Dementia and Dehydration
- Rebecca Crapo OTR/L, FMT
- Aug 18, 2022
- 7 min read
Updated: Jan 18
Increased confusion and/or alterations in typical behavior are initial indicators that an individual with dementia may be experiencing dehydration. Dehydration exacerbates cognitive decline in those with dementia. The brain and body's cells require water to function optimally. A deficiency of water in brain cells leads to the accumulation of toxic proteins within the brain. {1}
A study evaluating the cognitive function and hydration status of 1,091 individuals over the age of 65 revealed that those who were dehydrated faced a higher risk of developing dementia, while those with dementia were more susceptible to dehydration {1}
This article will reveal:
Why Fear of drinking
As individuals age, their overall risk of dehydration typically increases due to a natural decline in the sense of thirst, the use of medications that induce fluid loss, and the consumption of alcohol and/or caffeinated beverages. This risk is significantly heightened for those with dementia, becoming more critical as the disease advances. Without reminders and visible prompts to drink, individuals with dementia may go extended periods without consuming any fluids.
Risk during Dementia Stages
In the early stages of dementia, individuals may forget to drink due to a decreased sensitivity to thirst or an inability to remember their last drink. Many older adults reduce their fluid intake to minimize bathroom visits, aiming to reduce the risk of accidents. It is advisable to consume most fluids in the morning and early afternoon so that excess fluid is expelled by evening. Alternatively, consider planning your day with more frequent bathroom breaks.
Individuals with moderate dementia often struggle with the mechanics of drinking, such as turning on a faucet, locating glasses, or transferring liquid into a glass. They may also find it challenging to handle, hold, and position a cup to tilt their head back and drink.
The risk of dehydration is most acute in the advanced stages of dementia due to an inability to recognize thirst or hunger, a complete loss of thirst, or an inability to express thirst to others. Individuals may be unable to communicate their need for food or drink or may physically be unable to access or reach necessary items.
Fear Of Choacking
After consulting with a patient, I discovered that individuals often reduce their fluid or food intake when they become anxious and uncomfortable with swallowing. They may fear choking but are hesitant to admit it. These individuals might experience an unusual sensation in their throat or have observed frequent coughing after drinking. It is important to monitor this situation closely.
If you notice that your loved one frequently coughs after drinking, it is advisable to consult a doctor. A diagnostic test, known as a barium swallow exam, can be conducted to examine the throat during swallowing. This is crucial as coughing serves as a reflex to prevent fluids from entering the lungs. When food or liquid enters the lungs, it can lead to pneumonia, potentially resulting in hospitalization and a deterioration in health. While pneumonia is often associated with colds, it is actually linked to an infection in the lungs.
If you have increased choking with drinking
Use thickened liquids
When a person is continuing to cough or feel like they are going to choke while drinking/eating it can create a negative association and they may begin to avoid things that cause them discomfort.
Dehydration can lead to numerous medical complications beyond choking. We have discussed the risk of pneumonia due to fluids or food entering the lungs. Additional health concerns include delirium, which can increase confusion and lead to falls (resulting in further medical issues), urinary tract infections causing confusion, elevated blood pressure, constipation, kidney failure, and, in severe cases, death.
What is the recommended daily fluid intake?
The National Academies of Sciences, Engineering, and Medicine advises the following daily fluid intake: 125 ounces (3.7 liters) for men and 91 ounces (2.7 liters) for women.
Indeed, that is a substantial amount. I also strive to consume this quantity of fluids daily.
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Signs and symptoms of dehydration
Increased confusion/ (acute phase) hallucinations
Agitation
muscle cramping
nausea/dizziness
Dark/Amber looking Urine
Infrequent Urination
Strong smelling urine
Increased weakness
Dryness (dry eyes, nose, mouth and tongue, skin)
Urinating less often or in smaller amounts than usual
Elevated heart rate > 100 bpm if that's not typical for your partner
Increased difficulty with speech
Fatigue and sleepiness
Weight loss
Certain medications and vitamins can make urine darker, so be sure to look at the all symptoms.
How can you increase fluids?
Jell-O
A specific water bottle that measures the amount of fluid
Constant reminders
Pedialite
Suger-free Gatorade powder to give it flavor
Italian ice cups
Popsicles
Ice cream
Hot chocolate
Broth-based soups
Applesauce
Fruits and vegetables
Make lemonade together, be creative. I worked in a nursing home, where they had cucumber water and it was delicious. I worked in other nursing homes where they didn't give out water, they had to request it. Please make sure if your loved one is in the hospital they always have access to liquids. Always within hands reach.
How can we adapt their environment to increase water intake?
If you are living with or spending time with your loved one who has dementia.
Ensure there is a fresh drink within their reach at all times.
Instead of asking "Are you thirsty?" say "let's have something to drink," or "The doctor wants us to increase our fluid intake," and drink with them. Often, following the doctor's advice is more effective than family suggestions. They most likely will say they are not thirsty because they genuinely don't feel it.
Keep the drink at a moderate temperature, neither too cold nor too hot. With dementia, temperature sensitivity is significant. They will refuse if the temperature is too extreme for their senses.
How to set up the house for increased fluids?
Reminders: We all need to remember to drink more so why not have a picture with some words written in the bathroom and in the kitchen directing them to the water, the drinks, the cups?
What you can do to make it more comfortable for them to drink?
Join the wait list for the dementia caregivers educational course. Gaining expert advice from seasoned professionals in the field can significantly enhance your understanding and ability to provide compassionate care. This comprehensive course is designed specifically for caregivers who are navigating the challenges associated with dementia care, offering invaluable insights into effective communication strategies, daily care routines, and emotional support techniques. By joining the waitlist, you will be among the first to receive updates on course availability, exclusive resources, and early registration opportunities. Don’t miss the chance to empower yourself with knowledge that can make a profound difference in the lives of both caregivers and their loved ones affected by dementia.
The items below are on Amazon. I am an affiliate of amazon where I make a very small commission off of the products you buy off this website. It does not cost you anything,just a way for me to provide good content.
Great bottle to have around. Provides motivation, and an idea of the continued need for fluids. Great for everyone.
Some people have tremors in their hands. this cup allows you to hold onto it with two hands to keep it more secure when drinking.
These are great. If your loved one has a hard time tipping their head back, from a neck injury, or just positioning. There is a notch cut out in the front so all they have to do is tip their hand with the glass vs. their neck backward. Helps prevent from choking as well.
This is for someone who needs a large handle to hold onto their drink. Can slip the hand in and not worry about using fingers to grip it.
This cup puts out a limited amount of fluid. Preventing the person from choking if they can't control what is going in. It takes more time to get more fluid in, but it is great for preventing choking, or for someone who does not like the thickened liquids.
The "nosey cup" we use in the nursing home for people who can't tilt their heads back. The cut-out is in the front, so the cup can be turned up to drink but the head does not need to be tipped back.
This is great for someone who is bed-bound, poor or has no arm control, or is in a wheelchair it can be clamped onto anything, allowing the person the freedom to drink when they want.
This is great to use if you're loved one is in bed laying back a bit. Helps keep from choking and allows you to get more fluids in.
We use this powder in nursing homes. You can add it to any juice, water coffee. It thickens up the fluid without changing the taste. To help prevent patients from choking and getting fluid into their lungs, which results in pneumonia and fear of drinking/eating. It may sound or look gross but I have actually tried it and it does taste the same. The texture is obviously not as fluid, but it's a good way of keeping your loved ones hydrated and healthy. Speak with your doctor or speech therapist and they can tell you how much is appropriate depending on the severity of your loved one.
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