*Need to know - Confusion in over 60s*

My mum, lives in a care home for dementia residents, does not drink enough as she refuses water or juice so her fluid intake is very carefully monitored. When I visited on Boxing Day, they were a bit concerned that she was getting dehydrated as her lips were cracked so she was on the list to see the District Nurse. The care she gets is exemplary.

While I was there they were giving all the residents a treat - baileys coffee with marshmallows and cream! My mum does not like milk or coffee but by golly, she did not take long to drain her glass! The staff were amazed and thrilled so maybe they will make her another one soon!

My aunt is 84 and is always telling me she forgets to drink water. I am always encouraging her, I have said to have a jug of water/squash by the sink and to try and drink it during the day. She's very reluctant to 'being told what to do' unfortunately.

I just keep a glass of tap water on the coffee table rather than bottled stuff , I am lucky in that our tap water is very palatable , seeing the glass reminds me to have a drink , and to refill it means I move from the chair , which is important too

Not good to buy water EV because of the single use plastic. Could you refill the bottles you have with tap water?

Another very important thing is to try to eliminate sugars from the diet, sugar is very toxic and addictive, we don’t need it. Low carb and sugar free diets reduce insulin spikes. I have noticed that care homes push a lot of carbohydrates and sugary food onto their residents and it is supposed to be a nutritional diet! They also do not always monitor fluid intake enough! Drink plenty of water too in addition to other drinks and foods containing water. Reduce alcohol consumption, this is dehydrating and contains too much sugar. All of these help to maintain a clear and sharp mind. Elderly people don’t like to drink more as it can be a struggle to keep on going to the loo! My dear parents were the same, but low fluid intake can lead to confusion and giddiness and sometimes then hospital admissions to up fluid intake.

Glad to say I’ve never had a problem with not drinking enough - rather the reverse.

DH, OTOH…. He just doesn’t seem to have a ‘thirst’ indicator. Twice in the past few years he’s had health problems very largely down to not drinking enough - nothing too serious, thank goodness.

I used to tell him he didn’t drink enough but of course he took absolutely no notice - until medics told him the same in very strong terms. He does make a point of drinking considerably more now.

we are like plants and need frequently 'watering'

I'm guilty of not drinking enough liquid at times, especially in winter, and especially if I'm busy, like in the run up to Christmas. One of my sons noticed that I seemed extra vague on Boxing day and suggested that I have a big drink of water.
So I did, but added orange squash to it. It did seem to help.
I must drink more... so this is my new year resolution.

I started getting packs of a dozen small bottles of water with my Asda delivery and it does make a huge difference. I put one in front of me on the coffee table so that I don't forget to drink it. I have one of those per day along with the usual teas coffees and hot chocolate. It's so handy to know they're at hand. A squeeze of lemon or lime juice adds a bit of taste.

It is important in many ways to keep hydrated in order to keep well. You can go without food for a length of time, but not water.

This thread amused me. I was in hospital recently. I had a plethora of staff, asking me if I had memory loss etc. I was very unwell, but could not function as normal. They eventually told me I had an infection in my blood, and a worse infection in my bladder. After antibiotics I regained my brain with no confusion anymore. Fairly obs that infections can cause confusion in the over 60s. Searching for infections should be first event, before looking for dementia etc.

I have just got myself into the habit of having drinks at regular intervals during the day: first thing, mid morning, after lunch, mid afternoon, supper time and before I go to bed.

if I miss one for any reason, I make up for it later in the day. I also like my food 'wet'. lots of stews and casseroles, soups, fruit and vegetables.

I drink everything, tea, coffee, fruit tea, water. It is habit now. If I miss a drink I notice.

Agnurse, I wish it were possible for annual checks to take place. My husband is on multiple medications, principally for diabetes and angina, and is concerned that he has missed his checks, but our GP practice have stopped doing them because of Covid.

Can I just issue one word of warning about hydration. People can get slightly the wrong take on advice as to how much fluid they should drink each 24 hours, with disastrous results.

My former best friend, who was a total fitness freak and hypochondriac, came to visit me one morning for the day. She looked unwell on arrival, and seemed to worsen over the next hour. Eventually, I got out of her the fact that she had listened to a programme about drinking five litres of water a day, and had therefore done so in one go, soon after she got out of bed.
She was so unwell, and I knew that there were real inherent dangers to her internal organs from having taken in so much fluid so quickly. Eventually, I did take her to our local A&E for them to check her over, and they did keep her in for a few hours for observation.

Yup, dehydration, electrolyte imbalances, and infection can absolutely cause confusion in older people.

As far as dehydration - the thirst mechanism decreases with aging, so it is not uncommon for older people to become at least mildly dehydrated. I agree with looking to have a glass of fluid with every meal.

One of the key indicators of confusion indicating a delirium rather than dementia is that the confusion has a rapid onset and it fluctuates - the person will have periods of lucidity and periods of confusion. They may become aggressive and loud, or very lethargic. These are indicators that they need to be checked out. Addressing the underlying cause usually fixes the confusion.

