Tag: SNN Health

A caregiving daughter once wrote in and asked me this common question:

“How can I find a gerontologist* near me to review medications, and help care for my mother with dementia?”

As you may have noticed if you’re a regular reader, I often emphasize the importance of spotting and reducing risky medications, especially those associated with falls or memory problems.

Understandably, this caregiver wants to find a geriatrician who can review her mother’s medications, and otherwise oversee her mother’s care.

(*Note: Technically, a geriatrician and a gerontologist are not the same. Gerontology is the social science discipline of all things aging, and one can get either a master’s or a doctorate in this field. Whereas geriatrics is a medical specialty, so geriatricians must first get a medical degree, then do a residency in internal medicine or family medicine, and then do specialty training. So when people say they want a gerontologist for medical care, what they really want is a geriatrician.)

Now, medication review is usually included in geriatrics primary care. Geriatric care, after all, means healthcare modified to be a better fit with what happens as people get older. And being careful with medications is pretty integral to this approach.

But, although geriatric primary care is certainly worth looking for, it can be hard to find. (Read on for suggestions below.)

So it’s good to have a plan B, which can be getting a medication review — and fall risk assessment — outside of geriatric primary care. This can also be a good option if an older person is reluctant to change primary care doctors.

In this article, I’ll describe 3 places to look for geriatric primary care, and then 3 options for medication review.

Since this caregiving daughter’s family lived in Nebraska, I tried to find some examples in that area.

Where to look for geriatric primary care

Many people start their search by looking for a geriatrician to be a primary care doctor. It certainly never hurts to try finding one. Here are a few options to search:

• HealthinAging.org provides a Find A Geriatrics Health Professional referral tool. This database only includes professionals who are currently paying members of the American Geriatrics Society (AGS), so it will miss many doctors who are board-certified in geriatrics but not currently in the AGS.
• Google “Geriatrician in [insert your city or location].
• If you want the best information on a particular doctor’s board certifications, check the website of the related specialty board. Geriatrics is a subspecialty of internal medicine and of family medicine, so geriatricians are initially certified by either the American Board of Internal Medicine, or the American Board of Family Medicine.
  • You can check any doctor’s specialty certification at CertificationMatters.org, a website maintained by the American Board of Medical Specialties.

It’s great to be under the care of a geriatrician. But geriatric primary care is best practiced as a team sport.

So I always recommend people look for a clinic that’s been designed to provide good care to older adults. As a bonus, many such clinics are good at working with family caregivers.

Again, it’s better to look for clinics and doctors that practice the geriatrics approach, rather than to focus on finding “a geriatrician.”

Now, here are three places to look for geriatric primary care:

Academic medical centers: These are medical centers and clinics that are affiliated with a medical school. Most medical schools have a Division of Geriatrics that often sponsors a geriatrics primary care clinic. They may also sponsor innovative programs in eldercare, such as house calls programs.

• This webpage lists the University of Nebraska’s geriatric patient care services. They also have a “Home Instead Center for Successful Aging.”

PACE (Program of All-Inclusive Care for the Elderly) centers: PACE is a wonderful all-inclusive model of care which includes medical care, supportive services, and day center services. I recommend that all caregivers concerned about a frail older person consider PACE. The care is provided by an interdisciplinary team which includes doctors, nurses, therapists, and social workers. PACE programs currently are operating in 33 states.

• To learn more about PACE, visit “Who, What, and Where is PACE?” (The state-by-state list of PACE programs indicates that there may be a PACE program in Omaha, Nebraska.)
• Note that patients have to be nursing-home eligible in order to enroll in PACE. This usually means the older person needs help with Activities of Daily Living, but nursing-home eligibility varies state-by-state.
• PACE is covered by Medicare, but if the older person doesn’t also qualify for Medicaid, a monthly premium is charged.

Senior Health Centers. These are non-academic primary care clinics that are designed to meet the needs of older adults. They are worth investigating, although how good the care actually is will depend on the clinic, how well it’s set up, and how good the doctors are at addressing geriatric issues. As Medicare adapts to the growing older population, I expect these types of clinics will become more common.

