
9. Elmadfa et al. Body composition, changing physiological functions and nutrient requirements of the Elderly. Ann Nutr Metab 2008; 52 (suppl 1): 2-5
10. Ferry M. Strategies for insuring good hydration in the elderly. Nutrition Reviews, 2005: II: S22-S29

www.nestlenutrition-institute.org 4 Healthy Ageing: why is being well hydrated so important?

Good hydration is important
for the quality of life of seniors

Water is vital for the whole body Age can affect physical and cognitive functions. Water cant
solve this problem but it is necessary for seniors in their daily
andisessential for health. life. Indeed, maintaining good hydration is important for the
whole body including the brain.
1. Water is essential for the brain
Water is the main component of the body. This is true for
children and adults, but also for seniors, even though the
percentage of water in the body gradually decreases with
age. Water is everywhere. It hydrates every cell, every organ,
including the brain. More than 2/3 of the brain* is made up of
water11.

* 73% of an adults brain is made up of water.

11. Mitchell HH et al. The chemical composition of the adult human body and its bearing on the biochemistry of growth. The Journal of Biological Chemistry, 1945: 625-637

www.nestlenutrition-institute.org 5 Healthy Ageing: why is being well hydrated so important?

2. Intestinal comfort
It is common knowledge that elderly people are affected by
problems with bowel movements and constipation12. People
may experience feelings of heaviness, bowel discomfort... i.e.
minor yet most unpleasant problems ona daily basis.

From the Suares study13, constipation affects between 11%
and 18% of the people according to geographical region. And
the prevalence of this disorder is even higher for women and
older people. Constipation in the elderly has many potential
causes, including a reduced fluid intake, malnutrition, reduced
fiber intake, lackofphysical activity, impaired mobility, side-
effects of medication, an acute or chronic illness.
Therefore, it is important to recommend that your patients
practice regular exercise and go to the toilets at the same
time everyday either in the morning or after meals15.
It is also advisable to eat more fruits, vegetables andwhole
grain foods as sources of fiber. Maintainingadequate
fluid intake with fiber consumption isalsorecommended.
Indeedthebulking effect of fibers consists in retaining water.
Drinkingenough water isagood habit to teach them16.

Evidence in both disease-specific and generic quality oflife

(QOL) instruments has shown that constipation isassociated
with impaired health-related quality oflife14.

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3. Urinary incontinence
Urinary incontinence is an
important topic asithas a real
impact on daily life.
It is a rather sensitive issue
for women andespecially for
senior women17. Infact, urinary
incontinence affects about 19%
ofwomen aged 19to44years,
25% ofthoseaged 45to64 years,
and30% ofthoseaged65years
and older18.
How to define urinaryincontinence?
Urinary incontinence is a symptom or sign of any
involuntary loss of urine. Continence (storage of
urine) ismaintained when the urethral pressure is
greater than the pressure inside the bladder itself
(intravesical pressure)19. Urinary incontinence causes
include structural changes in vesical muscle as well
as impaired neural control and age-related changes of
the lower urinary tract20.

We know that there are many

misconceptions about urinary
incontinence! For example,
fearof incontinence may lead
people todecrease their water
consumption.