Confusion associated with dementia or depression is usually a gradual onset and a long-standing issue. The person slowly declines over time, rather than a sudden acute decline. One thing to keep in mind - some medications can contribute to confusion. Every older person taking multiple medications should ideally have a structured medication review at least once a year. This means the clinician makes a list of all the patient's diagnoses and matches them to prescribed medications. This is valuable for determining if multiple medications are being used for the same condition (depending on the medications and the condition, not all of them may be necessary), identifying medications that may not be appropriate for older people (there is an excellent resource called the Beers list that gives examples of these medications), and identifying "orphan drugs" - medications the patient is taking for which there is no clinical indication. ALL medications, even over the counter ones, NEED to be mentioned to one's provider to ensure there are no interactions.

When I go out for the day, especially if I am driving, I'm very thirsty when I get home. Perhaps I don't drink much for worries about finding a loo.
Thanks to this thread I WILL TRY HARDER

No apologies necessary PippaZ threads go whichever way gransnetters want.
If even one person benefits e.g. recognises that an older person might simply be suffering from dehydration and acts accordingly then I am content.

Esspee I am really sorry if I have messed up what was a really useful thread. I, like most people I imagine, do not like being "reprimanded". I don't mind someone pointing out the factual errors in my post - but the criticism made assumptions about what I was saying that were just not true.

We may be looking after the old and frail but we are all, ourselves, getting older and getting into an easy habit might save some of the worry for those who may have to look after us later. Your post was raising such a good point so I appologise again

I posted this as I tend to drink far less than the recommended amount and notice that friends do the same. It has made me want to try harder to consciously drink more.

greenlady102

PippaZ

greenlady102

PippaZ

I was listening to a recent R4 programme about the little things we can do each day to help our health. They suggested a glass of water with each meal would help. That is much easier to do and to suggest to older relatives than a certain amount. It needs to be water though, not juices, etc.

Not true. As ex NHS clinician, I can confirm that any non alcoholic liquid hydrates, also juicy fruit or liquidy food like soup or custard will assist too.
Yes I know that coffee and tea are said to be duiretic but the effect is not enough to overcome their hydrating effect. The best non alcoholic drink for anyone is the one that they will drink in sufficient quantity.
If the person on R4 specifically ruled out all watery drinks except actual water then this needs challenging.
One cause of limiting fluid that hasn't been mentioned in "good to know" is a concern about incontinence or needing to use the loo during the night. This can be exacerbated if the person is taking diuretics. Juggling the timing of diuretics can help, also getting proper advice about managing incontinence, but this should NEVER include limiting fluids or going the "no fluids after xxx time" route.

You opinion Green Lady. This is the programme www.bbc.co.uk/sounds/play/m0010wl7

It's presented by Dr Michael Mosley and includes information about mild dehydration and cognative imparement which some may find interesting. It's a very referenced programme and dispels some myths. He consults Stuart Galloway, who is Professor of Exercise Physiology at Stirling University.

I agree that rehydration doesn't necessarily have to be from water. The point of the programmes however is the simplicity of suggesting "Just one thing" you can do daily that will help you. Obviously, you can have other sources of rehydration but this is talking about making these things easy - so it suggests a glass of water (and only water) with each meal.

here's a piece based on research, not opinion, also published by the beeb. www.bbc.com/future/article/20140402-are-coffee-and-tea-dehydrating

I disagree with the "only water" thing because the best dehydration preventer is the one that people will actually drink or eat....and pub med, who are the gold standard for research, agree that tea and coffee do not contribute to dehydration....this will probably really upset him, but Michale Moseley is wrong. pubmed.ncbi.nlm.nih.gov/19774754/

It's not something to agree or disagree with; just a pleasant bit of Radio4. The programmes aren't aimed at people who had been hospitalised, just your ordinary you or me.

It wasn't about "water only" all the time as a way of rehydrating but to give people an easy to remember routine that will do them no harm and may well do a little good. No one was forcing the ordinary person who was listening. It was something they could decide to do, or not. It was all in the programme if you listen to even a little of it and I had explained.

Well done for being an ex NHS clinician. I am sure we all feel indebted. I am not an ex clinician. However, the people who made the programme knew their subject.

I just liked the programme. It made me feel it would be easy for me to do a little something that would not do me harm and might help a little. I shared it because I thought others might find it useful. If I had known someone would feel their "expert" toes were being trodden on I wouldn't have bothered.

I took my car to the garage today. Although I’m over sixty, they failed to offer me a drink of water.

ninathenana

Sorry I think that should read early dementia not alzheimers there are several types of dementia

You are right ninathenana, dementia would have been more accurate. Thank you.

I’ve heard before of people saying that plain water only is good,but it’s not true, and even if it was, what if people just won’t drink it?

In my mother’s dementia-only care home, whereUTIs were a particular risk because of incontinence, they were offered small glasses of weak orange or black currant squash frequently throughout the day, in addition to tea or coffee at certain times. Most of them simply wouldn’t drink plain water. My mother
hardly ever would, even before she had dementia.

Meals usually included something with a lot of fluid, such as soup, stewed or tinned fruit and custard,or jelly and ice cream.

i heard that programme.
the thing that bothered me was that i thought it is better to drink between meals, rather than with them, as it dilutes the digestive juices, so may lead to indigestion ?
but agree it's generally to drink more, almost anything, not alcohol, and avoid soda/pop.

Thank you for opening this E, both informative and interesting. Think I do okay on the fluid intake but will slightly up my water after this. Cheers!

I have witnessed lack of fluids and how it can affect someone because of our elderly relatives. It’s very useful information thanks for passing it on.