Dehydration & Alzheimer's  

It's as Simple as a Glass of Water
by Esther Trepal, RD, MS, CDN


ary was acting strange. She complained about being dizzy and very tired. She seemed to be breathing rapidly. She was having even more difficulty than ever remembering things. Her caregiver noticed all these changes and was concerned. She called 911. After a workup, the doctors in the emergency room wrote out a prescription for, you guessed it, fluids. Mary was dehydrated.

Dehydration is a condition where more fluid is leaving the body than is coming in. The body is over 50% water.It is very important for keeping cells, tissues and organs in good condition. For example, fluid is needed to transport nutrients, prevent constipation, and regulate temperature.

While all older adults are at risk for dehydration, this risk increases for persons with Alzheimerís. Besides forgetting to drink, persons with Alzheimerís may have challenges in communicating their needs or have difficulty swallowing. If they are incontinent, they may avoid fluids to reduce urinary flow. In addition, as part of normal aging, the sense of thirst decreases.

But itís not just about how much fluid is coming in. Itís also about what is going out. For example, someone on diuretics can have excess urinary output. Also keep in mind that caffeinated beverages and alcohol promote urination. Fevers or sweating can also lead to fluid loss as can bouts of vomiting and/or diarrhea.Running heaters during the winter months can dry the air and also cause dehydration.

Because the signs and symptoms often mimic dementia, dehydration can be easily overlooked. You know your person with dementia the best and will likely be the first to notice changes in how they behave or appear. Some of the signs and symptoms of dehydration are dry mouth, low urine output or dark yellow urine, constipation, lethargy, fatigue, headache, muscle weakness, dizziness, lightheadedness, confusion, or rapid breathing.

For mild dehydration, drinking fluids is generally sufficient. Start out with small amounts provided frequently. When in doubt, call 911 or your doctor.

The best practice, of course, is to avoid dehydration. Most seniors need at least 7 cups of liquid per day, but this is just an estimate. Actual amounts will vary person by person. Water is not the only source of fluids. Many other beverages are available, as well as some semi-solid foods, such as yogurt. See the table for more ideas. Most fruits and vegetables have high water content. Some good choices are watermelon or other melons, oranges, apple sauce, tomatoes, cucumbers and salad greens. These can supplement fluid intake to meet the persons overall needs.

Itís Not Just Water

Some Alternate Fluid Choices inlcude:
Juice, Milk Tea, herb tea Coffee, Fruit drinks, Soup (broth), Popsicles, Ice cream, Yogurt, Jello, Pudding, and Soda.

Flavor water with lemon or lime juice.

Most fruits and vegetables have high water content. Include them in the diet every day.

Push Fluids (Gently)
Sometimes it is difficult to get someone to drink as much as they should. Here are some tips to help you along.
  • Offer fluids consistently throughout the day, not just with meals and medications.
  • Provide beverages that are well liked and tolerated.
  • Make fluids easily accessible.
  • Assist those who cannot drink independently.
  • Verbally encourage fluid intake.
  • Increase social interaction with meals.
  • Supervise those who have dysphagia (swallowing problems)while they drink.
  • For variation, include solid or semisolid foods with high water content (see suggestions in text).