Hydration, Part 2: Getting Enough to Drink

Last week's blog was about how important it is for our loved ones to get enough to drink. This week we get down to the nitty-gritty and talk about how to make that happen.

Martha told her support group, “I know it is important that Dean gets plenty to drink but he forgets. What can I do to get him to drink more?” Other members agreed that this was a problem for them too and the list of reasons grew to include pickiness, fear of aspiration, poor motor control, and resistance because “then I’ll have to pee.” Here were some of the ideas the group came up with:

Develop a routine where you offer water or other fluids on a regular basis. Since a loved one is often unaware of the importance of hydration, just having drinks available may not be enough.

Use verbal and visual cues. Ask your loved one it they’d like a drink. Hang pictures of people enjoying a drink of water where your loved one can see them.

Be a role model. Caregivers need to stay hydrated too! If you are also drinking, you loved one will be much more willing to drink up.

Make it a social event. Ask visitors, family members and friends to suggest taking a drink. Have fluids available for them to drink with your loved one too.

Offer help as needed. Caregivers become great at offering such help in a matter-of-fact way that is easy for a loved one to accept with dignity. But remember that LBD fluctuates. At times when a loved one is less helpless, step back and let them be independent—if messy. That’s sometimes more difficult for a caregiver to do than helping!

Know your loved ones drink preferences and cater to them as much as you can. Experiment with a variety of food and fluid options to find other favorites.

Know your loved ones temperature preferences. For example, some people won’t drink water unless it is very cold—others refuse to drink it with ice cubes. Some prefer hot drinks, but always make sure it isn’t too hot. (The ability to tell if a drink is too hot is another skill that may be fading and a loved one could easily a tongue—or worse.)

Make it appealing. Make flavored ice cubes by pouring juice or mashed fruit into a freezer tray. Add a little fruit to the water…a few berries, a slice of watermelon or peach—any fruit will work. Try adding spices or essential oils, like ginger or rosemary. (If you use essential oils, be sure to use the ones with labels that say they can be ingested. See LBDtools.com for more about essential oils.)

Add variety. Make water the main fluid, but add a variety of others, such as coffee, milk, teas and juices, depending on your loved one’s likes and diet restrictions.

Use food. Offer foods with more fluid content like broccoli, yogurt, melons, and gelatin. Soups are also good. Offer smoothies, shakes, ice pops and sherbets instead of drier desserts like cake or pie. It all adds up.

See a speech therapist if choking has become a problem. Just one or two sessions can teach you and your loved one some skills that will greatly decrease choking. The speech therapist may also suggest thickened fluids. These are easier to swallow.

Always offer fluids with dryer foods such as cookies or toast.

Use a container that makes drinking easier and spills less likely. Drinking cups are available with large easy-to-use handles. Also a closed container like a sports bottle with a straw or a Sippy cup. If the container is clear, it acts as a cue and you can monitor the level of the fluid as well.

Use persistence when a loved one fears that drinking too much will lead to excessive bathroom hassles. Adequate hydration actually improves kidney function and decreases urges to void. However, your loved one may not be able to reason well enough to understand this explanation. Instead, offer fluids again in a short while. You can also assure your loved one you will be there to help with the "hassles" as needed.

Take water along when participating in activities. Exercise increases the need for fluids.

Make sure your loved one doesn’t get too hot. Avoid overdressing and when outside, avoid hot sun and seek out shade. When a person’s inner thermostat doesn’t work well, what is too hot for the caregiver may be comfortable for the loved one, and so look for signs of mild dehydration (see previous blog) before assuming that your loved one is too hot.

In a care facility, make sure staff is not simply setting a pitcher and glass near your loved one and assuming that will do the job but offering fluid on a regular basis (hourly or so) even if your loved one is capable of pouring from the pitcher.

Much of this is 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

Hydration, Part 1: Why It Is So Important

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