# I just got this email from my sister re: us old farts drinking fluids



## Finch Platte (Nov 14, 2003)

Arnaldo Liechtenstein, physician.

Whenever I teach clinical medicine to students in the fourth year of medicine, I ask the following question:

What are the causes of mental confusion in the elderly?

Some offer: "Tumors in the head". I answer: No!

Others suggest: "Early symptoms of Alzheimer's". I answer again: No!

With each rejection of their answers, their responses dry up.

And they are even more open-mouthed when I list the three most common causes:

-uncontrolled diabetes;

-urinary infection;

-dehydration.

It may sound like a joke, but it isn't. People over 60 constantly stop feeling thirsty and consequently stop drinking fluids.

When no one is around to remind them to drink fluids, they quickly dehydrate. Dehydration is severe and affects the entire body It may cause abrupt mental confusion, a drop in blood pressure, increased heart palpitations, angina (chest pain), coma and even death

_This habit of forgetting to drink fluids begins at age 60, when we have just over 50% of the water we should have in our bodies. People over 60 have a lower water reserve. This is part of the natural aging process._

But there are more complications. Although they are dehydrated, they don't feel like drinking water, because their internal balance mechanisms don't work very well.

In Conclusion:

People over 60 years old dehydrate easily, not only because they have a smaller water supply, but also because they do not feel the lack of water in the body.

Although people over 60 may look healthy, the performance of reactions and chemical functions can damage their entire body

So here are two alerts:

1) _Get into the habit of drinking liquids_. Liquids include water, juices, teas, coconut water, milk, soups, and water-rich fruits, such as watermelon, melon, peaches and pineapple; Orange and tangerine also work.

_The important thing is that, every two hours, you must drink some liquid. Remember this!_

2) Alert for family members: constantly offer fluids to people over 60. At the same time, observe them.

If you realize that they are rejecting liquids and, from one day to the next, they are irritable, breathless or display a lack of attention, these are almost certainly recurrent symptoms of dehydration.

So spread it around! Don't Forget, Do It Now! Your friends and family need to know for themselves and you too, to be healthier and happier.

It's great advice to share with people over 60.


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## MSU Alum (Aug 8, 2009)

The single most important factor for me, riding, is how hydrated I am.


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## Bikeworks (Sep 10, 2020)

ER RN here. As soon as I get anyone over the age of 55 or so brought in for acute change in mental status, after being assessed for stroke the very next things I go to are a finger stick, sepsis, and UTI (urosepsis), especially if it's a female.


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## vegen (Jan 2, 2006)

Just wanted to chime in here that my grandmother got delerium (different than dementia but the same) from a UTI that was undiagnosed for years and also caused her to not drink water. She did not recover.


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## Crockpot2001 (Nov 2, 2004)

Yup! my job, all day, every day, is looking at the nutrition/hydration status of my elderly patients. UTI's impact the elderly psych status viciously. Don't fear coffee or tea as they are NOT a diuretic, reduce booze intake, increase high moisture foods intake like fruits, soups, and veggies, make fluids a part of every part of the day. Also, as a casual observation, I see an increase in UTI's and dehydration AEB labs, with significant weather changes that require forced air temp control. When it starts to get hot and muggy the A/C dries the air. When it gets cold the forced air heater dries the air. 

Crockpot RD, CSG


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## Crockpot2001 (Nov 2, 2004)

vegen said:


> Just wanted to chime in here that my grandmother got delerium (different than dementia but the same) from a UTI that was undiagnosed for years and also caused her to not drink water. She did not recover.


Sorry for your loss. I wish I could say that scenario is rare. I typically see the lack of hydration results in the UTI. Chicken and egg, right?


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## spaightlabs (Dec 3, 2011)

I drink a gallon a day. On the odd day I don't get all of my water I can definitely feel it.


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## vegen (Jan 2, 2006)

Crockpot2001 said:


> Sorry for your loss. I wish I could say that scenario is rare. I typically see the lack of hydration results in the UTI. Chicken and egg, right?


Thank you.

