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Dehydration and Dementia

Image courtesy rakratchada torsap @ http://www.freedigitalphotos.netI heard on the news this morning that most of the U.S. is experiencing dangerously high heat levels.  Warnings have been issued for people to take steps to avoid becoming over-heated, and to be sure to drink plenty of fluids.  So I thought it would be good to share some information about dehydration, and specifically how it can affect persons who have dementia.

Dehydration is very common in the elderly.  I have heard that it is the second most common diagnosis for the elderly, when they are admitted to the hospital.  In one study, 31 percent of the residents in a long-term care facility were found to be dehydrated.  Another study showed that 48 percent of older adults admitted to the hospital from the emergency room showed signs of dehydration.

Dehydration occurs when a person’s body gives off more water than it takes in — through urination, sweat, metabolic processes, and other means.  The human body relies on water to regulate our body temperature, maintain blood pressure, and get rid of bodily waste, among other things.  If we don’t take in enough water, it can lead to confusion, weakness, urinary tract infections, pneumonia, bedsores in persons who spend most of their time in bed.  In extreme cases, dehydration can cause death.

It is actually more common for the elderly to become dehydrated than it is for younger folks.  But this isn’t always due to a person not drinking enough.  Some of the other reasons that can cause a person to become dehydrated include:

  • the use of some medications (for example, diuretics used to treat high blood pressure and depression can cause increased urination, and other medications can produce increased sweat production),
  • as a person ages, his sense of thirst diminishes,
  • a person who is frail may have a harder time getting up to get something to drink,
  • as the body ages, the kidneys function less efficiently, and are less able to conserve fluid,
  • some illnesses, especially those that can cause vomiting or diarrhea, can cause excess loss of bodily fluids,
  • caregivers may not sense that the person needs fluids
  • some persons with dementia may have lost the ability to reason that, if they feel thirsty, they should go and find something to drink,
  • or a person may get up to get something to drink, and by the time they get to the kitchen have forgotten what they are there for.

The common belief is that a person needs to drink eight glasses of water a day.  But the fact is that we all require different amounts of fluid.  Some foods have a high water content.  Fruits, vegetables, and soups have a lot of water in them.  It is a good idea, when we are dehydrated, to increase our consumption of these foods.  And if we are acting as caregiver for a person who often doesn’t drink enough, this can be compensated for by encouraging him to eat some of these foods.

Some people believe that drinking beverages which contain caffeine can lead to dehydration.  Others dispute this, however, reasoning that the amount of caffeine in a cup of coffee or a glass of tea is rather small, and will not affect our overall daily fluid consumption.  Now, if a person sips on iced tea or cola drinks all day, that may produce a different result.  The same principle holds true for beer.  Large people, athletes, and those who perspire heavily (such as those who work outside) need to drink more than others.

It is sometimes difficult to tell if a person is mildly dehydrated.  One way to determine if you may be dehydrated is to weigh yourself every morning.  If you have lost two pounds or more from the previous day, there’s a good chance you may be dehydrated.  Also, watch out if you feel especially thirsty — more so than usual — or if you have a headache.

A person is considered to be mildly dehydrated if he has lost two percent of his body weight.  A person who has lost four percent or more of his body weight is said to be severely dehydrated.  Even mild dehydration can have serious consequences for your health, especially if you have heart or kidney problems.  Those persons who have chronic health problems, particularly the elderly, should closely monitor themselves for signs of dehydration.  However, it should be noted that signs of dehydration that show up in younger persons aren’t always apparent as they grow older.  (This may be one of the reasons why the aged are so often admitted to the hospital with symptoms of dehydration.)

Some of the symptoms of dehydration include:

Mild dehydration

  • dry mouth/tongue, with thick saliva
  • passing only a small amount of dark-colored urine, or not urinating at all
  • cramping in limbs
  • headaches
  • no tears or few tears when crying
  • weakness, with a general feeling of not being well
  • excessive or unusual sleepiness or irritability

Severe dehydration

  • Low blood pressure
  • Convulsions
  • Severe muscle cramping and contractions, especially in the limbs, back, and stomach
  • Bloated stomach
  • Rapid, weak pulse
  • Dry, sunken eyes with few or no tears
  • Wrinkled skin with no elasticity
  • Rapid breathing

Older persons who are adequately hydrated experience constipation less frequently, and so they have to use fewer laxatives.  They fall less often, and men will have a reduced risk of bladder cancer.  Chronic problems with constipation can lead to an increased possibility for colorectal cancer.

To ensure that the person you are caring for does not become dehydrated, watch to make sure he drinks plenty of fluids during the day.  If he isn’t inclined to drink much, try to incorporate foods that have a high water content into  his diet (broccoli is a good one, as is watermelon).  Check his urine output to determine that he is producing a goodly amount, and that it is not dark in color.  If he is incontinent, keep track of how many times you have to change his underwear.  He may need to be educated to drink, even when he isn’t thirsty.  Sometimes it may help to give him a glass of water every hour, and instruct him to drink it.  Keeping a glass of water or a water bottle next to his chair or his bed may provide a good prompt to drink.  Sports drinks can also help replenish electrolytes and other nutrients as well as fluids.

If your loved one is in a nursing home, be sure that the facility has a hydration program in effect.  Sadly, I have worked in buildings where the only fluids that some residents get during the day is what they drink with their medications and with meals.  Ideally, the staff should go into the residents’ rooms and give them a glass of water to drink at least every hour.  They should have a pitcher of water that is kept filled with cold water, and placed within reach.  (I’ve had to tell aides that the water pitcher doesn’t do the resident any good if it’s on the other side of the room.)  A variety of beverages should be offered, not only at meals but in between.  And, it is important to note that thickened liquids (if a person requires them because of swallowing problems) have decreased hydration value, which means that the person should be given even more fluids than the average person.

Sources:

http://www.aplaceformom.com/senior-care-resources/articles/elderly-dehydration

http://www.parentgiving.com/elder-care/dehydration-a-hidden-risk-to-the-elderly/

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  1. July 17, 2013 at 3:46 PM

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