The short answer
- A lower intake is rarely one problemSeven reasons come up again and again, and grouping them by what kind of problem they are shows what to do about each one.
- A fading sense of thirst is normal, not a habitThe signal that should prompt a drink becomes less reliable with age, so a routine works better than waiting to be asked.
- Cutting back for fear of a leak makes it worseA drier bladder becomes more irritable, not less, and it is often something a GP can treat rather than just manage.
- Some causes need a GP appointmentA medicine's side effect and a swallowing problem are not things to work around at home.
Women need at least 1,600ml a day and men at least 2,000ml, according to the British Dietetic Association's guidance for older adults, and that target does not fall with age even though the drive to meet it does.
The three kinds of reason
Grouping the seven reasons by what kind of problem they are
A relative who is drinking less rarely has a single, tidy reason, and treating it as one problem tends to fail. Some of the seven reasons below are a choice your relative is making, for a reason of their own. Some are happening without them noticing at all. Two of them are for a GP to look at, not something to solve at home.
Something to talk through, or serve differently
Worth a conversation- Worried about needing the toilet, or about a leak, especially at night or away from home
- Water tastes different than it used to, plain or metallic, often because of a medicine or a dry mouth
- Getting up for a drink, or to the toilet afterwards, has become hard work
Talk it through, and change how a drink is served rather than pushing harder.
Happening without them noticing
Needs a routine- A fading sense of thirst that comes with age, so it stops working as a warning sign
- Dementia disrupting the routine of eating and drinking, or the ability to recognise thirst at all
Offer a drink at set points in the day rather than waiting to be asked. Nobody here is choosing to drink less.
Something for a GP to look at
See a GP- A medicine with a diuretic effect, or one causing a dry mouth
- Difficulty swallowing safely, which can bring a fear of choking
Raise it at the next appointment, or sooner if it is new. Never stop a prescribed medicine without asking first.
None of these are mutually exclusive, and it is common for two or three to apply at once, a fading sense of thirst alongside a worry about the toilet, say. The rest of this page goes through each one in turn. If you already know the reason and just want the fixes, how can I get my elderly relative to drink more fluids? sets out what to serve, and how, in full.
A fading sense of thirst
Why an older person can be dehydrated without ever feeling thirsty
This is the most universal of the seven reasons, because it happens to some degree in almost everybody as they age, and it is also the easiest to miss, because there is no obvious moment when it starts.
The amount of water the body holds falls gradually with age, and the kidneys become less able to concentrate urine and hold onto fluid when supplies run short. At the same time, the signal that is meant to make someone reach for a drink when fluid is low becomes less sensitive. The Royal College of Nursing lists both changes, a decline in the sensation of thirst and less efficient kidneys, among the reasons older people are at higher risk of dehydration than younger adults.
4 to 6 litres
Body water typically lost between age 20 and 80
A gradual change over decades, not a sudden one.
Reduced
The kidneys’ ability to concentrate urine
Makes it harder for the body to hold onto water once fluid is short.
6–8
Cups or glasses a day, still the target
The daily target for older people does not fall, even though thirst does.
Hydration for Health, Ageing and hydration; Royal College of Nursing, Dehydration in older people; NHS Eatwell guidance.
The practical effect is that thirst stops being a trustworthy warning sign. Your relative is not choosing to drink less here, and pointing out that they "must be thirsty" will not help, because the feeling is simply not there in the way it used to be. How serious is dehydration in the elderly? explains what happens once this goes unaddressed, and what are the symptoms of dehydration in the elderly? covers the signs to watch for instead of waiting for thirst.
Fear of the toilet
When the fear is about a leak, not the drink itself
Cutting back on fluids to avoid an accident is one of the most common reasons a family notices, and it is also one that makes the underlying problem worse rather than better.
Urinary incontinence can be an embarrassing thing to talk about at any age, and an older person who has started to leak, or who worries they might, will often decide the simplest fix is to drink less. It rarely works out that way. A bladder that holds a smaller volume of more concentrated urine becomes more irritable, not less, and concentrated urine raises the risk of a urinary tract infection, which can itself cause sudden confusion in an older person. Bladder & Bowel UK's guidance is not to restrict fluids when troubled by incontinence: it recommends the usual daily amount, spread through the day, because a bladder that is well hydrated over time learns to hold more and becomes less sensitive, not less.
What helps
- Keeping to the usual amount through the day, rather than cutting back
- Easing off only in the couple of hours before bed if broken sleep from the toilet is the specific problem
- Choosing water, diluted juice or a decaffeinated drink over tea, coffee or alcohol, which push urine production up
- Asking the GP or a continence nurse about the leak itself, since many kinds of incontinence can be treated rather than just managed
- A commode or a raised toilet seat nearby, if getting there in time is what is standing in the way
What makes it worse
- Stopping drinks, or cutting back sharply, which makes the bladder hold less and become more irritable
- Assuming nothing can be done about the leak, rather than asking
- Relying on tea and coffee through the day, which encourages more frequent trips
- Treating a new leak as ordinary ageing rather than mentioning it to a GP
If mobility is part of why the toilet trip feels risky, the getting to a drink, or the toilet section below covers that side of it separately.