We actually don't know which came first because she also didn't tell anyone what was going on. I suspect it was a UTI resulting from dehydration but then the UTI also prevented rehydration because the urges were unpredictable (I think). We didn't find out about any of this until she was in a full blown delerium episode and had to go to the hospital because she also hid it all (I understand this is pretty typical too). They never could get the UTI cleared up but the care she was getting in the assisted living place she was in was subpar also. It was a bad situation all around.

Drink that water people!


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## Sanchofula (Dec 30, 2007)

So Arnaldo missed one:

Depression.

I see a lot of older folks who complain of increased confusion and memory issues, they come in with concerns that they are developing dementia. The rule outs include delirium, depression, insomnia, and substance abuse.

In delirium we're looking at metabolic issues, infection, diet, hydration, medications/interactions, etc...

It's not that folks don't feel the need to drink; though in dementia that is common, but they feel like they can get away with it like they did when they were younger (but they can't).

So yeah, drink more, eat right, and get some exercise.

As long as you can remember how to get to the trail head (and get home), you are good


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## MSU Alum (Aug 8, 2009)

Crockpot2001 said:


> Don't fear coffee or tea as they are NOT a diuretic.....


I did not know that, but there are plenty of studies out there that substantiate that this is true.


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## Sanchofula (Dec 30, 2007)

vegen said:


> Just wanted to chime in here that my grandmother got delerium (different than dementia but the same) from a UTI that was undiagnosed for years and also caused her to not drink water. She did not recover.


Some folks have chronic UTI, esp. in the elderly and frail, in your grandmother's case it probably wasn't undiagnosed so much as either hard to treat or recurrent. It's easy enough to hydrate someone, just give them an IV, but changing habits is a whole other thing.


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## Crockpot2001 (Nov 2, 2004)

MSU Alum said:


> I did not know that, but there are plenty of studies out there that substantiate that this is true.


Feel free to post them. Caffeine *does* increase the sense of urgency and *does* stimulate the peristalsis of the bowels but output of urine is not significantly more then the added input of the fluid.


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## Crockpot2001 (Nov 2, 2004)

Nurse Ben said:


> So Arnaldo missed one:
> 
> Depression.
> 
> ...


Well said.


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## KRob (Jan 13, 2004)

Good to know. No wonder I couldn't find the rice in the storage room the other day when I was making dinner after my long ride. Ha ha. Kidding, aside, I do sometimes forget to drink enough water. My wife measures her water out every day and makes sure she gets it all. I should probably follow suit. (60 now)


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## WHALENARD (Feb 21, 2010)

My understanding is that caffeine in of itself is a mild diuretic just that the body adapts to it so quickly that we build a tolerance and the diuretic effect goes away.



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## Crockpot2001 (Nov 2, 2004)

WHALENARD said:


> My understanding is that caffeine in of itself is a mild diuretic just that the body adapts to it so quickly that we build a tolerance and the diuretic effect goes away.
> 
> Sent from my Pixel 4a (5G) using Tapatalk


Yup, very mild. I would rather an elderly person drink as much coffee or tea as they like than have them suffer from decaf death  Alcohol is a much stronger diuretic and a more significant concern when considering hydration status.


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## MSU Alum (Aug 8, 2009)

Crockpot2001 said:


> Feel free to post them. Caffeine *does* increase the sense of urgency and *does* stimulate the peristalsis of the bowels but output of urine is not significantly more then the added input of the fluid.


"Doses of caffeine equivalent to the amount normally found in standard servings of tea, coffee and carbonated soft drinks appear to have no diuretic action."








Caffeine ingestion and fluid balance: a review - PubMed


The most ecologically valid of the published studies offers no support for the suggestion that consumption of caffeine-containing beverages as part of a normal lifestyle leads to fluid loss in excess of the volume ingested or is associated with poor hydration status. Therefore, there would...




pubmed.ncbi.nlm.nih.gov





This one is specific to exercise and caffeine.
"Caffeine exerted a minor diuretic effect which was negated by exercise. Concerns regarding unwanted fluid loss associated with caffeine consumption are unwarranted particularly when ingestion precedes exercise."








Caffeine and diuresis during rest and exercise: A meta-analysis - PubMed


Caffeine exerted a minor diuretic effect which was negated by exercise. Concerns regarding unwanted fluid loss associated with caffeine consumption are unwarranted particularly when ingestion precedes exercise.




pubmed.ncbi.nlm.nih.gov





"Our data show that there were no significant differences across a wide range of haematological and urinary markers of hydration status between trials. These data suggest that coffee, when consumed in moderation by caffeine habituated males provides similar hydrating qualities to water."








