There are potentially multiple problems resultant from the links between dementia and dehydration.
- First, dehydration can cause symptoms which can be confused with dementia
- Second, dementia can cause dehydration
- Thirdly, dehydration can aggravate dementia
- Fourthly, dehydration is an increased danger when dementia is in its final stages
- Finally, ensuring that a person with dementia is sufficiently hydrated is very difficult
Dehydration has symptoms in common with senile dementia symptoms, age dementia symptoms and Alzheimer’s symptoms. Rehydrating an older person can often allow them to return to a full and normal life.
The most common symptoms of dehydration include thirst, persistent fatigue and lethargy, muscle cramps or weakness, decreased urination and a dark yellow colour of the urine, nausea and headaches, dizziness, memory function loss, confusion, deep rapid breathing, and increased heart rate.
Left unchecked, dehydration can even be fatal
It is evident from the author’s discussion of the experiences of care home quality inspectors that it is rare to find adequate care planning for support of rehydration, or avoidance of dehydration, in older people. The risk consequent on that lack of planning is that the resident becomes dehydrated, which either will cause symptoms which are confused with dementia, or aggravate a dementious state.
Dehydration risk is enhanced when the weather is hot, humid, or both. Older people are more at risk of dehydration because age brings with it a decreased ability to respond to external temperature changes and a decreased thirst mechanism (ability to feel thirsty). A bout of diarrhoea will also lead to water loss, and must be compensated for.
For many older people with dementia, lack of recognition of the vessel being used to administer water can be a problem. If the vessel is unfamiliar, for example a specialised feeding cup, or a non-spill cup, it is probable that the person with dementia will not associate the shape with water, and not use the vessel even when thirsty. It is therefore important in the area of hydration, as with dementia care in general, to stick to routines and familiar objects and surroundings. A non-spill cup may sound a good idea to a carer, but may well aggravate the problem.
To avoid dehydration, obviously intake of water is critical. An older person is usually said to need about 2 to 3 pints of water a day, or 6 tea cups. However this does not need to be wholly or even predominantly in the form of liquid water. The body does not differentiate between liquid water intake and the intake of water as an element in solid foodstuffs. Many foods contain a high proportion of water, therefore ensuring a high intake of those foods can go at least part way to providing adequate water intake. Food with high water content includes:
Food | % water |
Apples (raw) | 84% |
Applesauce (canned, sweetened) | 80% |
Apricots (raw) | 86% |
Apricots (canned) | 78% |
Asparagus (cooked) | 91% |
Avocados (raw) | 73% |
Bananas (raw) | 74% |
Bell Peppers (raw) | 92% |
Blackberries (raw) | 86% |
Blueberries (raw) | 85% |
Broccoli (cooked) | 91% |
Broccoli (flower clusters, raw) | 91% |
Cabbage (raw) | 92% |
Cantaloupe (raw) | 90% |
Carrots (raw) | 88% |
Cauliflower (raw) | 92% |
Cauliflower (cooked) | 93% |
Celery (raw) | 95% |
Cherries (raw) | 81% |
Corn (1 ear, cooked) | 70% |
Cucumbers (raw) | 96% |
Grapefruit (pink or red, raw) | 91% |
Grapes (raw) | 81% |
Honeydew Melon (raw) | 90% |
Kiwi fruit (raw) | 83% |
Lettuce (raw) | 96% |
Mangoes (raw) | 82% |
Nectarines (raw) | 86% |
Olives (ripe, canned) | 80% |
Oranges (raw) | 87% |
Peaches (raw) | 88% |
Peaches (canned) | 79% |
Pears (raw) | 84% |
Pears (canned) | 80% |
Plums (raw) | 85% |
Potato (baked) | 75% |
Raspberries (raw) | 87% |
Strawberries (raw) | 92% |
Tangerines (raw) | 88% |
Tomatoes (raw) | 94% |
Watermelons (raw) | 92% |
Incorporating ice chips, iced lollys, juice bars, gelatin, ice cream, soup, broth, fruit and vegetable juices, lemonade and flavoured water to incorporate liquids into the diet will also help water intake for those older people who have problems in taking water in directly.
Alcoholic and caffeine bearing drinks have a diuretic effect i.e. they can aggravate or initiate dehydration, and should be avoided. In a care setting, alcohol is likely to be controlled and not an issue, but serious consideration must be given to using only caffeine free tea and coffee as these are often seen as the most popular ways of offering water, especially by untrained and unaware carers.
