Dementia and Dehydration: What Caregivers Need to Know

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Hello everybody, and welcome to a new episode of The Truth, Lies Alzheimer's Show, and I'm Lisa Skinner, your host. Can you believe that it's already the middle of July and we are still experiencing a heat wave rolling, continuing to roll across the countryside. So that's what I want to talk to everybody about today is how dementia and dehydration are very closely linked. And the reason why is because Dementia can affect our brain systems that drive thirst, memory, communication, and routine. So people may not even notice that they're getting dehydrated or may not be able to reliably drink enough. Some don't even recognize that they're thirsty, but dehydration is extremely common in people living with dementia. And there are a range of reasons why they may struggle with drinking enough fluids. And if they are dehydrated, their dementia symptoms may appear worse. And I'm going to explain why in a minute. Even mild dehydration can make a person's cognitive function fall by 10%. Making them more confused. So here are some common links between dementia and dehydration. Number one, they oftentimes have a reduced thirst awareness because the brain's thirst signals can be weaker or harder to act on. So a person living with dementia may not feel or may not recognize the need to drink. Number 2, they may have difficulty initiating or remembering to drink. They may forget, they may not understand that they need fluids now, or they may lose the habit of regular drinking. Number 3, Oftentimes people living with dementia have problems with communicating, so they may be unable to explain thirst, interpret cues correctly, or ask for something to drink. Number 4, oftentimes people living with dementia are experiencing mobility and access barriers And what that means is they may be less able to reach the bathroom or drink setup, especially if they need assistance. They have to rely on somebody else to provide them with the fluids. Number 5, we often see swallowing and chewing issues with dementia. Some people also have swallowing problem— problems, and that's called dysphagia, which can make drinking harder or increase their fear of choking. The next one, we see medication and illness effects that can affect their hydration levels. Certain medications, for example, some diuretics, anticholinergics, and conditions like infections, fever, vomiting, diarrhea, or heat exposure raise a person's dehydration risk. And then mouth problems, something that we might not even stop to think about. Mouth problems can cause discomfort when a person drinks. For example, they may have tooth decay, so drinking could cause pain in that tooth area. Ill-fitting dentures are often a problem. Some people develop oral thrush or even mouth ulcers, so be mindful of those conditions. So I'm gonna answer this question now. Why someone with dementia might become dehydrated more easily. The best explanation is that thirst perception and response often become impaired when a person lives with dementia. They may not feel thirsty, or they may not connect that I feel uncomfortable with or I need fluids. Dementia affects a person's executive function and really causes many challenges. For example, planning to drink. Starting a drink can be difficult even if they physically can drink. But the process of thinking about it, and making it happen, implementing it, is often diminished. We see concentration issues that make finding the time to drink more challenging, or they may have difficulty drinking independently. For example, their hand-eye coordination is affected. And again, I said it a little earlier, they have to rely on other people to be paying attention and make sure they are at least being offered enough fluids during the hot season. We see behavioral and sensory barriers. So to give you an example of what that means is a person may refuse drinks due to being confused. Or dislike of taste or the temperature of the drink, or difficulty understanding what a cup is for. They often experience, as they progress through the stages of dementia, changes in their taste preferences. That happens a lot. So maybe now they prefer sweeter things or stronger drinks because they can taste them better than non-sweet things or subtler tastes. And then, of course, we always have to consider swallowing safety concerns. If swallowing is unsafe— and it often does become unsafe at the later stage of dementia— caregivers may offer less fluid to avoid choking sometimes reducing intake too much. And we have to also be mindful of care gaps. If a person with dementia is far enough along in the stages of the disease, they will need prompting, supervision, and/or assistance. Missed cues happen regularly, or fewer opportunities to drink can lead to low intake. I'm going to now share with you signs of dehydration in people living with dementia. Uh, some signs overlap with many illnesses, so context matters, but these are some of the most common clues. You want to look for behavioral changes, especially sudden behavioral changes like increased confusion, increased agitation, increased drowsiness, or acting unlike themselves for no apparent reason. You might notice dry mouth and lips. You might notice they have sticky saliva. Their lips are cracked. Or that their tongue looks dry. Pay attention for sunken eyes, the appearance of sunken eyes, or poor skin elasticity. Sometimes their eyes may look hollow and the skin may not snap back to its normal shape when gently pinched or pulled. That can be a definite sign of dehydration. Decreased urination. So you're noticing fewer wet diapers than they had before, incontinent briefs, fewer trips to the toilet, or dark-colored urine or odor. Strong-smelling or dark yellow urine. They may be experiencing pain, like from headaches. They might not be able to tell you, but you can usually tell by face grimacing or body language. So if you point and they nod, "Yep, that's where it hurts," then you can probably, through process of elimination, figure out they are experiencing You know, could be an extreme headache with dehydration, extreme dizziness or weakness. Dehydration can also show up as unsteady walking or refusing to move. Muscle cramps are common with dehydration. Low blood pressure symptoms are also common with dehydration, and that can cause lightheadedness when standing. And could present as near falls because they're lightheaded. They can develop a fever or become overheated, especially after hot weather and being in a warm room, or maybe they were