Monitoring Hydration in Dementia Care: Why It Matters and How to Help

Staying hydrated is essential for overall health and well-being, but for people living with dementia, drinking enough fluids can become a challenge. Changes in memory, perception, and swallowing ability can all contribute to dehydration, which can lead to serious health complications.

In this blog post, we’ll explore why hydration is particularly important for people with dementia, the risks of dehydration, and practical strategies to help ensure they get enough fluids throughout the day.

Why Hydration is Crucial in Dementia Care

Water makes up around 60% of the human body and is essential for:

• Brain function – Supporting cognitive processes such as memory, attention, and problem-solving.
• Body temperature regulation – Preventing overheating or excessive cooling.
• Digestion and circulation – Keeping the digestive system functioning and helping nutrients and oxygen reach cells.
• Joint and muscle health – Reducing stiffness and improving mobility.

In dementia care, dehydration can worsen confusion, increase the risk of falls, and lead to hospitalisation if not addressed.

Why Do People with Dementia Struggle with Hydration?

As dementia progresses, individuals may experience several challenges that affect their ability or willingness to drink:

1. Forgetting to Drink

• People with dementia may not recognise thirst or simply forget to drink throughout the day.
• They may also forget where drinks are placed or how to drink from a glass or cup.

2. Changes in Perception and Sensory Awareness

• Visual and spatial perception issues can make it difficult for a person to spot a clear glass of water, especially if it blends into the background.
• They may not associate a glass or cup with the action of drinking.

3. Swallowing Difficulties (Dysphagia)

• Some individuals with dementia develop dysphagia, a condition where swallowing becomes difficult, increasing the risk of choking.
• They may avoid drinking because it feels uncomfortable or unsafe.

4. Reduced Mobility and Physical Barriers

• If a person struggles to move independently, they may not be able to reach drinks easily.
• Conditions such as arthritis can make holding a cup difficult.

5. Medication Side Effects

• Some medications prescribed for dementia and other conditions can have diuretic effects, increasing urine production and the risk of dehydration.
• Other medications may cause a dry mouth, making drinking less comfortable.

6. Communication Difficulties

• A person may be thirsty but unable to express their need for a drink.
• They may also struggle to ask for help if they can’t access fluids themselves.

Signs of Dehydration in People with Dementia

Dehydration can happen gradually or quickly, so it’s important to recognise the early signs:

• Increased confusion or agitation
• Dizziness, weakness, or increased risk of falls
• Dry mouth, lips, or sunken eyes
• Dark-coloured urine or reduced urine output
• Constipation
• Headaches
• Sleepiness or extreme tiredness

Severe dehydration can lead to urinary tract infections (UTIs), kidney problems, and hospitalisation, so early intervention is essential.

Practical Strategies to Encourage Hydration

1. Offer Fluids Regularly

• Don’t wait for the person to say they are thirsty—offer drinks at regular intervals.
• Create a hydration schedule to ensure they are drinking throughout the day.

2. Use Clear, Visible Cups or Mugs

• Choose a brightly coloured cup (e.g., red or blue) to contrast with the table or surroundings.
• Avoid clear glasses if they blend into the background.

3. Make Drinking Easy

• Offer easy-to-hold cups with large handles or non-slip grips.
• Use straws or lidded cups if the person struggles to hold a cup steadily.

4. Provide a Variety of Drinks

• If the person refuses water, offer juice, milk, herbal tea, diluted squash, or flavoured water.
• Carbonated drinks or warm beverages may be preferred over plain water.

5. Include Hydrating Foods

Not all fluids need to come from drinks. Hydrating foods include:

• Soup and broths
• Water-rich fruits (melon, oranges, grapes, strawberries)
• Yoghurt and custards
• Jelly and ice lollies
• Smoothies or milkshakes

6. Support Safe Drinking for Those with Dysphagia

• If the person has difficulty swallowing, seek advice from a Speech and Language Therapist (SLT).
• Thickened drinks may be recommended to prevent choking.
• Avoid drinks that are too thin and may cause coughing or aspiration (e.g., water, tea, coffee).

7. Make Drinking Part of Routine Activities

• Encourage hydration during mealtimes, social activities, or when taking medication.
• Offer a drink with TV programmes, music sessions, or reading time.

8. Keep Fluids Within Easy Reach

• Ensure there is always a drink nearby, especially at the bedside at night.
• Use non-spill bottles if the person carries drinks around.

9. Use Positive Encouragement

• If the person refuses to drink, try a gentle, reassuring approach rather than forcing it.
• Offer small sips at a time instead of a full glass.
• Sit together and drink with them—they may be more likely to drink if they see someone else doing it.

When to Seek Medical Help

If you suspect dehydration, take action quickly. Seek medical support if the person:

• Appears disoriented or unusually drowsy
• Has a dry, sticky mouth and refuses fluids
• Has stopped urinating or has dark-coloured urine
• Shows signs of severe dehydration, such as sunken eyes or confusion

In some cases, hospital treatment with intravenous (IV) fluids may be needed.

Final Thoughts

Staying hydrated is essential for the health and well-being of people living with dementia. Since they may not always recognise their thirst or ask for a drink, carers play a vital role in ensuring they receive enough fluids throughout the day. By making drinks more accessible, offering a variety of fluids, and creating a positive drinking routine, you can help reduce the risk of dehydration and its associated complications.

If you are concerned about dehydration, don’t hesitate to seek professional advice from a GP, dietitian, or Speech and Language Therapist. Small changes can make a big difference in keeping someone safe, comfortable, and hydrated.

Sources

1. Dementia UK. (2023). “Hydration and Dementia”. Available here
2. Alzheimer’s Society. (2023). “Drinking and Dementia”. Available here
3. NHS. (2023). “Dehydration in Older Adults”. Available here
4. Royal College of Speech and Language Therapists. (2023). “Dysphagia Management in Dementia”. Available here