If your senior loved one is experiencing the life-changing effects of dementia, then you know how seemingly small variations in one’s activities and environment can present drastic challenges.
This very fact indicates a corresponding truth that can be a source of comfort: simple adjustments can be very effective in improving quality of life. Hydration is one of these simple yet powerful priorities that are essential for maintaining health, especially for seniors living with dementia.
In our guide, we explain the relationship between dehydration and dementia, along with how you can help prevent dehydration and recognize risk factors and symptoms.
Table of Contents
- Is Dehydration Common in Dementia Patients?
- How Dehydration Affects Cognitive Function in Dementia Patients
- Dehydration and Dementia in the Elderly: A Possible Reciprocal Relationship
- 12 Factors That Put Dementia Patients at Risk for Dehydration
- Signs of Dehydration in Dementia Patients
- Tips To Ensure Seniors With Dementia Stay Adequately Hydrated
- Senior Services of America: Providing for the Physical, Emotional, and Social Needs of Our Dementia Residents With Care and Compassion
Is Dehydration Common in Dementia Patients?
Dehydration is often observed in people with dementia, whether because cognitive impairment interferes with sensing and communicating the need for hydration or because poor hydration leads to cognitive impairment. Unfortunately, the two reinforce each other, so it is important to be proactive to ensure adequate hydration in dementia patients.
How Dehydration Affects Cognitive Function in Dementia Patients
The human body contains about 60% water, and this percentage is even higher in the brain. Every cell — particularly brain cells — requires an adequate supply of water to function properly. If there is insufficient water, the brain must work harder to perform its regular functions, leading to cognitive impairment in elderly patients.
Dehydration and Dementia in the Elderly: A Possible Reciprocal Relationship
It is unclear which phenomenon is more influential with respect to the other, but the connection between dehydration and dementia is firmly established.
Lower hydration status has been associated with an increased risk for the development of dementia. A possible explanation for this is known as the hydromolecular hypothesis, which attributes decreased cognitive performance to the misfolding and aggregation of proteins as a result of low water volume in the body. Proteins that do not form the proper shape cannot perform their functions, among these being:
- Long term memory storage
- The enabling of associative memory; and
- The linkage of networks essential for cognition
Dehydration may contribute to brain dysfunction such as dementia, particularly in older adults, due to their greater vulnerability to the water loss associated with aging. At the same time, dementia puts patients at higher risk of dehydration.
12 Factors That Put Dementia Patients at Risk for Dehydration
Because dementia (and aging in general) is a condition that affects almost every aspect of a person’s life, it can affect a person’s ability to maintain adequate hydration status in many ways.
Physical Factors
#1: Dexterity or Mobility Limitations
As adults age, they may not be able to move with ease. Getting to the refrigerator may exert more effort than before. Depending on their dexterity, certain types of cups or glasses may be difficult for them to hold. As a result, they may feel less inclined to invite the physical discomfort of fixing drinks for themselves. Or they may have lost the ability entirely.
# 2: Swallowing Difficulties
Patients may have trouble swallowing and avoid drinking because of the discomfort of doing so and/or because of their fear of choking. Although dysphagia is not considered a typical sign of aging, older patients are at higher risk for swallowing difficulties due to wear and tear on the esophagus and dry mouth.
#3: Incontinence
Incontinence issues, affecting about 30% of older women and 15% of older men, may keep elderly patients from drinking enough water for fear that they’ll have an accident. They may be concerned about uncontrollable leakage or not being physically able to reach the bathroom in time.
#4: Other Health Conditions or Medications
Patients with kidney damage or poorly controlled diabetes are even more susceptible to dehydration. In addition, medications commonly utilized by older patients can lead to water loss. These include:
- Blood pressure medications, such as diuretics or ACE inhibitors
- Laxatives
- Some diabetic medications, such as SGLT2 inhibitors
Cognitive Factors
#5: Forgetting To Drink
Because of the effects of dementia, they may simply forget to drink enough water and liquids. Or they may think they drank just a few minutes ago, when in fact hours have elapsed.
#6: Other Memory Issues
In addition to forgetting to drink, they may forget where the glasses are or where the water bottles are stored, for instance. They may have lost the muscle memory to properly perform this activity of daily living.
