Importance of Hydration with Dementia

Why is hydration important

Water makes up around 60% of our body weight. We are powered by water! Keeping hydrated helps our organs function efficiently, our joints moving, our temperature regulated and supports our cognitive function. When we age, our sensations can change which can make it hard to tell if we are thirsty or not. It’s really important to keep drinking regularly throughout the day even if we don’t feel thirsty, especially for those living with dementia. Dehydration can increase confusion and agitation, it can also increase the risk falls and urinary tract infections which can sometimes lead to hospital stays; this is far more common in people over the age of 65.

Hydration challenges

There are some specific challenges that can affect older people and especially those living with dementia. The sensation of feeling thirsty can become less reliable as we age. Some medications (specifically diuretics or laxatives) can increase fluid loss meaning the person should be drinking more than usual. For people with a dementia there may be additional challenges such as:

• Memory loss: The person may forget to drink or not recall when they last had a drink. They may find themselves going to the kitchen to get a drink but once in the kitchen forgetting to make it or not be able to recall how to.

• Communication: The person may struggle to communicate their needs. They may not identify that they feel thirsty, they may not be able to communicate what drink they would like or process the right answer when asked if they would like a drink.

• Recognition: A person may feel anxious if presented with an unfamiliar drink or vessel to drink from. They may be fearful about what they are being presented if it is not recognisable and resist drinking it, for example, tea in a plastic beaker as opposed to a porcelain teacup.

• Incontinence anxiety:  A person may resist drinking if they fear it will result in increased frequency of urination and so restrict their fluid intake. However, this can make urine more concentrated which will irritate the bladder and result in more urgent toilet visits. The person may also be worried about locating the toilet or perhaps the ability to get there if mobility is difficult.

Some people may need to take guidance from a healthcare professional if, due to other conditions, they are on fluid restrictions or perhaps have a catheter. Advice should always be taken if there is a change in health or specific concerns. You can also talk to a healthcare professional for advice on incontinence issues.

Staying hydrated when living with dementia

The recommendation as a guideline is for a person to drink around 2 litres or 3.5 pints a day, this is approximately 6-8 drinks a day, (unless you have been advised otherwise by a health professional). However, when the weather is hot or if you are taking part in physical activity, it is important to have additional drinks or alternatives.

Hydration is not only about drinking 2 litres of water. Caffeine, alcohol and sugary drinks should be avoided if possible, but there are some food items which can also contribute to daily fluid intake.

Hydration options include:

• Tea, including fruit teas or other decaffeinated hot drinks

• Flavoured waters or squash

• Fruit juice

• Smoothies

• Thin vegetable soups

• Gravy

• Porridge or cereal with milk

• Jellies

• Yoghurt

• Ice lollies

• Vegetable crudites - Cucumber slices or celery

• Fruits – Watermelon or strawberries

Tips to encourage intake

The “right” cup & “right” place

• Use the persons favourite mug or glass. Select a mug with a favourite image or message on it

• Try using different coloured mugs or glasses

• Use cocktail, beer and wine glasses (for non-alcoholic drinks) if these are familiar– there are lots of plastic version available too if safety is a concern

• Make sure drinks are accessible, within reach and sight line of the person.

• Use a bright coloured drink mat to catch their attention

• Remember, just because the drink is by someone it still may not be drunk if not prompted. Also, an empty glass does not necessarily mean it has been drunk; it could have been spilt or poured away.

Presentation

• Add ice cubes and fruit garnishes for interest

• Add a drop of juice to change the colour so more visible

Social

• Have a drink with the person – mirroring an activity is helpful for people with dementia

• Find a reason to “toast” each other as an excuse to drink

• Make the drinks together

Opportunities

• Have a glass of water whilst wating for the kettle to boil

• Have a full glass of water when taking medication

• Use a memory clock or timer to prompt a drink throughout the day & make drinking part of the daily routine.

• Small amounts frequently are good, especially if the person has difficulty swallowing

• Aim for a glass at every meal and one in between each meal as a minimum

• Keep a bottle of water by the bed to drink when waking up

Signs of dehydration in people with dementia

Some of the signs of dehydration to be aware of are below. Because the person may be unable to communicate what is wrong it is vital to recognize these signs. Dehydration is usually because a person is either not drinking sufficiently, or they have lost fluids, perhaps due to diarrhoea or vomiting. If you think someone is experiencing dehydration, then it is important to seek medical help immediately, don’t wait until it potentially gets worse.

• Increased confusion, anxiety or irritability

• May appear more lethargic and fatigued

• May be dizzy and less coordinated

• May have a dry mouth and possibly cracked lips

• Strong smelling or dark coloured urine, and reduction in output

• Constipation

• May complain of headaches or possibly muscle cramps

Follow these tips to keep yourself and those you care for hydrated, especially in the warmer weather we are currently experiencing. Always seek help if you are concerned about someone becoming dehydrated as it can become dangerous, particularly for older adults. Being alert and staying on top of fluid intake can keep everyone safer this summer, so make drinking more water a new habit.