Preventing Dehydration for Older Adults

Observational Trial:


Proportionally older adults have a higher number of chronic conditions and frailty, when compared to the general population. In addition, a variety of physiological factors make older adults more susceptible to dehydration, including kidneys’ decreased ability to concentrate urine, blunted thirst sensation and decreased mobility.  Chronic conditions, frailty and effects of aging on the bodies’ ability to regulate fluids combine to make the older adult population more vulnerable to the problems associated with dehydration. Mild dehydration in older adults can lead to changes in mood, fatigue, headaches and disorientation.  The problem becomes more serious when changes in environment, activity level, temperature and even medication, come into play. Inadequate fluid intake also increases the risk for kidney stones, constipation and urinary tract infections. The cost of potentially avoidable hospitalizations related to dehydration for older adults is estimated to be over $1 billion annually.

Fortunately, the majority of these dehydration issues can be prevented through simple changes in oral hydration habits. The AquaTally hydration tracking cup (Figure 1) was developed to raise people’s awareness about their hydration and support building a healthy hydration habit. The AquaTally simplifies the task of tracking by adding an indicator ring and numbers on the container. To track hydration, users simply turn the white indicator ring to line up with the numbers on the AquaTally. The numbers 0-8 can either represent cups (8oz) or refills (16oz). It is also very easy to track other fluid sources, like a glass of water at a restaurant, by just adding the amount to the tally.

Figure 1 - AquaTally Hydration Tracking Cup

Figure 1 – AquaTally Hydration Tracking Cup

The purpose of this paper is to describe a small observational trial that tested the AquaTally as an aid to coaching and tracking hydration. This paper describes the methods used and findings from the trial.


The study group for the observational trial was recruited from a continuing care retirement community (CCRC) in Florida. Potential participants were sent an informational flyer about the trial, then provided a chance to ask questions during a regularly scheduled site meeting. Those that wished to volunteer contacted the site’s administrator, nurse or dietitian. All were asked to consult with their physician or dietitian regarding their hydration needs before volunteering.

The trial group consisted of older adults residing in both the independent and assisted living portions of the CCRC. The site’s dietitian provided training for all of the participants on general hydration practices and instruction on using the AquaTally. Participants then used the AquaTally to track their hydration for 30 days and subsequently completed a written survey. Staff helped participants complete the surveys as needed. Staff also completed a written survey. The surveys were developed with support from the University of Arkansas, Fayetteville and the site’s dietitian. The surveys consisted of two sections; the first section tested the level of agreement or disagreement to specific statements, and the second part had open-ended questions relative to use and suggestions for improvement. Staff at the site collected the surveys after the trial period, and the results were analyzed to measure perceptions regarding the effectiveness of the AquaTally.


The entire study group from the CCRC included 28 older adults and five staff members. Ten participants lived in assisted living (AL) and 18 lived in independent living (IL). Ages of residents ranged from 61 to 95 years of age (average age of 81 years) with 24 women and four men. Residents reported health concerns, such as: balance, vision, hypertension, urinary tract infections, kidney stones, anemia, diabetes and osteoporosis. Two participants in AL had mild dementia.

Figure 2 shows the survey results for the IL participants. IL participants used the AquaTally for a wide variety of hot and cold beverages, but mainly for water and juice. The AL results are shown in Figure 3. As with IL, the AL participants used the AquaTally for many beverages, but mainly water. Staff results are shown in Figure 4. Four of the five staff members said they used the AquaTally daily with AL participants. Staff felt that the AquaTally was most useful for prevention of dehydration and urinary tract infections.

The most frequent suggestions for improvement included: 1) a more mobile version without a straw (i.e., a travel cover), 2) a smaller size, 3) an option for use in the microwave and 4) an option for a handle. AL participants had more difficulty with the size of the AquaTally than IL participants. No issues were reported relative to being able to see the numbers or turn the tracking ring.

In reviewing the structured responses as compared to the open ended questions, a trend emerged that showed the importance of addressing preferences for the cup style in addition to the hydration tracking functionality. If there were concerns relative to the straw, use of the cover, or desire for a more mobile option, the rating of the effectiveness decreased. For example, if someone was unhappy with the cover, they were more likely to disagree with question 6 (“The AquaTally made it easy to keep track of how much fluids I drank”).

Figure 2 – Responses from Independent Living (N=18), SD/D = Strongly Disagree/Disagree, N = Neither and SA/A = Strongly Agree/Agree.


Figure 3 – Responses from Assisted Living (N=10), SD/D = Strongly Disagree/Disagree, N = Neither and SA/A = Strongly Agree/Agree.


Figure 4 – Responses from Certified Nursing Assistants (N=5), SD/D = strongly Disagree/Disagree, N = Neither and SA/A = strongly agree/agree.


The results from participants and staff were uniformly positive. Based on responses, the AquaTally simplified the task of coaching and tracking hydration. 65% of IL and 70% of AL participants responded that AquaTally made drinking the right amount easier. In addition, 70% of IL and 90% of AL participants responded that AquaTally made it easy to keep track of how much they drank. Both of these responses demonstrate that participants found the AquaTally to be a helpful tool. Comparing responses between IL and AL also shows that participants in AL had a higher degree of concern about their hydration prior to using the AquaTally, 80% of AL vs. 55% from IL. This likely correlates to the more positive responses from AL participants who may have felt a greater need to improve their hydration due to other health concerns. It is also important to note that 73% of IL and 100% of AL participants indicated that the AquaTally was the most effective way to track hydration compared to other methods.

The results of the staff survey show strong support for the AquaTally with 100% of staff responding that they would like to have the AquaTally as a tool to give to older adults with hydration concerns. 80% of staff also felt that using the AquaTally improved participant health and quality of life. Additionally, 100% of staff indicated that the AquaTally made educating participants on proper hydration easier. Based on responses, the staff clearly believes that the AquaTally is a tool that can improve hydration habits and make coaching proper hydration easier.


Responses from IL, AL and staff indicate that the AquaTally is a useful aid in coaching and tracking hydration. Adding the hydration tracking onto the cup simplified the task of tracking daily hydration and made drinking the right amount each day easier. Staff found the AquaTally easy to use, flexible and a valuable educational tool.

Developing additional options for container size and style will make it easier for some older adults to use the AquaTally. However, based on the very positive feedback, it is clear that using the AquaTally with older adults has the potential to improve hydration habits.


AquaTally would like to thank the Bishop’s Glen staff and residents for participating in the observational field trial. AquaTally would also like to thank Carol H. Elliott, RDN, LDN for helping recruit participants and educate them on hydration and the AquaTally. We greatly appreciate your support in working to develop a simple and effective coaching tool to make preventing dehydration easier.

AquaTally would also like to thank Dr. Matthew Ganio, and his research team at the University of Arkansas, Fayetteville for their assistance in creating the survey and ongoing support in understanding hydration and study design.

AquaTallys were provided free to the participants. No member of Bishop’s Glen, or the participants, were compensated. All participation was completely voluntary.