• To look for this kind of clinic near you, try Googling for “senior health center + [name of location]”.
• I was not able to find any such clinic near Lincoln, Nebraska. Some senior clinics I have come across include Oak Street Health and ChenMed.

Where to look for a medication review consultation

Finding new primary care for an older adult can be difficult, and new patient appointments are sometimes not available for months.

If this is the case for you, consider looking for help getting a medication consultation. Here are three options to consider:

Academic medical centers: Many Geriatrics Divisions offer consultation services that are meant to complement existing primary care.

• Medication review is usually included in a geriatric consultation.
• Some medical centers have fall prevention clinics, which sometimes include a comprehensive medication review along with an assessment of other fall risk factors. To find a fall prevention clinic near you, try Googling “fall prevention clinic geriatrics + [location].”

Pharmacy consultations: Reviewing the medication list with a pharmacist can be a good way to identify medications to ask the doctor about. Although finding someone specialized in geriatrics is ideal, pharmacists are generally very knowledgeable about medication side-effects in older adults.

• If your parent lives near a medical school or university, see if there is a School of Pharmacy offering medication review. Although I didn’t find anything online at the University of Nebraska School of Pharmacy, I know that UCSF’s School of Pharmacy has been involved in such efforts.
• You can also ask the pharmacist at your parents’ retail pharmacy. In truth, I have no experience with such consultations, so I’m not sure how comprehensive they are likely to be. But, it’s probably worth a try.
• If your parent is in a Medicare HMO, consider asking if a medication review is available.

Consulting pharmacists: The American Society of Consultant Pharmacists can connect you to a “Senior Care Pharmacist.” This is another service that I have no personal experience with, but it may be worth trying.

• This type of medication review probably is paid out-of-pocket, although it’s possible that sometimes they are able to bill insurance.

If you do get a consultation for medications and falls, be sure to ask about the plan for communicating the recommendations to your parent’s usual primary care provider. Especially if your consultation took place with a pharmacist, you’ll need the regular doctor to implement any changes to prescription medication.

If you’ve had any experiences finding geriatric primary care or consultative services: what worked for you? I’d love to hear from you in the comments below. Bonus points if you’ve tried pharmacy consultation, as I have relatively little experience with these and I’d love to know whether I should be recommending this more often to families.

Would you like to be able to ask me questions about medications or other aspects of aging health? Learn more about the Helping Older Parents Membership, where you can receive ongoing eldercare guidance from me and my team of geriatric care managers.

This article was last reviewed in July 2026.

Q: My mother is 80.  She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time.  She is a retired Psych nurse and has shown signs in the past of paranoia. 

Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night.  With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed.  

How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K

A: Great question. As you may know, it’s fairly common for aging adults to develop problems like the ones you are describing. Some older adults will also start leveling a lot of false accusations. Understandably, these problems are frustrating and worrying for adult children.

You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below.

But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms.

A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time).

Furthermore, it’s often hard to get a resistant older parent medically evaluated.

Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated.

Paranoia, false accusations and psychosis

Paranoid symptoms (e.g. believing that someone is out to get you, or is taking your stuff, or is in the house at night) falls into a category of mental symptoms that is technically called “psychosis.”

Symptoms of psychosis can include:

• Delusions, which means believing things that aren’t true or real (which can include false accusations)
• Hallucinations, which means seeing or hearing things that aren’t there.
• Disorganized thoughts or speech, meaning saying or thinking things that seem illogical or bizarre to others.

Psychosis is uncommon in younger people but becomes much more common as people get older. That’s because any of these symptoms can emerge when people’s brains aren’t working properly for some reason.

A 2015 review article on “late-life psychosis” estimates that 23% of people will develop symptoms of psychosis in late life.

