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.
How do you know if you are drinking enough?
An older adult, their home caregiver or family member
can take simple steps daily to check hydration status.
First, thirst should not be experienced at any time.
Second, urine should be colorless or straw colored, and
odorless. Being familiar with a urine color chart is
good practice for all ages and critical for older adults
to avoid dehydration. First morning urine should not be
dark, and urination should occur every two to four hours
during waking hours. Some medications and foods such as
asparagus give urine an odor, but normally urine should
Increase daily fluid intake, especially water!
At least half of your daily fluids should be water.
Water significantly reduces older adults’ risk of
becoming delirious. Milk, vegetable or fruit juice, and
soup are also healthy fluid choices. Carbonated and
caffeinated drinks should be limited due to their
diuretic effect. The body needs water to filter
alcoholic beverages from the body. Therefore, increased
water consumption is needed overall as well as to
balance the dehydrating effects of unhealthy drinks.
Drinking healthy fluids is as important as eating
Family members and home caregivers should:
Educate older adults on dehydration risks
Encourage/remind seniors to drink
Teach loved ones not to wait to feel thirsty to drink
Teach loved ones to drink regularly throughout the day
Make fluids easily accessible
Serve fluids at a temperature the individual prefers
Encourage water with ALL meals
Boost the flavor of water by adding drops of lemon/ lime
Limit fluid intake one to three hours before bed
Offer popsicles, juice, gelatin, Italian ice, sherbet
to those who dislike water.
Increased awareness of dehydration as a cause of
confusion and delirium should begin when older adults
are “young-old” (65-74 years) in order to form healthy
drinking habits carrying them into “middle-old” (75-84
years) and “old-old” (85 years and above). Family should
report poor eating or drinking to the primary care
provider so interventions can be initiated to prevent
dehydration and its consequences. Educate your older
family members and their caregivers on the importance of
hydration and ways to facilitate good fluid intake.
Why not reduce your or an older loved one’s chance of
developing delirium by eliminating the dehydration risk
Catherine D’Aniello holds a BSN from University of
Connecticut and MSN from University of Hartford. She has
30 years of geriatric experience and is currently a
Resident Care Coordinator at a skilled nursing facility.
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