Do Elderly Persons Need to Be Encouraged to Drink More Fluids?

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Abstract
A recently published and widely quoted modified food guide pyramid encourages persons over the age of 70 years to ingest eight glasses (2 liters) of fluids per day. We challenge the need for this much fluid intake and even question whether it may do more harm than good. Equal numbers of Hispanic and non-Hispanic white men and women were selected randomly from the Health Care Financing Administration (Medicare) rolls and recruited for a home interview followed by a 4-hour interview/examination in a senior health clinic. Questionnaires and examinations were used to determine usual daily self-reported intake of fluids, lying and standing blood pressures, history of falls over the past year, and the presence of chronic constipation and chronic fatigue or tiredness. Serum samples were obtained for determination of sodium, urea nitrogen (SUN) and creatinine concentrations, and calculation of SUN/creatinine ratios. Interviews/examinations were conducted on 883 volunteers (mean age of 74.1 years). Most participants (71%) estimated that their usual fluid intake was equal to or exceeded six glasses per day. Evidence of hypernatremia (serum sodium concentration > 146 mEq/l) was not observed in the 227 individuals ingesting less than this. Hyponatremia also was rare in this population. Fluid intake showed no significant associations with lying and standing blood pressures, a history of falling, or the frequency of chronic constipation or fatigue/tiredness. Until we have more evidence-based documentation that fluid intake of eight glasses (2 liters) per day improves some aspect of an elderly person's health, encouraging a fluid intake above a level that is comfortable for the individual seems to serve little useful purpose.