6 causes of paranoia and psychosis in aging

In the above review article, the authors organize the causes of late-life psychosis into six “Ds”:

• Delirium (10 %).
  • This is a very common condition of “worse-than-usual” mental function, often brought on by the stress of severe illness, surgery, or hospitalization. See 10 Things to Know About Delirium for more.
• Drugs, alcohol, and other toxins (11%)
  • Medication side-effects can cause delusions, hallucinations, or other forms of psychosis. Pay special attention to medications known to affect memory and thinking. Abuse of — or withdrawal from — alcohol or other substances can also cause psychosis symptoms.
• Disease (10%)
  • Many physical health problems can interfere with brain function. These include electrolyte problems such as abnormal levels of sodium, potassium, calcium, or magnesium in the blood, low levels of vitamin B12 or folate, thyroid problems, severe liver or kidney dysfunction, infections, and neurological diseases. Brain damage from minor strokes can also cause psychosis symptoms.
  • Urinary tract infections can cause psychosis, but in my experience, they are almost never the cause of paranoia or other symptoms that have been going on for weeks, months, or longer. (A positive urine culture in an older person who has been having psychosis symptoms for a while probably reflects a colonized bladder.)
• Depression (33%) and other “mood disorders,” including bipolar disease (5%)
  • About 15% of people with major depression may experience psychotic symptoms. Delusions of guilt or deserved punishment are especially common.
• Dementia (40%), including Alzheimer’s disease, Lewy-Body dementia, and others
  • Delusions are extremely common in dementia, especially delusions of theft, spousal infidelity, abandonment, and persecution. Hallucinations (especially visual hallucinations) are also common, especially in Lewy-Body dementia. For more on how dementia is diagnosed, see How We Diagnose Dementia: The Practical Basics to Know.
• Delusional disorder (2%) and schizophrenia-spectrum disorders (1%)
  • These two conditions have many symptoms that overlap with those of dementia, delirium, or other conditions affecting thinking. Doctors must exclude these more common conditions before diagnosing a person with schizophrenia or delusional disorder. Schizophrenia affects an estimated 0.1-0.5% of people over age 65. Many were diagnosed earlier in life but some people can develop the condition later in life. Delusional disorder affects an estimated 0.03% of older adults.

The authors of this review article also note that it’s common for older adults to have vision and hearing problems, both of which can trigger or worsen delusions and hallucinations.

So as you can see, when older adults experience delusions, hallucinations, and paranoid thoughts, there is almost always something more going on with their health. Figuring out what is beneath the “crazy” or “irrational” or “paranoid” behavior is key.

Hence, I recommend you keep these six causes of paranoid symptoms in mind, as you try to find out more about how your mom has been doing.

I also recommend you check for other signs of problems with thinking or memory; you can learn about 21 signs I recommend checking for in the video below.

How to check on “levels of decline” and safety

It’s great for you to be proactive and want to help check on your mother safety and situation. Ultimately you’ll need to work with professionals, but you can speed the process along by checking for common red flags, and bringing them to the attention of your mother’s doctor.

As a geriatrician, I generally try to assess an older person in the following five domains:

• Ability to manage key life tasks
  • These include the ability to manage Activities of Daily Living (key tasks we usually learn as young children, such as walking, dressing, feeding ourselves, and toileting) and also Instrumental Activities of Daily Living (key tasks we learn as teenagers, such as managing finances, transportation, meal preparation, home maintenance, etc).
• Safety red flags
  • This includes signs of financial vulnerability or exploitation, risky driving, leaving the stove on, wandering, or signs of elder abuse.
• Physical health red flags
  • These include weight loss, declines in strength or physical abilities, falls, frequent ER visits, and complaints of pain.
• Mood and brain health red flags
  • These include common signs of depression (especially sadness and/or loss of interest in activities), signs of loneliness or isolation, new or excessive worrying, as well as other signs of memory and thinking problems
• Medication management red flags
  • These include signs of difficulty taking prescriptions as directed, checking on possible medication side-effects, and identifying medications that are on the Beer’s list of medications that older people should avoid or use with caution.

