Dehydration (Exsikkose) & malnutrition in the Kenntnisprüfung

Which signs indicate dehydration (Exsikkose)?

• Standing skin folds, dry mucous membranes, concentrated urine, confusion
• Moist, cool skin, oedema of the lower legs and an increased urine volume
• High blood pressure, slow pulse and pale, diluted urine with a clear level of consciousness
• Increased salivation, a shiny tongue and skin folds that flatten quickly

Explanation: The classic signs: standing skin fold, dry oral mucosa, dark concentrated urine, weakness and acute confusion. Blood pressure tends to fall, the pulse rises. These are indications, not proof: in older people no single sign is reliable, not even the skin fold – dehydration is confirmed by the doctor or by laboratory tests.

Why do older people often drink too little?

• Because fluid requirements fall to about half in old age, so drinking less is enough
• The sense of thirst declines physiologically; fear of trips to the toilet and swallowing problems add to this
• Because the sense of thirst increases in old age, but drinking spoils the already poor appetite
• Mainly out of habit — a changed sense of thirst hardly plays a physical role

Explanation: The declining sense of thirst is the core physiological mechanism; added to this are fear of incontinence, forgetting (dementia) and dysphagia. The fluid requirement itself hardly falls.