No evidence of dehydration with moderate daily coffee intake: a counterbalanced cross-over study in a free-living population - PubMed


It is often suggested that coffee causes dehydration and its consumption should be avoided or significantly reduced to maintain fluid balance. The aim of this study was to directly compare the effects of coffee consumption against water ingestion across a range of validated hydration assessment...




pubmed.ncbi.nlm.nih.gov





The Mayo clinic.
"While caffeinated drinks may have a mild diuretic effect - meaning that they may cause the need to urinate - they don't appear to increase the risk of dehydration."








The myth about caffeine and dehydration


Caffeinated drinks usually won't dehydrate you, but water is still your best option.




www.mayoclinic.org





It appears that the body acclimates to caffeine in regular users such that the small diuretic effects are mitigated.
I'm thinking in terms of healthy individuals and exercise, though.

I think these studies need to be looked at in context. I can hydrate pretty quickly if I drink 20 to 30 ounces of water, or a hydrating electrolyte mixture if I'm already dehydrated. I doubt I could drink that much coffee or iced coffee, but probably could drink that much iced tea.
In the elderly, particularly if they have recently started or increased caffeine intake, I would be more alert to the possibility that there could be a more pronounced diuretic effect.
If I knew an older person in this category, I'd keep an eye on them.

This is the abstract of a study I haven't read, but it addresses mechanisms and is interesting, at least.
"Caffeine is an alkaloid which belongs to the family of methylxanthines and is present in beverages, food and drugs. Caffeine competitively antagonizes the adenosine receptors (AR), which are G protein-coupled receptors largely distributed throughout the body, including brain, heart, vessels and kidneys. Caffeine consumption has a well-known diuretic effect. The homeostasis of salt and water involves different segments of the nephron, in which adenosine plays complex roles depending on the differential expression of AR. Hence, caffeine increases glomerular filtration rate by opposing the vasoconstriction of renal afferent arteriole mediated by adenosine via type 1 AR during the tubuloglomerular feedback. Caffeine also inhibits Na(+) reabsorption at the level of renal proximal tubules. In addition, caffeine perturbs the hepatorenal reflex via sensory nerves in Mall's intrahepatic spaces. Here, we review the physiology of caffeine-induced natriuresis and diuresis, as well as the putative pathological implications.








[Mechanisms of caffeine-induced diuresis] - PubMed


Caffeine is an alkaloid which belongs to the family of methylxanthines and is present in beverages, food and drugs. Caffeine competitively antagonizes the adenosine receptors (AR), which are G protein-coupled receptors largely distributed throughout the body, including brain, heart, vessels and...




pubmed.ncbi.nlm.nih.gov


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## Finch Platte (Nov 14, 2003)

MSU Alum said:


> I did not know that, but there are plenty of studies out there that substantiate that this is true.


I thought if you regularly drank coffee/tea is was not, but if you go above what you usually drink, then it's a diuretic. No?

That's what happens to me, anyhoo. I have a cup of coffee in the a.m., then if I drink more, I p!ss like a racehorse.


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## Finch Platte (Nov 14, 2003)

Butt weight, there's more!

*12 Incredible Benefits of Lemon Water You Never Knew*









12 Incredible Benefits of Lemon Water You Never Knew


The simple combination of lemon juice and water can have incredible benefits for your weight and your health.




www.thehealthy.com


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## Sanchofula (Dec 30, 2007)

Finch Platte said:


> Butt weight, there's more!
> 
> *12 Incredible Benefits of Lemon Water You Never Knew*
> 
> ...


Next thing you know we'll be reading about the life saving benefits of calcium carbonate


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## Finch Platte (Nov 14, 2003)

Nurse Ben said:


> Next thing you know we'll be reading about the life saving benefits of calcium carbonate


Only if injected.


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## MSU Alum (Aug 8, 2009)

Finch Platte said:


> I thought if you regularly drank coffee/tea is was not, but if you go above what you usually drink, then it's a diuretic. No?
> 
> That's what happens to me, anyhoo. I have a cup of coffee in the a.m., then if I drink more, I p!ss like a racehorse.