Because concerned family members often ask me about checking on an older parent, I’ve written a book, “When Your Aging Parent Needs Help,” that walks families through how to do this; it includes checklists based on the five sections above.

You can use the book and checklists to spot these red flags that often represent serious safety or health problems.

Now, no book is going to enable you to diagnose your parent. And no book can guarantee that you’ve identified and addressed the most important safety issues. You’ll need to work in person with professionals to do that.

But by being methodical in observing your mom and in documenting your observations, you will make it much easier for professionals to figure out why your mother has developed these behaviors you are concerned about.

Also, by identifying specific red flags or problem areas, you’ll be better equipped to work with your mom and other family members on addressing safety concerns. That’s because it’s much more effective to focus on issues that are specific and concrete (“I noticed that you seem to be having trouble with your grocery shopping”), rather than simply telling an aging parent that you are worried about their safety.

Tips on following up on safety issues and memory problems

Once you’ve identified safety issues and signs of underlying health problems, you’ll want to follow up. You’ll need health professionals to help evaluate and manage any underlying health problems, and you may find you need help from other types of experts as well.

If your older parent is paranoid and resisting your involvement, this often becomes a stuck spot for families.

How to get unstuck depends on the situation. Here are some ideas that often help:

• Relay your concerns to your parent’s doctor. The doctor needs to know about the symptoms and problems. The doctor may also be able to persuade your older parent to accept some help, or even the presence of another family member during medical visits.
  • Patient privacy laws (e.g. HIPAA) do not prevent families from providing information to a person’s doctor over that person’s objections.
  • The doctor will probably not disclose health information to you but may do so under certain circumstances. That’s because when a patient is “incapacitated”, doctors are allowed to disclose relevant health information to family members, if they feel it’s in the best interest of the patient. For more on when health providers may disclose information to family members, see 10 Things to Know About HIPAA & Access to a Relative’s Health Information.
  • If you send your concerns in writing, they will probably be scanned into the medical record.
  • Also ask if any social work services are available through your parent’s health provider.
• Contact organizations that support older adults and families, for assistance and for referrals. Some good ones to try include:
  • Your local Area Agency on Aging; find it using the locator here.
  • Family Caregiver Alliance. The navigator showing state-by-state services is especially nice.
  • Local non-profits serving seniors and families. Try using Google to find these.
• Get help from a geriatric care manager (now known as aging life care professionals) or other “senior problems” expert. This usually requires paying out-of-pocket, but can enable more hands-on assistance than is usually available through social workers and non-profits.
  • The ideal person will be good at difficult conversations with older adults, will be able to help you communicate with doctors if necessary, and will know what local resources are available to address any safety or living issues you detect.
• Get advice from other adult children who have faced similar situations. You can find caregiving forums and message boards online, where people share ideas on getting through these challenges.
  • There are active forums of people caring for older relatives on Reddit and Facebook.  You can find a lot of ideas and support there. However, most such forums have minimal moderation from professionals, so you should double-check on any medical, legal, or financial advice you get.
• Consider contacting Adult Protective Services if you think this might qualify as self-neglect. Self-neglect means an older person is living in a way that puts his or her health, safety, or well-being at risk. It’s not uncommon for older adults with memory or thinking problems to self-neglect.
  • This is considered a form of elder abuse and can be reported to Adult Protective Services (APS).
  • For a good overview of self-neglect and how APS can get involved, see here.
  • In most states, health providers and certain other professionals are “mandated reporters” for elder abuse and self-neglect, which means they are supposed to report any such suspected cases to APS.