#7: Inability To Communicate
Dementia patients may have difficulty letting their caregivers know they are thirsty or are feeling the effects of dehydration. Common communication problems in dementia patients include:
- Using nonsensical speech
- Difficulty using the desired word
- Inability to grasp part or all of what others are saying
#8: Losing Track of Time
Time-shifting sometimes occurs in patients with dementia. As short-term memory suffers, they may begin to rely more on long-term memory and be unable to attend to things that happen in the short term.
A patient who doesn’t remember when they last had something to drink may go hours without drinking unless prompted by someone. When prompted, they may or may not feel inclined to drink.
#9: Not Recognizing the Signs of Dehydration
They may not realize their headache is because of dehydration or that they haven’t used the restroom for a long while. Normally, these signs are effective prompts that a person must drink, but a person with dementia may not recognize the cue.
Body Function Factors
#10: Changes in Thirst Sensation
Reduced thirst has been observed in elderly patients, even when they have a fluid volume deficit. Disruption to the thirst mechanism, though the precise cause is unclear, interferes with the elderly patient’s ability to recognize their need for fluids.
#11: Decline in Water Storage in the Body
Sarcopenia, or skeletal muscle decline, is a common phenomenon among elderly adults that leads to mobility issues and loss of independence. Muscle is a major reservoir for water, so when muscle declines, so does the amount of water stored.
#12: Changes in Kidney Function
Kidney function decreases with age, meaning older adults have a diminished capacity to balance body fluids. Thus, they are more susceptible to dehydration, even if they drink adequate amounts of fluid.
Signs of Dehydration in Dementia Patients
The following symptoms may indicate that an elderly patient is dehydrated:
- Dry mouth
- Dark or strong-smelling urine
- Behavioral changes or agitation
- Muscle cramping or weakness
- Sluggishness
- Dizziness or nausea
- Headache
- Constipation
- Sunken eyes
- Bad breath
Tips To Ensure Seniors with Dementia Stay Adequately Hydrated
There are many ways you can be proactive to prevent dehydration in your loved one:
- Offer drinks during each meal and several times throughout the day — whether the patient has expressed thirst or not — especially when they have been physically active or the weather is hot. Keep fluids accessible and visible to the patient, even when you are out running errands or keeping appointments.
- Offer different kinds of fluid (and at different temperatures) so your loved one can choose what appeals to him or her at the moment. Good choices include flavored or sparkling water, tea, hot chocolate, smoothies, and nutritional shakes.
- Drink often to model good hydration.
- Allow them plenty of time to finish drinking. Try to note whether they have spilled or poured out a drink.
- Offer water-rich foods, such as fruits, vegetables, broth-based soup, popsicles, etc.
- Provide 4-6 oz of water with pills and encourage them to drink it all.
- Follow a hydration schedule to establish a good routine. This might include labeling water bottles, using charts to remind your loved one to drink, or consistently taking a drink break when transitioning between activities.
- Use drinking vessels that are easy to handle (for instance, sippy cups or straws, if necessary).
- Do not offer beverages that can cause the patient to lose fluid, such as caffeine or alcohol.
- Ensure their environment is comfortable and relaxed. Any agitation may discourage them from drinking.
For advice about how to address further difficulties with staying hydrated, consult a healthcare provider. For instance, if your loved one struggles with swallowing, resists your efforts to encourage drinking, or takes medication that interferes with water storage, this may call for interventions you haven’t thought of.
Senior Services of America: Providing for the Physical, Emotional, and Social Needs of Our Dementia Residents with Care and Compassion
Senior Services of America operates several senior living communities in Washington, Oregon, and Idaho. Our team members throughout these communities uphold our commitment to the safety and empowerment of our residents.
We prioritize full and effective communication with residents and their families and respect for their dignity and personal goals. Our high standard of care ensures that our residents receive service from professional, caring, and honest individuals. Our communities offer:
- Assisted living: Designed for seniors who need help with certain activities, such as meal preparation, medication management, and housekeeping.
- Independent living: Designed for seniors who don’t need help with activities of daily living, but who want to be part of a supportive community with opportunities for socializing.
- Memory care community: Dedicated to caring for seniors with Alzheimer’s disease and other related dementias. This community is staffed by a team that has received specialized training and is available at all times to carry out individualized care plans to meet your loved one’s needs.
- Respite care: Designed for caregivers who need a temporary place to recharge and find relief from the stress of caregiving.
Find your nearest location for more information.
The content in this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.