I think that sounds reasonable. In fact, I think some of the data support that. These were often well acclimated caffeine drinkers who drank a "moderate" amount.


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## WHALENARD (Feb 21, 2010)

Caffeine ingestion and fluid balance: a review - PubMed


The most ecologically valid of the published studies offers no support for the suggestion that consumption of caffeine-containing beverages as part of a normal lifestyle leads to fluid loss in excess of the volume ingested or is associated with poor hydration status. Therefore, there would...




pubmed.ncbi.nlm.nih.gov





Sent from my Pixel 4a (5G) using Tapatalk


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## chazpat (Sep 23, 2006)

I'm a few years shy of 60 but I think I need to do a better job with my hydration. 

Last summer I was going on long rides on my CX and pretty sure I was getting dehydrated in the heat. I've started carrying a bottle with an electrolyte along with water in my Camelbak on all rides this summer. Also usually carrying a bottle with electrolyte when I run, even though I'm not running far at this time. Though I'm drinking a couple of cups of coffee, I think I need to consume more water in the morning, I feel a bit dehydrated in the morning, especially if I drank even one beer.


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## upstateSC-rider (Dec 25, 2003)

I can see this happening to me eventually, I intentionally limit water intake after 7 or so because I hate having to wake up 2 or 3 times/night having to urinate, especially when I rarely get good sleep to begin with.


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## Carl Mega (Jan 17, 2004)

Crockpot2001 said:


> Caffeine *does* increase the sense of urgency


I have felt this sense of urgency. pee-pee dance!


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## Shark (Feb 4, 2006)

Carl Mega said:


> I have felt this sense of urgency. pee-pee dance!


#2! I mean, x2 

Is dehydration the reason old people are wrinkled?

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## Xylx (Mar 18, 2005)

My wake up and drink water call was a blood test a few months ago that showed kidney issues (high creatinine). What helped me hydrate more than anything was a Contigo brand water bottle. It is very easy to drink out of and ice cubes last for hours. I've always been good at hydrating while riding (Camelbak early adopter), but I was not very good at staying hydrated while at home or in the car. My Contigo never leaves my side now.


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## natas1321 (Nov 4, 2017)

I drink enough water on says I ride, usually 6-7 liters (1 liter before, after and every 30-40 minutes during the ride). It's the days I don't ride that I don't remind myself to keep hydrated. 

Sent from my moto g(7) supra using Tapatalk


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## kosmo (Oct 27, 2004)

Finch Platte said:


> It may sound like a joke, but it isn't. People over 60 constantly stop feeling thirsty and consequently stop drinking fluids.
> 
> 1) _Get into the habit of drinking liquids_. Liquids include water, juices, teas, coconut water, milk, soups, and water-rich fruits, such as watermelon, melon, peaches and pineapple; Orange and tangerine also work.
> 
> _The important thing is that, every two hours, you must drink some liquid. Remember this!_


Great post, thanks.

This is certainly true for me. At 62, I hardly ever feel thirsty anymore, and this from a kid whose dad said he couldn't go on a 1 hour car ride without needing a drink of water.

But I sure recognize that draggy afternoon feeling that makes me realize I'm behind on hydration.

I'll add one that seems to have been missed (apologies if I read too quickly):

_*Watch the color of your pee: straw-colored or lighter is good, darker is bad.*_


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## mudflap (Feb 23, 2004)

Sleep better when the brain is well hydrated.


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## Finch Platte (Nov 14, 2003)

I went to the market today, intending to get a couple weeks' worth of lemons. Nope! At .67 cents apiece, I bought a couple and will grow my own damn lemons.

(FP does math in his head. .67 times 30 is $20 a month for lemons. )


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## azjonboy (Dec 21, 2006)

I work outside in the Phoenix heat so generally drink about 2 gallons of fluid a day. When riding that amount goes up considerably.


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## kosmo (Oct 27, 2004)

mudflap said:


> Sleep better when the brain is well hydrated.


But more old-man-middle-of-the-night-pees, yes?!

Conundrum!