When it comes to contacting the doctor and hiring an expert to help, it’s best if you can get your mom’s agreement before proceeding. (Or at least, not have her explicitly forbid you from doing these things). Here are some tips to help with your conversations:

• Use “I” statements as much as possible. “I’ve noticed you’ve been calling people during the night. I’ve noticed you sometimes have difficulty with your words. I’m concerned and I’ve heard it’s important to have such symptoms evaluated by a doctor, because they can be due to treatable medical problems.”
• Frame any suggestions you make as a way to help your mother achieve her goals. For most older adults, these include living at home for as long as possible, maintaining good brain function and physical function, and otherwise remaining as independent as possible.
• Avoid relying on logic. Logic never works well when it comes to emotionally-charged subjects. And it especially doesn’t work if people are experiencing any difficulties with memory or thinking. So don’t expect your mom to be logical and don’t rely on logical arguments to convince her.

For more on approaching a parent who is resistant to help, I explain how to do this in my free online training for families:

Now, if you find it causes your mother intense anxiety or agitation to discuss your concerns and your suggestions for helping her, it may be reasonable to just proceed. After all, you do have reasons to believe that some kind of health issue is affecting her thinking.

So especially if you’ve identified any safety problems, it’s reasonable to move ahead despite her preference that you not intervene.

In closing, I’ll reiterate that this is a very tough situation to navigate, and it usually takes time and persistence for families to make headway. Do try to take care of yourself as you work through this. Connecting with others facing similar challenges is a great way to get support and practical ideas on what to do next.

Good luck!

This article was last reviewed and updates were made in July 2026.

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration? And what are symptoms of dehydration in older women that we can look out for?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include:

1. Frequently offering the older person a drink, preferably on a schedule,
2. Offering beverages the person seems to prefer,
3. Not expecting older adults to drink a large quantity at a single sitting,
4. Addressing any urinary incontinence issues that might be making the person reluctant to drink often.

But your question brings up other issues in my mind. Has frequent dehydration been confirmed? (Dehydration can be hard to correctly diagnose.) Have you been able to measure how much your mother drinks, and how does this amount compare to the recommended daily fluid intake for older adults?

Also, is the real goal to prevent or manage frequent urinary tract infections, and is increasing her hydration likely to achieve this?

So let’s review the basics of dehydration in older adults, the symptoms of dehydration in elders, and what’s known about helping older adults stay hydrated. I will then share some additional tips on helping your mother maintain hydration. I also made a video on this subject on my Youtube channel, you can watch it here:

The Basics of Dehydration

What is dehydration and what causes it?

Dehydration means the body doesn’t have as much fluid within the cells and blood vessels as it should.

Normally, the body constantly gains fluid through what we eat and drink, and loses fluid through urination, sweating, and other bodily functions. But if we keep losing more fluid than we take in, we can become dehydrated.

If a person starts to become dehydrated, the body is designed to signal thirst to the brain. The kidneys are also supposed to start concentrating the urine, so that less water is lost that way.

Why are older adults at higher risk for dehydration?

Unfortunately, the body’s mechanisms meant to protect us from dehydration work less well as we age. Older adults have reduced thirst signals and also become less able to concentrate their urine.

Other factors that put older adults at risk include:

• Chronic problems with urinary continence, which can make older adults reluctant to drink a lot of fluids
• Memory problems, which can cause older adults to forget to drink enough, or forget to ask others for something to drink
• Mobility problems, which can make it harder for older adults to get something to drink
• Living in nursing homes, because access to fluids often depends on the availability and attentiveness of staff
• Swallowing difficulties

Dehydration can also be brought on by an acute illness or other event. Vomiting, diarrhea, fever, and infection are all problems that can cause people to lose a lot of fluid and become dehydrated.

COVID-19 has also been linked to dehydration in older adults (although it’s hard to say whether that’s because the virus itself dehydrates them versus people drinking less when they are weak and sick). And of course, hot weather always increases the risk of dehydration.

Last but not least, older adults are more likely to be taking medications that increase the risk of dehydration, such as diuretic medications, which are often prescribed to treat high blood pressure or heart failure. (Diuretics are also sometimes prescribed for leg swelling due to aging veins, but research shows they don’t work well for this purpose. Learn more here: Leg Swelling in Aging: What to Know & What to Do.)

