Hydration Tips for those Living with Dementia

We understand that keeping the person you care for hydrated is challenging, in particular when you can't always be around to keep track. We have collated some tips from research and experts, and hope you find at least one helpful.

How much is enough?

Dehydration can take a few forms, where here we are focused here on low-intake of fluid, which is widespread in older people due to the reduced thirst response. The amount of water "experts" say we should have keeps increasing; but what's the truth? One strategy is (for the elderly) to drink 1.7 litres every 24 hours (1), and the Alzheimer's Society say 1.5 to 2 litres a day (or, 10 glasses / 10-12 cups) (2). However, this suggestion is generic, and according to the European Society for Clinical Nutrition and Metabolism (ESPEN) recommend that hydration strategies for those living with dementia is individualised (3).

Individualised hydration is commonly used by scientists supporting elite athletes, using tools such as an portable handheld device, however, this is time-consuming and not practical for use at home. A more simplistic method is to simply look at the toilet water after each visit, and to estimate hydration status based on the colour.

Taken from NHS South Tees Hospitals NHS Foundation Trust website (4)

This also has its difficulties, both technically, because the urine is diluted in an unknown volume of toilet water, making the estimated colour unknown, and depending on the stage of dementia, it's difficult to know if the person living with dementia will recognise the signs of dehydration and/or take appropriate action.

Our invention, Hydro Care (5), combines these approaches analysing the toilet water and providing hydration status feedback to the individual (via a screen) and/or to a carers personalised mobile phone application.

So, what can I do that will help?

Whilst an individualised approach is more challenging for assessing hydration status (until Hydro Care), there are lots of ways to promote drinking more including choosing a drinking vessel that the person living with dementia might prefer.

• The Size

  • It doesn't feel too overwhelming, e.g., that they're unable to finish.

  • It's not too heavy; providing a jug or glass they can easily lift without spilling.

• The Shape

  • Having handles on one or both sides of a drinking vessel.

  • Having a lid to maintain the temperature, which can be easily removed or replaced.

  • An internal cone-shape for the fluid helps with emptying the vessel without having to tip the head back.

  • A drinking spout can ensure more drinking and less spillage.

• The material

  • Non-slip material on the bottom to avoid spillages, and/or the handles making it easier to hold and manoeuver

  • Thermally insulated to maintain the desired temperature

  • A heat colour changing material, that indicates when the beverage is really hot and gradually changes as it gets cooler.

• The colour

  • A colour that is easy to spot, e.g., clear materials can make identifying the drinking vessel more challenging.

  • A colour that is easy to recognise, e.g., this is my drinking vessel for me to use.

• The design

  • Having a coloured material, but the liquid inside can also be seen, to identify how much has been drank

  • An attractive design that the individual living with dementia can be proud to have with them, and drink from, and doesn't compromise their dignity.

Taste and temperature can be altered for preference, profoundly affecting how much someone drinks. Simply, if they like drinking it, then they will drink more!

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"Roy’s family and the introduction of a flavoured drink to encourage the patient to drink. His weekly fluid intake doubled as a result and the intervention avoided the use of alternative invasive rehydration therapy" (6)

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Can eating food help?

It's not only drinking that can help. It's estimated that food accounts for 20-30% of daily fluid intake (7), so the type of food someone is provided and their ability to eat it will also positively affect hydration status. This is the principle behind foods like Jelly Drops; tasty bite sized treats that are sugar free and 95% water.

Water Content	Foods
90 - 99 %	Melon, strawberries, lettuce, cabbage, celery, spinach, pickles, squash (cooked)
80 - 89 %	Fruit juice, yoghurt, apples, grapes, oranges, carrots, broccoli (cooked), pears, pinapple
70 - 79 %	Bananas, avocados, cottage cheese, ricotta cheese, potato (baked), corn (cooked), shrimp
60 - 69 %	Pasta, legumes (soybeans, peanuts, fresh peas and beans, pulses - chickpeas, lentils, dried peas / beans), salmon, ice cream, chicken breast.
50 - 59 %	Ground beef, hot dogs, feta cheese, tender loin steak (cooked)
40 - 49 %	Pizza
30 - 39 %	Cheddar cheese, bagels, bread
20 - 29 %	Pepperoni sausage, cake, biscuits
10 - 19 %	Butter, margarine, raisins
1 - 9 %	Walnuts, peants (dry roasted), chocolate chip cookies, crackers, cereals, pretzels, taco shells, peant butter
0 %	Oils, sugars

Water content range for different types of food (8)

References

1. Schols, J.M.G.A., De Groot, C.P.G.M., Van Der Cammen, T.J.M. and Olde Rikkert, M.G.M., 2009. Preventing and treating dehydration in the elderly during periods of illness and warm weather. JNHA-The Journal of Nutrition, Health and Aging, 13, pp.150-157.

   
   

2. https://www.alzheimers.org.uk/get-support/daily-living/drinking-hydration

   [accessed 28 December 2024]

   
   

3. Volkert, D., Beck, A.M., Faxén-Irving, G., Frühwald, T., Hooper, L., Keller, H., Porter, J., Rothenberg, E., Suominen, M., Wirth, R. and Chourdakis, M., 2024. ESPEN guideline on nutrition and hydration in dementia–Update 2024. Clinical Nutrition, 43(6), pp.1599-1626.

   
   

4. https://www.southtees.nhs.uk/wp-content/uploads/2022/08/Urine-colour-chart.pdf

   [accessed 28 December 2024]

   
   

5. https://tess7912.wixsite.com/hydrocare/about-1

   [accessed 29 December 2024]

   
   

6. Beales, A., 2017. An innovative approach to hydration for a patient with dementia. Nursing Older People, 29(4).

   
   

7. Iversen, P.O. and Fogelholm, M., 2023. Fluid and water balance: a scoping review for the Nordic Nutrition Recommendations 2023. Food & Nutrition Research, 67.

   
   

8. Popkin, B.M., D'Anci, K.E. and Rosenberg, I.H., 2010. Water, hydration, and health. Nutrition reviews, 68(8), pp.439-458.