Dementia and Dehydration: What Caregivers Need to Know

Hello, everybody, and welcome to a new episode of

the Truth Lies on 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 two, 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

three, 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

four, 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 five, we

often see swallowing and chewing issues With dementia, some

people also have swallowing 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, anticholinergetics,

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 going to

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. 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 one to two 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.

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. 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, 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 encourage somebody to

drink an entire cup of a 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 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.