A UK study of older adults in residential care found that 46% had impending or current dehydration, as diagnosed by blood tests.

How is dehydration diagnosed?

For frail older adults, a simple preliminary check, if you’re concerned about dehydration, is to get the older person to drink some fluids and see if they perk up or improve noticeably. (This often happens within 5-10 minutes.)

This is not a clinically-proven method, but it’s easy to try. If drinking some fluids does noticeably improve things, that does suggest that the older person was mildly dehydrated.

For a truly accurate diagnosis in older adults, the most accurate way to diagnose dehydration is through laboratory testing of the blood. Dehydration generally causes abnormal laboratory results such as:

• Elevated plasma serum osmolality: this measurement relates to how concentrated certain particles are in the blood plasma
• Elevated creatinine and blood urea nitrogen: these tests relate to kidney function
• Electrolyte imbalances, such as abnormal levels of blood sodium
• Low urine sodium concentration (unless the person is on diuretics)

(Doctors often sub-classify dehydration based on whether blood sodium levels are high, normal, or low.)

Dehydration can also cause increased concentration of the urine — this is measured as the “specific gravity” on a dipstick urine test. However, this is not an accurate way to test for dehydration in older adults, since we tend to lose the ability to concentrate urine as we get older. This was confirmed by a 2016 study, which found that the diagnostic accuracy of urine dehydration tests in older adults is “too low to be useful.“

What are the symptoms of dehydration in elders?

There are also a number of physical symptoms associated with dehydration. However, a 2015 study of older adults found that the presence or absence of dehydration symptoms is not an accurate way to diagnose dehydration.

Physical symptoms of dehydration may include:

• dry mouth and/or dry skin in the armpit
• high heartrate (usually over 100 beats per minute)
• low systolic blood pressure
• dizziness
• weakness
• delirium (new or worse-than-usual confusion)
• sunken eyes
• less frequent urination
• dark-colored urine

Symptoms of dehydration in women are generally the same as in men.

But as noted above: the presence or absence of these physical signs are not reliable ways to detect dehydration. Furthermore, the physical symptoms above can easily be caused by health problems other than dehydration.

This study published in 2019 confirmed that commonly used symptoms do not accurately detect dehydration in frail older adults: Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study.

In 2020, a European group working on diagnosing dehydration in nursing home residents proposed a diagnostic approach that is summarized here. It involves a combination of medical history, physical signs, and laboratory testing.

In short, there is no easy simple way to confirm (or rule out) dehydration in an older person.

So if you are concerned about clinically significant dehydration — or about the symptoms above — blood tests results may be needed. A medical evaluation for possible dehydration should also include an interview and a physical examination.

What are the consequences of dehydration?

The consequences depend on how severe the dehydration is, and perhaps also on how long the dehydration has been going on.

In the short-term, dehydration can cause the physical symptoms listed above. Especially in older adults, weakness and dizziness can provoke falls. And in people with Alzheimer’s or other forms of dementia, even mild dehydration can cause noticeable worsening in confusion or thinking skills.

Dehydration also often causes the kidneys to work less well, and in severe cases may even cause acute kidney failure.

The consequences of frequent mild dehydration — meaning dehydration that would show up as abnormal laboratory tests but otherwise doesn’t cause obvious symptoms — are less clear.

Chronic mild dehydration can make constipation worse. Otherwise, a 2012 review found that the only health problem that has been consistently associated with low daily water intake is kidney stones.

A 2013 review on fluid intake and urinary system diseases concluded that it’s plausible that dehydration increases the risk of urinary tract infections, but not definitely proven.

A 2020 review on the effect of increasing fluid intake to prevent UTIs also noted that “Patients with UTI are often advised by clinicians to keep adequately hydrated or drink more fluids. However, the evidence base for this recommendation remains unclear.”

Speaking of urinary tract infections (UTIs), if you are concerned about frequent bacteria in the urine, you should make sure this reflects real UTIs and not simply a sign of the older person’s bladder being colonized with bacteria.

