Spring has arrived in Florida. While the days are sunny and beautiful, they’re also warm, which means the heat index is rising. Do you know whether your residents are getting enough hydration? It doesn’t take much for someone who is young and healthy to get behind in her hydration intake. With elderly residents who are frail, it can happen even more quickly.
When you don’t drink enough water or other liquids, you can find yourself feeling thirsty by the end of the day. Often, we become busy taking care of our daily tasks and just forget to hydrate; it’s not that we’re purposely neglecting our bodies. With the heat in Florida, it can happen to the best of us. Unfortunately, it happened to me and caused a mild medical emergency. I had water in my cup, and it sat on my desk as the tasks of the day kept me out of the office. It can happen to you and your residents, even when your staff is making sure they have a full cup of fresh water in their room.
So, what is dehydration? Dehydration is a term used to describe an excessive loss of water which disrupts the body’s normal functions. Dehydration happens when an individual loses more fluids than they take in. The human body is constantly in a state of losing water. If fluids aren’t replaced, the body eventually does not have enough water available to perform normally.
Dehydration is one of the most common reasons for a resident to need hospitalization since they have a decreased sense of thirst after the age of 65. One issue affecting elderly dehydration can be related to the resident’s inability to voice his or her need for fluids or specific fluid preferences. Keep in mind that if a resident has dementia, they may regress to speak mostly their original language and cause even more limited communication.
The most common signs and symptoms of dehydration include persistent fatigue, lethargy, muscle weakness or cramps, headaches, dizziness, nausea, forgetfulness, confusion, deep rapid breathing, or an increased heart rate. Changes in a resident’s normal functioning in any of the above-mentioned ways could be from simply not taking in enough fluids.
Almost everyone gets about half their daily water requirement from solid foods and fruit and vegetable juices. However, seniors often have a reduced sense of thirst and a reduced appetite, so they are less likely to verbalize initial signs of dehydration. To lessen the chances of dehydration, consider fruits and vegetables like applesauce, apricots, asparagus (cooked), bananas, blackberries, blueberries, broccoli (cooked), cauliflower (cooked), cherries, grapes, raspberries and strawberries. These are easier for seniors to consume. Also remember that many foods naturally, or because of preparation, are part of fluid intake such as soups and ice cream.
In the assisted living setting, it is common for residents to go through adjustments related to moving into your facility. This transition might also be a risk factor for dehydration, as the resident may not want to speak up and tell staff her needs or desires.
Dehydration, in, most circumstances, can be prevented. So, what are some steps that can be taken?
Drinking the same liquid in the required amounts every day can be discouraging. Although it’s important to drink water on a regular basis, the body also benefits from the liquid in other water-based drinks and foods, like a glass of natural juice or a snack of watermelon wedges. The advantage of having a variety of liquids and water-based fruits and vegetables being provided is the increased motivation to eat or drink. Thus, it increases chances of staying hydrated.
One of the issues that can affect how much an elderly person consumes is the convenience of getting a drink. Keeping drinks nearby and access to a variety of fluids is important and will help staff with providing fluids. Having options available for the late evening and nighttime hours is part of that convenience for residents.
Reminders and counting down
It can be helpful to have a daily visible reminder for residents as to how much liquid he or she needs to consume every day (generally eight glasses per day). It also helps to mark down how much they have consumed and how much they have left to drink. If a resident is specifically at high risk for dehydration, ask the physician or home health nurse to teach the resident how much he or she should be consuming in a day and remind the resident to meet that need. Sometimes, encouraging residents to meet their set goals can keep them on track.
Avoiding fluids with caffeine
There are some common drinks which have caffeine and can increase the chance of dehydration in the elderly, as they cause the body to release more liquid. These include tea, coffee and caffeinated soft drinks. Replace caffeinated beverages with decaffeinated versions of the same products, or offer alternatives such as water infused with electrolytes or vitamin-rich juice mixes.
Address the fear of incontinence
As people age, it’s not uncommon to have weakened pelvic muscles and fear having ‘accidents’, especially at night. Helping the elderly feel comfortable will make drinking enough liquids a less stressful and potentially embarrassing process. Ensuring that the bulk of liquids are consumed earlier in the day, emphasizing the importance of using the bathroom before bed, and using incontinence-friendly undergarments are all ways to safeguard against accidents and help prevent dehydration in the elderly.
Prevention is possible. Preventing dehydration is not the same as overhydrating. Some residents have certain diagnosis and are on limited intake restrictions. It is not for the ALF staff to go against physician instructions and orders if a resident has restrictions but to help maintain basic hydration needs that all people have. Dehydration can occur very quickly with depression, dementia, loss of convenience, increased medication side effects and lack of initiation. Be the support your residents need. There is not a one-size-fits-all answer to dehydration prevention; however, focusing on frequent flavorful fluids can help you and your staff minimize the risk. Teach your staff to offer fluids as part of every interaction with your residents.