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Adopting healthy habits canbringareal relief.
Drinking enough water throughout the day isimportant
for seniors to be well hydrated.
A decrease in fluid intake should only be tried in patients
with abnormally high fluid intakes21, as a decrease in
fluids may lead to urinary tract infections, constipation,
ordehydration.
Maintaining normal weight through adulthood may be an
important factor in preventing the development of urinary
incontinence especially in women, because overweight
increases the pressure onthe bladder and surrounding
muscles.
12. MayoClinic: http://www.mayoclinic.com/health/dehydration/DS00561/
DSECTION=symptoms
13. Suares NC, Ford AC. Prevalence of, and Risk Factors for, Chronic Idiopathic Constipation
in theCommunity: Systematic Review and Meta-analysis. Am J Gastroenterol 2011; 106:
1582-1591.
14. Rao S et al. Update on the management of constipation in the elderly: new treatment
options. Clinical Interventions in Aging 2010: 5 163-171
15. Gallagher et al. Constipation in old age. Best Practice & Research clinical
gastroenterology 2009;23: 875-887
16. Bouras EP and Tangalos EG. Chronic constipation in the elderly. Gastroenterol Clin N Am
2009; 38: 463-480.
17. Norton P et al. Urinary incontinence in women. Lancet, 2006; 367: 57-67
www.nestlenutrition-institute.org 8 Healthy Ageing: why is being well hydrated so important?
Prescribing some physical rehabilitation therapies witha
physiotherapist including musculation of thepelvic floor
can also be useful for initial management ofurinary
incontinence18,23.
It is also a good idea to advise your patients to take time
for going regularly to the toilet.
Thus, it is important to help seniors stay well
hydrated and recommend that they drink
enough water, regularly throughout the day.
18. Shamliyan TA et al. Systematic Review: Randomized, Controlled Trials of Nonsurgical
Treatments for Urinary Incontinence in Women Ann Intern Med. 2008;148: 459-473
19. Glazener et al. Urodynamic studies for management of urinary incontinence in children
andadults (review). The cocherane collaboration 2012; 1-43
20. Goepel M et al. Urinary incontinence in the elderly. Deutsches Arzteblatt International
2010; 107:(30) 531-536
21. Hay Smith J. et al. Adult conservative management. In Incontinence. Edited by Abrams P,
CardozoL, Khoury S, Wein A. Paris: Health Publication Ltd. ; 2009:1025-1120
22. Rena RW et al. Improving urinary incontinence in overweight and obese women through
modestweight loss. Obstet Gynecol. 2010 August; 116(2 Pt 1):284-292
23. Thuroff JW et al. EAU Guidelines on urinary incontinence. Eur Urology 2011 ; 59:387-400
Help them to stay
well hydrated

1. Good hydration is important

for the whole body

Drinking water helps to maintain the water balance.

Everyday, water loss must be compensated by sufficient
intake of water3. That is why it is important for your patients
to remain properly hydrated.

A healthy sedentary adult living in a temperate climate

loses 2l to 3l of water a day, mainly fromurine. But other
vectors are also responsible for the body water loss: the skin,
therespiratory tract and, at a low level, thedigestive system.
Itisimportant to compensate those losses by asufficient
water intake. Water balance for adults
Our body produces water by metabolism and gets water from
food but this is not sufficient to fulfill thebody needs. So an Healthy adults regulate water balance with precision, but water
adult should drink, on average, 1.5lof water a day**. turnover in the elderly can be compromised.

**For a healthy sedentary adult living in temperate climate

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With ageing, all the parameters of water metabolism undergo
changes and so, the water balance evolves.
Elderly people show lower non-renal water losses (mainly due
to lower sweat losses); at the same time renal concentration
capacity becomes impaired, resulting in an increased
obligatory urine volume. Because eating habits are changing,
the volume of water obtained from food increases slightly
with age whereas the metabolic water decreases. So the
water balance remains nearly the same and the water intake
recommandations can be maintained24.
But water input can be reduced due tothe diminution ofthe
thirst sensation and appetite. Thereforeitisimportant to teach
your patients the healthy habit of drinking regularly throughout Water balance for seniors

Remind your patients the day and explain to them the importance ofdrinking 1.5l**,
to drink before being thirsty. theequivalent of8 glasses*** ofwater per day10.
In fact, when the sensation of thirst arises, The daily needs are even higher when the outside temperature
the body is already slightly dehydrated. increases or when the inside temperature isoverheated.

24. Manz et al. water balance throughout the adult life span in a German population. ** For a healthy sedentary adult living in temperate climate
BritishJournal of Nutrition 2011; 1-9 *** One glass=20cl

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 To help them drink
8 glasses** ofwater per
day, give them simple
dailylandmarks :

2. Give them a tip

to check theirhydration level
Observing the colour of urine is an easy andrapid way to
assess whether someone isproperly hydrated2,3.

If urine is dark-coloured rather than pale yellow, it might mean

that the patient isnotdrinking enough.
The urine colour can be affected by certainfoods, vitamin
supplements ormedicaltreatment.

** For a healthy sedentary adult living

in temperate climate - one glass = 20cl

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Healthy Ageing:
why is being well hydrated
so important?

www.nestlenutrition-institute.org