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Hydration and Delirium
By Catherine D’Aniello, MSN, RN
Did you know that:
Delirium is different from dementia?
Dehydration is a cause of delirium?
Older adults can avoid delirium by
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
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
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.