This is a very common condition known as asymptomatic bacteriuria, and incorrectly diagnosing this as a UTI can lead to pointless overtreatment with antibiotics. (More on this issue below, or see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.)

How is dehydration treated?

The treatment of dehydration depends on:

• Whether the dehydration appears to be mild, moderate, or severe
• What type of electrolyte imbalances (such as high/low levels of sodium and potassium) appear on laboratory testing
• If known, the cause of the dehydration

Mild dehydration can usually be treated by having the person take more fluids by mouth. Generally, it’s best to have the person drink something with some electrolytes, such as a commercial rehydration solution, a sports drink, juice, or even bouillon. But in most cases, even drinking water or tea will help.

Mildly dehydrated older adults will often perk up noticeably after they drink some fluids, usually within 5-10 minutes.

Moderate dehydration is often treated with intravenous hydration in urgent care, the emergency room, or even the hospital. Some nursing homes can also treat dehydration with a subcutaneous infusion, which means providing fluid through a small IV needle placed into the skin of the belly or thigh. This is called hypodermoclysis, and this is actually safer and more comfortable for older adults than traditional IV hydration.

Severe dehydration may require additional intervention to support the kidneys, and sometimes even requires short-term dialysis.

How to prevent dehydration in older adults?

Experts generally recommend that older adults consume at least 1.7 liters of fluid per 24 hours. This corresponds to 57.5 fluid ounces, or 7.1 cups.

What are the best fluids to prevent dehydration?

I’m unaware of any research or guidelines clarifying which fluids are best to drink. This is probably because clinical research hasn’t compared different fluids to each other.

As to whether certain fluids are dehydrating: probably the main fluid to be concerned about in this respect is alcohol, which exerts a definite diuretic effect on people.

The effect of caffeine on causing people to lose excess water is debatable. Technically caffeine is a weak diuretic. But real-world studies suggest that people who are used to drinking coffee don’t experience much diuretic effect.

Now, caffeine may worsen overactive bladder symptoms, so there may be other reasons to be careful about fluids containing caffeine. But as best I can tell, coffee and tea are not proven to be particularly dehydrating in people who drink them regularly.

The safest approach would still be to drink decaffeinated drinks. But if an older person particularly loves her morning cup of (caffeinated) coffee, I’d say to consider accommodating her if at all possible.

How to help older adults to stay hydrated?

A 2015 review of nursing home interventions intended to reduce dehydration risk concluded that “the efficacy of many strategies remains unproven.” Still, here are some approaches that are reasonable to try:

• Offer fluids often throughout the day; consider doing so on a schedule.
• Offer smaller quantities of fluid more often; older adults may be reluctant to drink larger quantities less often.
• Be sure to provide a beverage that is appealing to the older person.
• See if the older person seems to prefer drinking through a straw.
• Supplement fluids with water-rich fruit (e.g. watermelon) or other foods with high water content.
• Identify any continence concerns that may be making the older person reluctant to drink. Keeping a log of urination and incontinence episodes can help.
• Consider a timed toileting approach, which means helping the older person get to the bathroom on a regular schedule. This can be very helpful for people with memory problems or mobility difficulties.
• Track your efforts in a journal. You’ll want to track how much the person is drinking; be sure to note when you try something new to improve fluid intake.
• Offer extra fluids when it’s hot, or when the person is ill.

Practical tips for family caregivers

Let’s now return to the issues brought up in the question.

Family caregivers are often concerned about whether an older person is drinking enough. Since dehydration is indeed very common among older adults, this concern if very important.

However, before expending a lot of energy trying to get your mother to drink more, I would encourage you to consider these four suggestions:

1.Measure how much your mother is actually drinking most days.

This can require a little extra effort. But it’s very helpful to get at least an estimate of how much the person drinks. This can confirm a family’s — or doctor’s — hunch that the person isn’t taking in enough fluid, and can help the care team figure out how much more fluid is required.

