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Hydration and Delirium

By Catherine D’Aniello, MSN, RN

(Page 1 of 2)

Did you know that:

  • Delirium is different from dementia?

  • Dehydration is a cause of delirium?

  • Older adults can avoid delirium by staying hydrated?

Delirium is a mental disturbance characterized by new or worsening confusion, changes in level of consciousness or hallucinations. Delirium is different from the slow progression of dementia or Alzheimer’s disease. It has a sudden onset from hours to days and although delirium can be reversed, it is easier to prevent than cure.

All “elderly” adults (people over 65 years old) are at risk for delirium due to factors involving their own internal weakness and environmental insults. Some risk factors, such as advanced age or having dementia, are fixed. Other risk factors such as pain, malnutrition, dehydration, sensory loss, depression and fever are modifiable with intervention. With each factor present, delirium risk increases. Therefore, the key to preventing delirium is reducing the number of modifiable risk factors.

Infection and dehydration are common modifiable delirium risk factors. Older adults usually know when they have an infection, but do not recognize when they are dehydrated.

Mental status changes begin with mild dehydration and worsen with each stage, ending in delirium. In moderate dehydration, short-term memory loss occurs.

Once an older person is thirsty, they are already mildly dehydrated. Symptoms of severe dehydration include dry mouth and lips, sunken eyes, increased mental status changes and decreased urine output. This is a medical emergency which results in delirium and if not reversed, death ensues.

Failure to recognize signs of dehydration predisposes older adults to becoming increasingly and chronically dehydrated, which is a slippery slope towards delirium. Closing this knowledge gap will reduce delirium risk because inadequate fluid intake is relatively easy to remedy.

Why are older adults prone to dehydration?

Generationally, older adults are not focused on hydration. Many seniors purposely limit fluid intake because they fear bladder accidents. Others with compromised mobility may curb fluid intake to avoid extra bathroom trips. Poor access to fluids or needing help to drink may limit intake. Many drink water only when taking medication. Living in over-heated indoor spaces dehydrates even without sweating.

Older adults have decreased muscle mass and increased fat; because 75 percent of body water is stored in muscle, seniors have less capacity to store water. Women have more body fat than men at any age, so older women are at even higher risk of dehydration. Due to decreased kidney function, older adults cannot conserve fluids as well as younger people.

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