The human body needs water to function; to perform various and numerous physiological functions including regulating the body’s temperature, removing waste from the body as well as and carrying out cell functions; to survive. Hydration is crucial yet extremely challenging in an individual with Dementia.
Anybody can become dehydrated. In basic terms, “dehydration means your body loses more fluids than you take in”. 1
Risk factors for becoming dehydrated include the following and are often combined:
- Older age
- Residing in long-term care
- Requiring assistance with foods and fluids
- Cognitive impairment/confusion
- Impaired functional status and assistance required for feeding
- Inadequate numbers or appropriately trained staff to assist
- Multiple medications, particularly diuretics
- Decreased thirst
- Acute illness, diarrhoea and vomiting. 2
Dehydration and Dementia
The risk of dehydration is much higher with older people, rising even higher when the person also has Dementia. People with advancing dementia are increasingly vulnerable as they may simply forget to drink or then forget they have made themselves a drink or where they have put it.
The memory cues may prove unsuccessful; they may not recognise the cup or glass as something that may hold water or that they could drink from. The signals that would ordinarily inform the brain of thirst can be altered with Dementia reducing initiation to drink in the first place. Various medications can exacerbate dehydration, particularly diuretics and laxatives. Subsequently, many people then limit their fluid intake for fear of incontinence.2
Signs to look out for:
- The person is warm to the touch.
- The person seems more confused than usual (this can be challenging to distinguish in later stages of Dementia).
- Lips appear dry and/or cracked.
- The skin is a lot drier than usual and may peel or shed.
- The person may complain of headaches.
- A person’s blood pressure is lower than usual.
- A person’s pulse is faster.
- The person’s urine appears darker and has a strong odour.
- Eyes can become sunken.
Dehydration and malnutrition are often observed together and pose particular risk to those with Dementia. Both have significant negative impacts upon health and wellbeing and are observed in the community, care settings as well as in hospital.
Often not timely recognised or treated, likeliness of hospital admission and ultimately mortality are increased with dehydration. Even with mild symptoms, cognitive function is further impaired and can affect mood and motivation. Physically, individuals can become weak and dizzy and at increased risk of falls. Development of pressure sores and skin conditions, urinary tract infections and acute kidney injury are possible.
In a wider sense, this then impacts greatly on the wider health economy with much higher demand on GP services and ultimately hospital admissions. 3
So, what can be done to improve hydration for individuals with Dementia?
Making an event of having fluids can help. Why not organise an excuse for a drink together and raise some valuable funds too by visiting https://www.dementiauk.org/support-us/fundraise/time-for-a-cuppa/ 5
- Provide staff training regarding the importance of hydration.
- Provide a daily fluid intake goal for the individual.
- Make available the individual’s preferred fluids.
- Ensure fluids are available all the time.
- Ensure the drink is appealing visually as well as the taste.
- Ensure fluids are actually offered or given to the person regularly throughout the day.
- Use opportunities at specific points of the day such as routine appointments or activities.
- Make available a variety of fluids, some hot and cold.
- Provide some assistance if required or suitable receptacles/drinking aids.
- Always give a full glass of fluid with any medications to be taken.
- Put up notes or reminders.
- Make the process easier and more visual – put a jug of water and glass out.
- Include hydrating foods in diet. 4