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Dealing with dehydration in the elderly
Elderly people are at a higher risk of dehydration than young people, due to physiological changes that occur as part of the ageing process. Many conditions and increased physical or mental frailty also complicate the issue, so carers need to be aware of the common risk factors, the consequences, how to recognise the signs of dehydration and how it can be prevented.
Risk factors in dehydration
Being in residential care is a recognised risk factor for dehydration. However, if your loved one has live-in care, particularly if they need dementia care, they can still be at risk.
Elderly people, especially those living with dementia or those who have had a stroke often do not have the same sensation of thirst as they used to and they may not realise they are thirsty.
Impaired renal function can also be a risk factor, as the hormones do not respond to dehydration as well.
Some medications such as laxatives and diuretics can exacerbate the likelihood of an elderly person becoming dehydrated, and if they are incontinent, they may deliberately restrict their intake of fluids, as they are worried about “accidents”.
People who need assistance with feeding can be at higher risk, particularly if they live in a care home where inadequate staff training may mean that there is a general lack of awareness about how important hydration is.
If your loved one needs assistance with eating and drinking but receives at least 24-hours of care at home, their companion care provider can ensure that they have a sufficient fluid intake each day.
Staying hydrated in the heat
- Drink plenty of water – you should aim to drink at least eight glasses of water per day. If you’re looking after a loved one with dementia, be sure to remind them or support them to take on fluids.
- Understand your medication – there are certain prescriptions that may make it more likely for you to become dehydrated, especially in hot weather.
- Eat lots of vegetables – many vegetables have a high water content, and also provide the nutritional value you need to stay healthy in the heat.
- Listen to your body – if you’re out in the sun, pay more attention than normal to what your body is telling you. Be alert to symptoms such as headaches, fatigue, nausea and lightheadedness.
- Mix up your fluids – water is always the best way to hydrate, but it’s not the only way. Cups of tea, glasses of squash and even a bowl of soup can help keep you hydrated.
Consequences of dehydration
If an older person becomes dehydrated, they are more likely to be hospitalised and have an increased mortality risk. Even if they are only mildly dehydrated, they will feel tired and will have poorer concentration, memory problems and slower reaction times.
Other complications of dehydration include weakness, dizziness, low blood pressure and an increased risk of falls. If your loved one has an inadequate fluid intake, they will also be at greater risk of developing a urinary tract infection and may also become constipated.
Common signs of dehydration include a dry mouth, tongue and lips. You may also notice that the elderly person has sunken eyes and dry, papery skin. They may seem to be unusually drowsy, confused or disorientated too. They might also feel dizzy because their blood pressure is low, however, and these signs are frequently seen in other conditions, so they might be due to another cause.
An elderly person who is dehydrated will often have concentrated urine which can appear dark and have a strong odour, while normal urine should be pale in colour and be odourless.
A person who is dehydrated may experience cramping in the limbs, headaches or feel generally unwell. They can become irritable and have difficulty sleeping.
Symptoms of more severe dehydration include a weak, rapid pulse, faster than usual breathing, severe muscle cramps and contractions and a bloated stomach.
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How can dehydration be prevented?
The most important strategy for preventing dehydration is to recognise when the person’s fluid intake is inadequate and ensuring that they drink more.
Residents in care homes may not drink enough because they are worried about not being able to get to the toilet in time, particularly if they need assistance. They may be physically unable to reach a drink and may not receive the help they need to stay properly hydrated.
Staff training on the importance of hydration, monitoring of fluid intake, assistance when necessary and the provision of the person’s preferred fluids are all important in care homes.
If your loved one receives elderly care at home, try to ensure they drink a minimum of five eight-ounce glasses of water or clear fluids each day. They should always have a drink accessible, and it is a good idea to monitor fluid intake.
They should be offered a variety of fluids, both hot and cold and given the assistance they need if they are unable to drink independently. Your loved one may find drinking easier with an aid such as a special cup, or a straw depending on their condition.
When they take their medication, offer a full glass of water to help them swallow it.
Spotting heat stroke
If you’re caring for a loved one – especially if they have dementia – it’s important to frequently check they’re not suffering any of the following symptoms. These can all indicate heat stroke:
- Dizziness and confusion
- Loss of appetite and feeling sick.
- Excessive sweating and pale, clammy skin.
- Cramps in the arms, legs and stomach.
- Fast breathing or pulse.
- Temperature of 38C or above.
- Being very thirsty.
How to encourage someone to stay hydrated
It can be difficult to persuade your loved one to drink the amount of fluid they need, especially when they do not feel thirsty or they are worried about incontinence. You could try the following strategies:
- Offer a choice of different drinks if they find water too tasteless or bland. They may like watered-down fruit juice, flavoured water or hot water embellished with a slice of orange, lemon or lime
- Approach them positively offering a drink as an attractive option rather than as a necessity
- Offer drinks regularly and leave then accessible so that your loved one can take them little and often if they prefer
- Avoid too much caffeine or alcohol
- Encourage them to increase their fluid intake in warmer weather
- Promote fluid intake more in the day than late at night if they have concerns about using the bathroom at night
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