This week’s blog is about why hydration is so important, why it is a problem with our loved ones and how to recognize dehydration when it occurs. Next week will be about how to make sure your loved one stays well hydrated.
Maintaining adequate fluids rates high among those things that decrease dementia symptoms, right up there with exercise, good nutrition, adequate sleep and stress management—and it is probably the easiest to do. Good hydration facilitates blood pressure and body temperature regulation, heart function, digestion, elimination, skin health—and brain function.
Conversely, poor hydration thickens the blood and impairs circulation, which makes the heart work harder. The thicker blood can’t transport enough oxygen to the brain and confusion increases. Without adequate fluids, digestion becomes sluggish, causing distention cramps and constipation. The body draws fluids from the skin for more urgent functions like those mentioned above, and the skin becomes dry and fragile.
Dehydration occurs when a person doesn’t drink enough fluids but it can also happen due to vomiting, diarrhea, excessive sweating or urination, fever, burns, chronic illness, diuretics, depression and exercise. Dehydration from air conditioning can cause dry eyes, itchy skin and parched lips.
Don’t expect your loved one to report thirst.
• Age and frailty causes one to eventually lose the ability to recognize thirst, even when cognition is not impaired.
• With LBD, a person can be thirsty, but know only that they feel uncomfortable. Add decreasing communication skills and reporting thirst becomes even more difficult.
• Many people take medication for high blood pressure and other heart related issues. Most of these drugs have the same effect.
These physical reasons are just the start. Your loved one may not be drinking enough for a variety of other reasons, including:
• Forgetting to drink. Without a thirst reflex, this can be expected.
• Not understanding or caring how important fluids are. As cognition goes, so does the ability to judge the importance of drinking.
• Resisting drinking for fear of choking. This is a valid fear. Choking can lead to aspiration, pneumonia and death.
• Being physically unable to wait on oneself and unwilling—or unable—to ask for help.
• Not liking the taste of water.
• Fears that drinking fluids will increase the need to void, and add to bathroom hassles.
Signs of even mild dehydration can include thirst, dry mouth and or tongue, dizziness, headache, weakness, fatigue, constipation, decreased urine output, confusion, concentrated yellow urine, rapid heartbeat, cramping of legs, no tears, irritable, excessive sleepiness and lethargy. For the person with LBD, another sign of dehydration is increased acting out. (Remember, acting out is the communication of some kind of discomfort.)
Since you can’t depend on your loved one to drink enough on their own to stay hydrated, this becomes the caregiver’s job. Maintaining good hydration involves being alert for the above signs of dehydration, knowing your loved one’s favorite drinks and the temperatures preferred as well and developing a drinking routine where fluids are presented regularly in an attractive fashion. Next week’s blog will include a variety of suggestions and ideas for making sure your loved one drinks enough fluids.
From the NCCDP - ICCDP Summer 2014 Newsletter and the European Hydration Institute
For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson’s & Lewy Body Dementia