Again, the recommendation for older adults is to consume at least 1.7 liters/day, which corresponds to at least 57.5 fluid ounces. In the US, where a measuring cup = 8 ounces, this is equivalent to 7.1 cups/day.

Keep a journal to record how much fluid your older parent is drinking. It’s generally important to track anything you want to improve.

2. Confirm that your mother is, in fact, often dehydrated.

As noted above in the section on diagnosing dehydration: physical symptoms and urine tests are not enough to either diagnose dehydration or rule it out.

Instead, consider these two approaches to confirming clinical dehydration. One is to see if her energy and mental state perk up when she drinks more. The other is to talk to the doctor and request blood tests to confirm dehydration.

Now, you don’t necessarily want to request blood tests every time you suspect mild dehydration. But especially if your mother’s dehydration has never been confirmed by a serum osmolality test, it might be useful to do this at least once.

3. If frequent urinary tract infections (UTIs) are a concern, learn about asymptomatic bacteriuria and try to determine whether these are real UTIs versus a colonized bladder.

Sometimes I’ve seen families hellbent on increasing hydration or taking other measures, because they are concerned about repeated or persisting urinary tract infections (UTIs).

But UTIs are a bit like dehydration. A UTI is a common problem in older adults and is potentially very serious. But it’s also easily misdiagnosed, even by professionals.

Sometimes, when an older person keeps being diagnosed with a UTI repeatedly, the problem is actually that the older person has asymptomatic bacteriuria. This is a very common condition in which an older person’s bladder becomes colonized with bacteria. It probably happens because people’s immune systems get weaker as they age.

So how is this different from a UTI? Both conditions will cause a positive urine culture, meaning that bacteria is in the urine. The main difference is that in asymptomatic bacteriuria, the older person doesn’t experience pain, inflammation, increased confusion, or other symptoms of infection.

In a young person, bacteria in the urine is very uncommon and almost always corresponds to a clinically significant infection. But in an older person, bacteria in the urine is common.

So you cannot diagnose a UTI in an older person just on the basis of a positive urine culture. Instead, the family and clinician must note other signs of infection, such as pain or delirium.

Families are often surprised to learn that clinical trials have repeatedly found that it is not helpful to treat asymptomatic bacteriuria, but it’s true. In fact, a 2015 study found that treating asymptomatic bacteriuria with antibiotics increased the likelihood of later having a real UTI, and that the real UTI was more likely to be antibiotic-resistant.

For more on this topic, see Q&A: Why Urine Bacteria Doesn’t Mean a UTI Needs Antibiotics.

4. Talk to your mother to get her perspective on drinking more (and to find out if continence issues are a concern for her).

Before you keep pressuring her to drink more: have you spent some time talking to her to learn more about her perspective on drinking more, and on avoiding dehydration?

The more we learn about how an older person sees a situation, the better equipped we are to try to assist them.

In particular, inquiring about how an older adult feels about drinking sometimes reveals that they are concerned about worsening their urinary continence symptoms. (Learn more about managing these here: Urinary Incontinence in Aging: What to know when you can’t wait to go.)

5. Pay attention to figure out which fluids your mother prefers to drink and try scheduling frequent small drinks.

Ultimately, there’s no substitute for paying close attention, keeping track of your observations, and doing some trial and error to figure out what seems to improve things.

No doctor has a magic formula to get an older person to drink more. So, identify the drinks your mother prefers, start tracking how much she drinks, and then start experimenting to figure out what works.

Usually, a combination of the following three approaches will improve fluid intake:

• Offer a beverage the person likes,
• Offer small-to-moderate quantities of the beverage on schedule,
• Address any urinary incontinence concerns.

You can also increase fluid intake by offering foods that contain a lot of water, such as watermelon, or perhaps soups.

Helping an older relative stay hydrated can be challenging, especially when you’re already managing many other health and caregiving concerns. Learn more about the Helping Older Parents Membership, where you can receive ongoing eldercare guidance from me and my team of geriatric care managers.

This article was last reviewed in June 2026.