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,
Tea, herb tea
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
- Provide beverages that are well liked
- Make fluids easily accessible.
- Assist those who cannot drink
- 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).