Older adults are naturally at high risk of dehydration. As we age, feelings of thirst become less noticeable, and the body can’t store as much water. But chronic or unresolved dehydration can be dangerous, because without sufficient fluids, the body may not be able to carry out its normal functions.
While dehydration can affect all people as they age, dehydration and dementia often go hand-in-hand. In fact, dehydration in elderly people with dementia occurs at significantly higher rates than those without cognitive decline, according to a 2018 study published in Nutrients journal. Older adults with dementia may not remember to drink regularly, and often need help or reminders to stay hydrated throughout the day. As Alzheimer’s disease and other dementias progress, seniors may lose the ability to recognize thirst, drink without assistance, or to verbally communicate their needs to a caregiver.
Learn common causes of dehydration and dementia, and how to spot early symptoms to seek treatment. Plus, eight easy tips to help keep your aging loved one hydrated.
Dehydration and dementia: 8 common causes
Dehydration in elderly adults with dementia is particularly common, since the part of the brain that recognizes liquid imbalance and lets people know they’re thirsty may not work properly as dementia progresses. Reasons seniors with dementia may become dehydrated include:
- Inability to recognize thirst. Natural aging limits the body’s ability to signal dehydration. In the early stages of dementia, a person may be less sensitive to thirst and less likely to remember when they last took a drink.
- Memory concerns. Dehydration in people with dementia can be exacerbated by memory loss. As dementia progresses, someone may no longer remember where the glasses are kept, how to turn on the faucet, or how to open a carton of juice.
- Decline in verbal communication. Dehydration in dementia’s later stages can be the result of compromised communication. Someone may be unable to express thirst to a caregiver, or suffer a complete loss of thirst and not understand why they need to hydrate.
- Medication. Certain medications prescribed to people with Alzheimer’s or another form of dementia may increase perspiration or urination, necessitating greater water intake.
- Fear of incontinence. Urinary incontinence is common in mid-to-late stage dementia. Seniors may limit their water intake to avoid frequent urination, leading to dehydration.
- Existing medical conditions. Some diseases put seniors at high risk of dehydration. Unmanaged diabetes causes frequent urination, while people with cystic fibrosis tend to have saltier sweat that can quickly unbalance mineral levels and lead to dehydration.
- Fluid regulation. The body’s water balance is regulated by feedback mechanisms that connect different parts of the nervous system with the kidneys. That feedback loop is compromised by cognitive decline.
- Illness. Sore throats and colds may make eating and drinking uncomfortable. Diarrhea and vomiting can also lead to dehydration — that’s why it’s important to push fluids during any common illness.
8 tips for preventing dehydration in people with dementia
Preventing dehydration in elderly with dementia is possible using the following tips:
- Keep water close. In the later stages of cognitive decline, many people experience mobility challenges. Having water nearby can help limit dehydration in elderly people with dementia — especially those who have difficulty getting their own.
- Set hydration reminders. Notes, notices, and alarms can help your loved one remember to hydrate regularly. A post-it note on the fridge or a sign taped to their bottle of water can serve as reminders. Phone alarms at regular intervals can also work — but be sure they know what the notification is for, or it may cause confusion.
- Invest in adapted drinking aids. Adapted drinking aids can make a big difference preventing dehydration in people with dementia. No-spill cups and mugs, straw stabilizers, and safe-swallow cups designed for those with cognitive impairment are all available online. Consider something brightly colored to draw attention to the beverage, or a cup that’s inscribed with your relative’s name.
- Stay hydrated with tasty, nutritious snacks. Getting the right nutrients can also be difficult for people with dementia. Offer water-rich snacks, like melon, cucumbers, high-protein broths, or calcium-fortified yogurts and smoothies throughout the day. Pre-made shakes, like Boost or Ensure, also provide nutritional support in liquid form.
- Use mirroring to encourage hydration. Mirroring is a common technique used to guide behaviors in people with dementia. While chatting with your loved one, take regular sips from your caffeine-free tea, and they’ll likely do the same.
- Make drinking breaks part of routine activities. In early and middle-stage dementia, many people can still enjoy activities like basic knitting or craft projects. Encourage set breaks for hydration during at-home dementia activities — for example, take a sip every time you finish a row in the scarf you’re knitting.
- Stay comfortable and cool. Maintaining body temperature is key in preventing dehydration in elderly with dementia, especially during warmer months. Since people experiencing cognitive decline often have trouble regulating internal temperature, it’s important to dress appropriately in loose-fitting clothing and keep the house cool.
- Provide their favorite drinks. Water may be the best option for hydration, but it isn’t the only one. Offering more flavorful options could make it easier to avoid dehydration in people with dementia. Sports drinks, flavored waters, and juice are all good options — avoid beverages with caffeine and alcohol, as they’re diuretics that increase urination.
Signs of dehydration in elderly people with dementia
Recognizing dehydration in dementia patients can be difficult, since many symptoms of elderly dehydration are behaviors commonly present in people with dementia, like disorientation, wandering, or fatigue throughout the day. Plus, seniors experiencing cognitive decline often have a harder time recognizing — or communicating — basic needs.
It’s important to have a baseline knowledge of your loved one’s behavior, to note any drastic changes. Keep these physical signs of dehydration in people with dementia in mind, and encourage regular water intake to avoid potential complications.
Early symptoms of dehydration include:
- Dry mouth
- Sunken eyes
- Decrease in urination (less than 4x/day)
- Dark urine (should be straw-colored or lighter)
- Muscle cramping
- Dizziness or lightheadedness
- Decreased skin elasticity
More serious signs of dehydration in elderly people with dementia include:
- Rapid heart rate
- More trouble with movement or walking than usual
- Increased disorientation or confusion
- Diarrhea or vomiting
- Urinary tract infections
What to do if dehydration in people with dementia persists
Chronic dehydration in people with dementia is a serious health risk. This is because dehydration and dementia are cyclical. Dementia makes it difficult for the body to regulate water balance; in turn, dehydration negatively affects cognitive performance, according to clinical studies by the School of Psychology and Clinical Language Sciences at the University of Reading.
Here are some additional ways to seek help if your loved one is struggling to stay hydrated:
- Talk to your loved one’s doctor. If dehydration symptoms persist despite increasing your relative’s liquid intake, talk to a doctor about how much fluid they need to consume each day to stay properly hydrated — it may be more than you expect.
- Consider other lifestyle adjustments. Maybe a change in medication could reduce dehydration, or your aging relative’s symptoms could be caused by a a vitamin or mineral deficiency, instead . Ask a doctor about any concerns, and remember to bring a list of all current medications.
- Look into hydration programs. Some memory care communities offer hydration programs to help reduce dehydration in dementia patients. Professional in-home care for dementia may use similar techniques.
If you’re concerned about managing your loved one’s dehydration and dementia at home, reach out to one of our free, local Senior Living Advisors. They’ll learn more about your family’s unique needs, and can recommend senior living or home care options that may work for you.
Banner Health. “Dehydration in Dementia Patients.” https://www.bannerhealth.com/staying-well/expert/dehydration-in-dementia-patients
Mayo Clinic. “Dehydration: Symptoms and Causes.” https://www.mayoclinic.org/diseases-conditions/dehydration/symptoms-causes/syc-20354086
National Institute on Aging. “Getting Enough Fluids.” https://www.nia.nih.gov/health/getting-enough-fluids
Nutrients. “Neurocognitive Disorders and Dehydration in Older Patients.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986442/
School of Psychology and Clinical Language Sciences, University of Reading. “Effects of Hydration Status on Cognitive Performance and Mood.” https://pubmed.ncbi.nlm.nih.gov/24480458/