Why dehydration triggers anxiety in older people

The recent spell of warm weather provided a welcome break after a cold and dreary winter. Now that those warm days have passed, it is the ideal time to look ahead and prepare for future high temperatures. Within a care setting, understanding how to keep older and vulnerable people safe during hot spells is essential for protecting their health. Managing dehydration in older people should be a primary concern for families and care professionals alike when temperatures rise.

When people are exposed to heat and direct sunlight there are a number of risks we need to be aware of. Some of these are obvious, though some less obvious, and the risk for vulnerable people can be severe. Some of the main risks we need to be aware of are dehydration, sun burn and heatstroke, as well as some medications becoming less effective or increasing the risk of direct sunlight.

Each of these risks can lead to other consequences depending on the needs of the individuals we support.

Dehydration in older adults

This is one of the most prevalent risks during hot weather. It’s really important to ensure our clients remain well hydrated. Dehydration can affect blood pressure, which can in run increase the risk of stroke and heart failure. It can lead to cognitive decline, affect balance and significantly increase the risk of falls. Falls are already the most prevalent type of incident we see in a care setting and these can increase further during hot weather.

Beyond physical complications, low fluid intake can affect mental health. When looking at psychological changes, understanding why dehydration triggers anxiety in older people helps care teams provide better support. Reduced fluid volume in the body causes physical stress, which increases cortisol levels and heart rates. This physiological stress response explains why dehydration can trigger anxiety in older adults, often presenting as sudden confusion, nervousness, or restlessness.

Recognising the signs of dehydration in older adults is vital for preventing these distressing symptoms. Dehydration can also lead to an increased risk of urinary tract infection. It can also affect skin integrity and make wounds slower to heal.

How to stop dehydration in older adults? 

Things to consider include increasing the amount of fluids offered to our clients, as well as keeping a record of the fluids they have consumed. In addition to just offering clients more drinks we can offer iced lollies, jellies and smoothies. Find some things that your client likes and that are appropriate for them.

If your client is living with dementia then consider that they may need to be reminded to take on additional fluids. If you have clients with a fluid restriction then you should refer this to the clinician overseeing them so that the fluid level and their medication can be reviewed.

Practical steps to manage sunburn

Sunburn can be very uncomfortable and severe sunburn extremely dangerous, especially for vulnerable people. Badly burned skin can take a very long time to heal and has the potential to become infected and lead to further complications such as sepsis. It is vital that we avoid this.

If your clients are going outdoors then consider the time of day. Ideally they will avoid going out at the hottest times of day, as this will increase the risk of sunburn and dehydration and, when they do go out, they should be encouraged to wear a sunhat and cover up any exposed skin.

For any exposed skin they should be supported to apply a high factor sunscreen. Always check that this doesn’t contraindicate with any medication, particularly topical medication that they use. When going to be outside look for shady spots so they’re out of direct sunlight. Remember to take some drinks with you so you can keep them (and yourself) well hydrated.

Recognising heat exhaustion

Heat exhaustion is when the body is becoming dangerously overheated and is losing vital water and salt. This can develop over several hours or even days during a heatwave, as fluids are gradually lost. It isn’t all about dehydration though; heatstroke can happen to a well hydrated person if they are exposed to higher temperatures for extended periods. Without intervention heat exhaustion can lead to heatstroke.

Signs to look for include cool and clammy skin or goosebumps even though the surroundings are hot, dizziness and physical weakness, nausea, loss of appetite and vomiting, as well as increased irritability and confusion, particularly for people living with dementia.

If you suspect that your client has heat exhaustion then you should move them to a cool place, support them to lie down and elevate their feet if possible, remove any tight clothing and remove any excess layers of clothing. If they are able to drink then give them plenty of fluids. Seek medical advice though 111 and if in doubt call 999.

Heatstroke

Heatstroke occurs when the body becomes unable to regulate its internal temperature. In an older or more vulnerable person this can quickly lead to organ damage, seizures and even death if left untreated.

If you are taking the above measures and your client’s condition is not improving then they may be suffering from heatstroke. Signs to look for include severe confusion, slurred speech, uncharacteristic behaviour, loss of consciousness and seizures. Physical signs include hot dry and flushed skin, a high body temperature, rapid heart rate and shallow breathing.

If you suspect that your client has heatstroke then you should call 999 immediately.

Does heat affect my medication?

Medication can increase the risk of hot weather significantly and there are a number of potential hazards. These can include increasing the risk of dehydration and reducing the ability to sweat and regulate body temperature.

Some medication can increase photosensitivity, which would present significant extra risk when going out into direct sunlight. Hot weather can also decrease the effectiveness of medication and so it’s important to ensure these are stored in a cool place and, for medicines stored in a fridge, that the fridge remains at the correct temperature.

Common medications to consider in hot weather include Antipsychotics and antidepressants, Parkinson’s disease medication, beta-blockers, diuretics, metformin, insulin, laxatives. This is not a complete list though and you should check whether your client’s medication will present an additional risk during hot weather.

Stay safe during warm weather

So, as we come into the summer months, take some time to check how your clients might be affected, as well as how you and your colleagues stay safe. Make sure you raise any concerns you have and seek advice form a qualified clinician. And enjoy the sunshine!