recently ill. They can all of a sudden develop a slower heart rate than expected, or contrary to that, a rapid pulse. These are all signs of dehydration. It often increases heart rate and the patterns do vary. Again, inability to swallow safely, or you notice that when they try to drink they cough. This may indicate both dehydration risk and a swallowing safety issue. If the person becomes very drowsy, has severe confusion, and cannot keep fluids down, they have very little to no urine, they have a fever or show signs of shock, meaning very weak, very fast heartbeat, maybe even fainting, be sure to seek immediate medical care. So here are guidance tips for keeping someone with dementia hydrated during these, this hot weather. Make hydration part of their regular routine. Offer small amounts regularly, for example, every 1 to 2 hours while they're awake, not just at meal times. You can use reminders and structured prompts to help. Or you can say, "Let's both have a drink now." That can work better than asking, "Are you thirsty?" You might just automatically get a no even if they are. Suggestion is powerful. Make fluids visible and easy to access. Keep a preferred cup or bottle within their reach if safe, and place it where they can see it. And familiarity, as we all know, is really key to providing an enriched and effective environment for people living with dementia. And that's why we're recommending a familiar cup or bottle. They'll recognize it and go, okay, I know what this means. I'm supposed to drink out of this. Offer the right choice of fluids. Water is often best, but there's a lot of other things that will suffice. Milk, soup, oral nutrition drinks, herbal teas if appropriate, and ice chips can help depending on their personal preferences. You can adjust the temperature of the drink and the presentation. Some people prefer cold drinks, other room temperature. And again, try using familiar cups and mugs. If there's a history of choking or coughing that's not due to dehydration, but they already have displayed choking or coughing, ask a clinician about doing a swallow evaluation and their recommendation for safer textures. There are some available. I used to give my mom one. It was called Thicket, and they are thickened liquids that are recommended Um, but we need to be mindful to follow the exact guidance if that is recommended to you. So here are some hydration-friendly strategies. Ice chips, small sips, straw cups, sip-by-sip offerings can be easier than large drinks. Track their intake and output. Put. So what does that mean? Note how much they drink each time you offer it and when they urinate, especially during heat, illness, or medication changes. Watch for causes of fluid loss. Please treat constipation, diarrhea, fever, and vomiting immediately. These can quickly increase the chance of dehydration. And then of course, pay attention to their skin and their comfort levels. Offer moisturizers, lip care, and check for dry mouth. Dry mouth can both signal dehydration and worsen comfort, which can reduce their want to drink. Consider supplementing their meals with soups, gelatin, yogurt, fruits with high water content. These all can help if swallowing is safe for them. All right, what to do if someone with dementia is refusing food or water. Here are some recommendations. Start by figuring out why they are refusing. And then respond in a way that matches the cause. Check for immediate medical red flags: a new fever, evidence of pain, diarrhea, coughing with drinking, very little urine, sudden worsening, sudden confusion, uh, or worsening confusion, or an inability to swallow safely. All of these things could be really severe signs, and you need to seek medical advice as soon as possible. Reduce any friction between you and make what you're communicating to them understandable. Offer one option at a time. For example, would you like water? Rather than multiple choices. They might not be able to decide, so they won't pick anything. So one offer at a time. Use simple, calm prompts and offer in a familiar cup. Offer smaller amounts more frequently. That's better than trying to get— encourage somebody to drink an entire cup of fluid. So a few sips every few minutes can be more acceptable than a full glass. Try different textures and delivery methods. For example, straws, cups with handles, spoon feeding if advised and absolutely necessary, warmer or cooler fluids, you could try both, or thicker liquids if swallowing issues exist. But don't force in unsafe ways. If they cough, gag, or seem to pocket food or fluids in their mouth, they retain them in their mouth, kind of shove them over to the pocket of the mouth, forcing can be extremely dangerous. In this instance, you want to just stop and contact the clinician about swallowing safety. And then always continue to assess their comfort levels and the— on their person and in the environment. If the person's in pain, constipated, too hot, too cold, recently restless or distracted, address those first. Use preferred flavors and different varieties of liquids. Some people accept certain drinks much more easily. For example, diluted juice with water. Oral hydration solutions, or favorite tea. Popsicles are a great option. And look at the timing. Hydration may be easier between meals or after toileting, so adjust to whatever will work. Consider assistance with hydration. Many people with dementia need supervision. And they often are pacing when something is bothering them. Sit them upright and offer sips slowly. How to distinguish symptoms of dehydration from the broader symptoms of dementia. This is a tough one. Sometimes it can be hard. To tell whether a person with dementia is just, you know, showing signs of dementia or signs of dehydration, because many of the symptoms of dementia are similar to dehydration symptoms such as confusion and mood changes, and they can easily overlap. So if refusal persists, contact their healthcare team. Persistent poor intake can lead to high dehydration and malnutrition and may require medication review, a swallow assessment, or short-term support planning. So that concludes this episode for the Truth Lies and Alzheimer's show for today. I'm Lisa Skinner, your host. I will, as always, be back next week with another new episode for you. So, as I always say, have a great rest of your week. Try to always stay happy and healthy, especially during the hot weather season, and I will be back next week. Take care for now. Bye-bye.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Welcome to Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.