Sarah’s story – “Dementia UK was our saving grace”
Sarah reflects on reaching crisis point when her husband, David, was diagnosed with young onset dementia and the support her family have since received from Dementia UK.
People with dementia may not always recognise when they are thirsty or be able to express their thirst. This may mean that they do not drink enough, resulting in dehydration.
On this page, our dementia specialist Admiral Nurses explain the importance of good hydration and how to prevent dehydration in a person with dementia.
The link between dementia and dehydration
Dehydration is common in people with dementia. There are a range of reasons they may struggle with drinking enough – and if they are dehydrated, their dementia symptoms may appear worse. Even mild dehydration can make a person’s cognitive function fall by 10%, making them more confused.
Why might someone with dementia become dehydrated more easily?
People with dementia may be more prone to dehydration. Reasons include:
- forgetting to drink
- difficulty recognising and/or expressing that they are thirsty
- loss of interest in drinking due to low mood
- concentration issues that make finding the time to drink more challenging
- difficulty recognising drinks
- difficulty drinking independently, for example if their hand-eye coordination is affected
- changes in taste – perhaps preferring sweeter or stronger tastes
- mouth problems that cause discomfort when they drink, for example tooth decay, ill-fitting dentures, oral thrush or mouth ulcers
- difficulty swallowing
Signs of dehydration in people living with dementia
The symptoms of dehydration will depend on the severity, so it’s important to know what to look out for.
Signs of mild to moderate dehydration
Signs of mild to moderate hydration include:
- 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- appearing vacant, sleepy or withdrawn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 yellow 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 – intense, often sudden confusion
- extreme thirst
- rapid breathing
- rapid heartbeat
- low blood pressure (this may not be obvious unless checked, although the person may feel dizzy when standing up)
- severe dizziness/lightheadedness
- not urinating or passing very dark urine in small amounts
- altered state of consciousness
How to distinguish symptoms of dehydration from the broader symptoms of dementia
It can be hard to tell whether a person with dementia is dehydrated, not least because they may not be able to identify or express that they are thirsty. In addition, many of the symptoms of dementia and dehydration – such as confusion and mood changes – can overlap.
However, if you notice any of the signs and symptoms above, or if the person’s dementia seems to have worsened suddenly, try to encourage them to increase their fluids using the steps below. If there is no improvement, please consult a medical professional.
General guidance for keeping someone with dementia hydrated
Everyone will experience dementia differently, so finding ways to keep the person hydrated is likely to involve some trial and error. However, you might like to try these tips:
- Allow the person time to drink without rushing
- Sit and have a drink with them
- Ensure the person is sitting upright and comfortably
- Mime taking a drink or using pictures to prompt them
- Use the person’s favourite cup or mug
- Offer different sizes and shapes of cup to see if they have a preference – brightly coloured cups or mugs may capture their attention
- A clear glass may help by allowing the person to see what’s inside, although some people struggle to see water in a clear glass
- Check that their cup or glass is not too heavy or a difficult shape to grasp
- If the person is struggling to pick up or drink from a cup, help them – but do encourage them to be as independent as possible
- Some people find it easier to drink through a straw
- Offer the person their cup in their line of sight, and describe the drink to them
- Ensure the person always has a drink within easy reach
- Try offer different kinds of drinks
- Keep the cup topped up so it’s easy to drink from and the person can see that it’s full
- Some people find it easier to take small but frequent sips than drink a full glass
- Use reminders – for example on the person’s phone or a smart device – to prompt them to drink
- Ask carers to offer drinks at the start and end of visits
- Offer a drink whenever anyone visits – drinking is a sociable activity
- See if the person can attend a memory café, day centre or lunch club – they may follow other people’s lead if they see them drinking, and be more willing to take direction from a staff member or volunteer
- Look out for any potential underlying problems, such as pain, depression or an infection, that could be affecting the person’s ability to drink – if in doubt, contact their GP
- If you are measuring fluid intake, pour drinks from a jug so that you can monitor how much has gone at the end of the day, or give the person a water bottle with measurement marks to drink from so they can keep track of how much they have consumed
- Consider joining a carers’ support group to share experiences and tips with others in similar situations
What to offer someone with dementia to keep them hydrated
Helping a person with dementia stay hydrated often depends on finding a drink that they enjoy.
- All fluids count (except alcohol), so try a range of different drinks – water, flavoured water, tea, coffee, hot chocolate, milk, fruit juice and squash
- Water temperature can have a huge impact on how appealing a drink is. Some people prefer an ice-cold drink, while others would rather have a warm drink, but bear in mind that very hot or cold drinks may be unappealing to some people
- Try offering stronger flavours, like a less diluted squash
- Consider what drinks the person enjoyed in the past and offer those
- People with dementia may have changes in tastes – they may develop a preference for sweet drinks, or unusual combinations of flavours
- Fluid intake can come from food, too – for example jelly, soup, ice lollies, yoghurt, custard, watermelon, pineapple, cucumber, pears, and even jacket potatoes contain fluid
What to do if someone is refusing food or water
Never force a person with dementia to eat or drink as this can cause distress and pose risks, such as choking. Try to keep calm and use the tips above – you may need to try different strategies before finding the ones that work. If either of you is becoming frustrated or distressed, stop and try again later.
If the person with dementia consistently refuses fluids, speak to their GP to rule out any medical issues and explore options for extra support – for example, a referral to a speech and language therapist if the person has difficulty swallowing.
Be aware that as a person nears the end of life, it is likely that they will naturally become less interested in food and drink. Please see ‘Hydration at the end of life’, below.
Hydration sweets and gummies
Jelly Drops are sweets that are designed to improve hydration for people with dementia who struggle to drink. They are 95% water and also contain electrolytes and vitamins to help with hydration and nutrition. They are designed to have an appealing flavour and texture to make them enjoyable and easy to eat.
Managing swallowing difficulties
If the person with dementia has problems with swallowing, for example choking on food or fluids or coughing as if their drink has ‘gone down the wrong way’, contact their GP. They may refer the person to a speech and language therapist, especially if there are safety concerns around choking.
Hydration at the end of life
As a person with dementia nears the end of their life, their body no longer has the same need for food and drink. They may have less interest in food and drink and eventually stop eating and drinking completely.
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 rather than hydration.
- 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 can 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
While this is an upsetting stage for carers, it’s a natural part of the dying process. You can ask the person’s GP or district nurse for support to keep the person comfortable, for example from a Palliative Care Team.
Read more about recognising the end of life.
Sources of support
To speak to a dementia specialist Admiral Nurse about hydration or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December) or email helpline@dementiauk.org. Alternatively, you can pre-book a phone or video call with an Admiral Nurse.
Dementia UK resources
- Delirium (sudden confusion)
- Healthy eating and drinking for a person with dementia
- Oral health and mouth care for people with dementia
- Recognising the final stages of dementia
- Tips for better communication
- Understanding dying
Other resources
- Urine colour chart – to identify signs of dehydration
- Bristol stool chart – to identify signs of constipation
- Swallowing problems and dementia
- NHS guide to dehydration
Book an appointment with an Admiral Nurse
Our virtual clinics give you the chance to discuss any questions or concerns with a dementia specialist Admiral Nurse by phone or video call, at a time that suits you.
