Dementia or Dehydration?

If you care for someone with Alzheimer's or dementia, then you know how frustrating it is when a doctor asks the world's dumbest question; 

"Does she/he ever seem confused?"

Confusion, slurred speech, forgetfulness, and hallucinations can be signs and symptoms of a variety of conditions. However, for those with a dementia, they can be the daily norm. 

Yet, ignoring these signs could allow a silent killer to

threaten the life of your loved one.

Dehydration

You know the basic importance of hydration. It keeps your electrolytes balanced, your blood volume normal, your kidneys functioning and your body healthy. Without adequate fluids, your body can't function--because deep down inside, we are all very squishy beings. 

Dehydration means that you use more fluids than you take in. That's why it is essential to drink lots of water when we are outside on hot days, when we are sick, and when we are physically active. 

Typically, we might think that an elderly person who is mostly sedentary (such as those who must remain in bed or depend on a wheelchair) could not easily become dehydrated. It would seem as though they are more than likely to take in more fluids than they lose in a day. 

But...

That isn't always true. Dehydration is actually very common in the elderly, regardless of their lifestyles. It is also not easy to detect unless you are 100% in their intimate business 24 hours a day. 

How Do the Elderly Become Dehydrated?

There are many reasons why the elderly may not consume enough fluids. Here are the most basic reasons: 

• Decrease in taste and thirst (this can lead to an apathy about eating/drinking. Basically, the effort to eat or drink isn't worth the bad or non-existent taste, especially if the thirst/hunger signals are not present.)

• Physical conditions: (it may be difficult or painful to make trips to the kitchen. Therefore they delay eating/drinking. Or they may have issues with swallowing and choking.)

• Forgetfulness and confusion: (those with dementia may believe they have been drinking, may overestimate the amount they have consumed, or simply not notice that they are thirsty)

• Embarrassment: (Those who are incontinent may feel embarrassed by lack of control and limit food and drinks to prevent accidents. Or, they may be embarrassed to ask for help getting food and drinks for themselves if they are physically limited.)

• Illness: (Many people forget to eat and drink when they feel bad.)

• Sleeping Too Much: (Long periods of sleep mean no fluids being taken in.) 

• Aging: (The body loses fluid volume as it ages, which means the body has less fluid to spare)

There are also factors that affect how much fluids a person loses over the day: 

• Medications containing diuretic

• Illness 

• Urinary tract infections

So What Are the Signs and Symptoms of Dehydration in the Elderly?

The signs and symptoms of dehydration are pretty much the same across all age groups. They include: 

• Low urine output

• Dark colored urine

• Urine with a strong or foul odor

• Decrease or cessation of sweating

• No tears while crying

• Dry mouth/decrease or absence of saliva

• Headache

• Dizziness

• Muscle cramps

• Flushed skin

• Sunken eyes

• Lethargy

• Feeling unwell

However, there are two symptoms that go along with dehydration in everyone that are much harder to notice in the elderly: 

Mental confusion and dry, non-elastic skin. 

When Its Not Dementia and Wrinkly Skin

Lets start with the skin. If someone asks you if your 89 year old mother or father has wrinkly skin, you are probably going to roll your eyes. The difference is that dehydrated skin can look as though it aged years overnight or just over a few hours. It is also non-elastic, and there is an easy way to tell this. 

You pinch it. 

But no, you don't pinch it like that!

Practice this on the back of your own hand (or wherever you have some thin skin to spare). Gently pinch up a little loose skin. If YOU are well hydrated, then this skin should pop back to its normal place as soon as you let go. 

In someone who is dehydrated, the skin may slowly return to its normal shape and position, or it could remain in a peak for a few seconds. This isn't an exact science, and there is no guide to how many seconds equal how dehydrated a person is. But if the skin does not return to normal right away and there are OTHER signs of dehydration present, take action immediately. 

Mental confusion is trickier if your loved one has dementia. Hopefully, you trust your gut instincts and know when something seems abnormal about an already abnormal behavior. If it seems like dementia behaviors have suddenly gotten a LOT worse in a short time, then chances are there is a physical issue at fault.

Preventing Dehydration

Obviously, the best way to prevent dehydration is to take in more fluids. That may not always be easy. Here are some tips for helping your elderly loved one stay hydrated:

• Set a timer or schedule reminders. (Always have fluids available, but when the timer goes off, make sure they drink.)

• Make fluids highly accessible. (keep a small glass, spill-proof cup, thermos, sports bottle or other container filled with fresh water or other favorite beverage. Keep this near your loved one at all times.)

• Use a cup with measurements. (Use the numbers to closely monitor intake for the day)

• Water is best, but it is boring. (Especially for those with diminished taste buds. Try to include some other beverages into the day besides water. Just follow your elder's nutrition plan. Consider flavor packets for water to make things more interesting.)

• Serve juicy foods. (Soup can greatly add to the fluid intakes for the day. So can broth and juicier fruits. Little amounts add up!)

• Serve "thirsty foods". (Depending on your loved one's diet plan, you can occasionally provide foods that are spicier or drier to promote thirst signals. Just remember to stick to what they like to eat!)

• Never leave home without a drink. (if you take the elderly out for the day, even if you are close to home, take a bottle of water along. Make sure they sip often.)

• Set a good example. (humans mimic each other is social settings. People with dementia will often imitate the motions and actions of others. If you drink often, then you are sending visual reminders and cues. )

• Take note of medications. (research or ask a doctor about the medications the elderly are taking. If they contain a diuretic or are known to cause fluid loss, ask how much fluids need to be replaced per day to compensate.)

And of course, if you think that your elderly loved one is dehydrated, take action immediately. Provide fluids (mild dehydration) or seek medical attention quickly.