Finch Platte said:


> I went to the market today, intending to get a couple weeks' worth of lemons. Nope! At .67 cents apiece, I bought a couple and will grow my own damn lemons.
> 
> (FP does math in his head. .67 times 30 is $20 a month for lemons. )


You need to read the somewhat tongue in cheek book "The 64 Dollar Tomato"! 🙃


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## mudflap (Feb 23, 2004)

kosmo said:


> But more old-man-middle-of-the-night-pees, yes?!
> 
> Conundrum!


Doesn't necessarily mean you need to drink during the night. Just saying if you is well hydrated, you sleep better and have reduced chance of muscle cramps that dehydration can bring on.


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## acer66 (Oct 13, 2010)

I am a functioning (according to me that is) drunk so I should be fine.


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## ZX11 (Dec 24, 2020)

One trick that worked for me was carrying around one of those big gulp cups (32oz?) from the fast food restaurants. I kept it filled with tap water and sometimes ice. Since it was always with me, I by habit would sip on it. Even if the water wasn't great tasting, I would get used to it. It kept me well hydrated. 

During the Atlanta summer Olympics back in the 90's, my big gulp cups of water kept me cool. People complained about the 99 degree high humidity but I didn't notice the heat. Didn't even run my air conditioner and just kept the windows open.


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## 411898 (Nov 5, 2008)

If you're not stopping periodically to piss off the side of the trail, you're not drinking enough fluids.


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## acer66 (Oct 13, 2010)

Hawgzilla said:


> If you're not stopping periodically to piss off the side of the trail, you're not drinking enough fluids.


I can not be bothered to stop besides that screws up my strave stats so I just sweat it it out by crushing it and slaying trails like a much younger boss.


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## 411898 (Nov 5, 2008)

acer66 said:


> I can not be bothered to stop besides that screws up my strave stats so I just sweat it it out by crushing it and slaying trails like a much younger boss.


Stops? No need to stop. Drink on the roll. Also, in case you haven't heard, strava is shutting its doors in November. So sad for you!


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## Xylx (Mar 18, 2005)

Hawgzilla said:


> If you're not stopping periodically to piss off the side of the trail, you're not drinking enough fluids.


And if anyone doesn't believe that is good advice try this: Get really dehydrated, go home, drink beer, get prostatitus and enjoy peeing blood which feels like razor blades coming out. Learned that one the hard way over 25 years ago.


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## Finch Platte (Nov 14, 2003)

Xylx said:


> And if anyone doesn't believe that is good advice try this: Get really dehydrated, go home, drink beer, get prostatitus and enjoy peeing blood which feels like razor blades coming out. Learned that one the hard way over 25 years ago.


Oh, boy, another malady to add to the lexicon of possible health woes.



> Prostatitis is swelling and inflammation of the prostate gland, a walnut-sized gland situated directly below the bladder in men. The prostate gland produces fluid (semen) that nourishes and transports sperm.
> Prostatitis often causes painful or difficult urination. Other symptoms include pain in the groin, pelvic area or genitals and sometimes flu-like symptoms.
> 
> Prostatitis affects men of all ages but tends to be more common in men 50 or younger. The condition has a number of causes. Sometimes the cause isn't identified. If prostatitis is caused by a bacterial infection, it can usually be treated with antibiotics.
> ...











Prostatitis - Symptoms and causes







www.mayoclinic.org


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## acer66 (Oct 13, 2010)

Xylx said:


> And if anyone doesn't believe that is good advice try this: Get really dehydrated, go home, drink beer, get prostatitus and enjoy peeing blood which feels like razor blades coming out. Learned that one the hard way over 25 years ago.


I was with you until you mentioned beer which reminded me that there is one too many beer in the fridge.


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## Brules (Jul 10, 2021)

I hadn’t seen anyone mention this yet (maybe I missed it?) - Drip Drop.

If you have issues with getting dehydrated easily - go to Walgreens and by the pedialite section will be small boxes of drip drop. There is 8 pkgs per box. Add it to a regular bottle of water and will prevent craps/dehydration and if you are cramping already will help tremendously with it. If you watch college/pro football - when the water ppl come out with bottles with like black tape around them those usually have drip drop in them vs the worthless gator aid.

It works amazingly well - 100x better than anything else out there.

Also is great for hangovers! 🤣


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