Good hydration for a person with dementia

• affect their cognitive function – eg making them more confused
• make their urine more concentrated, irritating the bladder and causing/worsening incontinence
• increase the risk of falls
• make any medication less effective

• forget to drink
• have difficulty recognising and/or expressing that they are thirsty
• lose interest in drinking due to low mood
• have concentration issues that make finding the time to drink more challenging
• have difficulty recognising drinks
• have difficulty drinking independently, e.g., because of impaired co-ordination
• experience changes in taste – perhaps preferring sweeter or stronger tastes
• have mouth problems that cause discomfort when they drink, e.g., tooth decay, ill-fitting dentures, oral thrush or mouth ulcers
• have difficulty swallowing

Signs of mild to moderate dehydration

• increased confusion
• agitation
• appearing vacant, sleepy or withdrawn
• mood changes
• headache
• increased thirst – but be aware that the person may not recognise or be able to communicate this
• dry mouth and lips
• bad breath
• fatigue
• dizziness/lightheadedness
• infrequent urination/dark urine
• constipation
• dry or shriveled skin or skin that has lost its elasticity
• sunken eyes
• muscle cramps

If any of these symptoms occur, you can try the tips below. If they do not improve, contact the person’s GP or phone NHS 111 for advice.

Signs of severe dehydration

If the person has any of these signs of severe dehydration, they may need immediate treatment. You should request an urgent GP appointment, take them to A&E or call 999 for an ambulance.

• delirium – extreme, often sudden confusion
• extreme thirst
• rapid breathing
• rapid heartbeat
• low blood pressure
• severe dizziness/lightheadedness
• not urinating or passing very dark urine in small amounts
• altered state of consciousness

• Allow the person time to drink without rushing
• Sit and have a drink with them
• Ensure the person is sitting upright and comfortably
• Try miming taking a drink or using pictures to prompt them. See Sources of support below for more communication tips
• If carers are coming in, ask them to offer drinks at the start and end of visits
• Offer a drink whenever anyone visits – drinking is a sociable activity
• Attending a memory café, day centre or lunch club may encourage the person to drink – they may imitate what other people are doing, and be more willing to take direction from a staff member or volunteer
• Consider if there are any underlying problems, such as pain, depression or an infection – if in doubt, contact their GP
• Join a carers’ support group to share experiences and tips
• If the person has difficulty swallowing, ask their GP for a referral to a dietician

• Try a range of different drinks – water, tea, coffee, hot chocolate, milk, fruit juice and squash
• Try different temperatures to see if they prefer a cold or warm drink
• Try offering stronger or sweeter flavours, like a less diluted squash
• Fluid intake can come from food, too, such as jelly, soup, yoghurt, custard, watermelon, pineapple, cucumber, pears, and even jacket potatoes
• Avoid alcohol – low- and zero-alcohol wine, beer and spirits are widely available. If necessary, a healthcare professional can help you formulate a plan for reducing/cutting out alcohol

• Offer the person their favourite mug, glass or beaker
• Offer different sizes and shapes of cup to see if they have a preference
• Try a clear glass so they can see what’s inside, or colourful cups to attract their attention
• Offer help if the person is struggling to pick up or drink from a cup
• Ensure they always have a drink within reach
• Check that their cup or glass isn’t too heavy or a difficult shape to grasp
• Describe the drink you are offering
• Keep the cup topped up so they can see it’s full and it’s easy to drink from
• If you’re measuring fluid intake, pour drinks from a jug so you can monitor how much the person has drunk

If, despite trying these tips, the person with dementia is not drinking enough – or at all – speak to their GP for advice.

Giving fluids through a drip or feeding tube can cause distress, so at this stage, it is often better to focus on offering drinks for comfort and enjoyment.

• If the person’s mouth is dry, you can wet their lips with a damp sponge or a baby toothbrush – you could dip the toothbrush or sponge into a drink that they enjoy
• Offer small sips of fluid if the person is able to swallow
• Try putting ice chips inside a clean cotton handkerchief for them to suck on
• If they like having their teeth or dentures cleaned, you can help them using a separate baby toothbrush and baby/mild/non-foaming toothpaste
• If their lips are dry, you can apply lip balm or Vaseline sparingly

Dementia UK resources

• Healthy eating and drinking for a person with dementia
• Mouth care for people with dementia
• Tips for better communication
• Delirium (sudden confusion)
• Understanding dying
• Recognising the final stages of dementia

Other resources

• Urine colour chart
• Bristol stool chart
• Swallowing problems and dementia
• NHS guide to dehydration