Medicines and swallowing
When dementia, a medicine or a swallowing problem is behind it
Two of these are not something to work around at home: a medicine's side effect and a swallowing problem are for a GP to assess. Dementia disrupting the routine of drinking is common too, and it usually calls for a routine at home rather than an appointment on its own.
Dementia disrupting the routine of eating and drinking
Common as dementia progresses
A medicine with a diuretic effect, or a dry-mouth side effect
Common with heart and blood pressure medicines
Difficulty swallowing safely
A new or gradually worsening problem
If dementia is the wider picture here, dementia care covers the day-to-day changes that come with it beyond drinking, and elderly medicine: getting medication right has more on reviewing what your relative takes and why, which is worth doing whenever a new symptom appears alongside a change in medication.
Getting to a drink
When the hard part is moving, not drinking
Decreased mobility changes the arithmetic of drinking. A drink left across the room, or a toilet trip that needs help, both become reasons to make do with less, without it ever being announced as a decision.
- 1
Move the drink, not the routine
TodayA filled cup on the arm of the chair or the bedside table gets drunk far more often than one left in the kitchen. A small table or trolley within reach closes the gap for someone who cannot easily fetch their own. - 2
Make the toilet trip itself easier
This weekA commode or a raised seat near where your relative spends most of the day removes the walk that may be putting them off drinking in the first place. An occupational therapist, reached through a GP or council referral, can assess what would help most. - 3
Ask about a regular visit
Ongoing supportA carer who calls at set times can bring a drink, stay while it is finished, and help with the trip that follows. Hourly carers on PrimeCarers charge £18 to £25 an hour with our fee included, and companion carers charge a little less, £15 to £20.
When it tastes different
When a medicine or a dry mouth changes how a drink tastes
Taste and thirst are both blunted by age, and a dry mouth from a medicine can make even a favourite drink taste flat, bitter or metallic. None of this means less liquid is needed. It usually means a different drink, or a different way of serving it, would be taken more readily.
- Dysgeusia
- An altered sense of taste, which can make ordinary food and drink taste different, sometimes metallic or less sweet than it should.
- Xerostomia
- The medical term for a persistently dry mouth, often a side effect of medication rather than a sign of not drinking enough.
- Polypharmacy
- Taking five or more medicines at once. It is the single biggest driver of dry mouth in older age, more so than any one drug on its own.
Dry mouth is estimated to affect 20 to 30 percent of people over 65, and research on medication-induced dry mouth points to medicines as the most important risk factor, responsible for the large majority of cases. If your relative takes several medicines, a review with the GP or pharmacist is worth asking for rather than assuming the taste change has to be lived with.
A relative who finds plain water unpleasant may switch to something else instead without saying so, a sugary squash or fizzy drink, or more alcohol than usual. It is worth noticing if that happens, because it can leave someone no better hydrated, or worse off than before, even though they are still drinking something. How can I get my elderly relative to drink more fluids? has practical ways to make a drink more appealing in the meantime, including serving it warm rather than cold, or infusing it with fruit, and does tea count as water intake? is worth reading if tea is what your relative would rather have anyway.
Questions
Questions families ask about an older relative refusing fluids
There is rarely a single reason, but two come up most often in families: a fading sense of thirst that comes with age, and a fear of needing the toilet or having an accident. Both are covered in full above, along with dementia, medication, mobility and taste, which also come up regularly.
Yes. The sensation of thirst becomes less reliable with age, and the kidneys become less able to hold onto water when supplies run low. It is one of the reasons dehydration is common and easy to miss in later life, and it means a routine of offered drinks works better than waiting to be asked for one.
That cutting back makes it worse, not better. A bladder that holds a smaller, more concentrated amount of urine becomes more irritable and more prone to infection. Bladder & Bowel UK recommends keeping to the usual daily amount and easing off only in the couple of hours before bed if disturbed sleep is the specific worry. It is also worth asking the GP about the leak itself, since many kinds of incontinence can be treated rather than just managed.
Yes. A person with dementia may not recognise that they are thirsty, may forget to drink, or may struggle to ask for a drink, according to the Alzheimer’s Society. Offering a drink at set points in the day, in a cup they recognise, tends to work better than waiting to be asked.
Possibly. Diuretics, often prescribed for blood pressure or heart conditions, are meant to increase how much fluid the body passes, and a dry mouth and increased thirst are listed as common side effects. Taking several medicines at once is also the biggest known driver of a persistently dry mouth. Raise it at the next medication review rather than guessing, and never stop a prescribed medicine without asking a GP or pharmacist first.
If a dry mouth, low energy, confusion or dizziness appear, or your relative has not passed urine for eight hours or more, treat it as something to act on rather than watch. What are the symptoms of dehydration in the elderly? has the fuller list, and what to do if an elderly person is dehydrated sets out the immediate steps.
Yes. A carer who visits at the same times each day gets to know what is normal for your relative and notices sooner when a drink has gone untouched. Companion carers on PrimeCarers charge £15 to £20 an hour with our fee included. How much does a companion carer cost? has the detail.