Caregiver to Caregiver

My friend, who serves as her mom’s caregiver, called one afternoon because her mom didn’t seem “just right.” Her blood pressure was higher than normal, her urine was dark yellow and she had just started complaining of a headache, something she seldom experienced. My first question was, “What has she had to eat and drink today?”

The reply: “Hardly anything; she balks at almost everything I offer her.”

“Gently pinch the skin on the back of her hand; when you let go, notice how quickly the skin returns to normal.”

“Uh, it just kind of stays put.”

“Sounds as if she may be dehydrated; you need to get some fluids in her – whatever she will take. And if her symptoms get worse, call her doctor.

That evening the phone rang. After numerous lemon popsicles and “a lot of iced tea” – two treats usually forbidden because of diabetes, my friend’s mom was feeling much better and her blood pressure was within normal limits.

Dehydration is a frequent problem in elderly adults, and caregivers should be aware of the causes, symptoms and treatments.

Dehydration is our body’s response to losing more water than we consume. Because as we age our body’s signaling mechanisms slow down, older people may not be cognizant of thirst. Seniors who have limited mobility or are unable to wait on themselves may hesitate to ask others to help them get a drink of water – something they may perceive as a bother.

Certain medications, such as diuretics, increase urination which requires that more fluids be taken in. Illnesses such as kidney disease or diabetes that are not controlled may increase the risk of dehydration. 

It is especially important for caregivers of those with dementia to monitor liquids and make sure the input is consistent with the output. 

The first clue that my friend’s mother may be dehydrated was the elevated blood pressure. Even mild dehydration can make your blood thicker and your vessel walls constrict, resulting in hypertension. 

Symptoms will differ and may not be easy to recognize. Checking skin elasticity by pinching (you can also do this on the stomach and chest, just below the collarbone) is a quick and easy test but may not always be accurate. Signs and symptoms to look for include unusual tiredness, complaints of feeling dizzy, muscle cramps, headache, sunken eyes, dry or sticky mouth (you can often hear a “smacking” sound), bad breath and lower than normal urine output or urine that is dark yellow.  

If dehydration become severe, urine may turn a deep amber or stop altogether. Pulse and respiration rates may increase outside normal limits, and sleepiness, irritability and confusion may occur. These would indicate notifying the health care provider immediately. 

Along with most life situations, prevention is easier than a cure, so here are some suggestions for encouraging you loved ones to stay well-hydrated.

• Make sure water is always available so your recipient does not have to ask. Keep a container (whatever works best) within reach whether they are in bed are sitting in a chair and refill as needed. (Think hospital service.)
• Give gentle reminders throughout the day that drinking plenty of water (or other beverages) will help his/her body feel better and run smoothly: because your cells are made of and surrounded by water, being well hydrated causes your body to perform better. Even your joints benefit as the lubrication makes it easier to move. Muscles also work better. Another important consideration, especially for seniors, is that drinking plenty of water can help prevent constipation.
• The most common recommendation for daily amount of water is 6 – 8 eight-ounce glasses. Sometimes this seems like a lot so it may help to have a schedule: one glass when you first get up; one glass with breakfast; one mid-morning; one at lunch; one mid-afternoon; one with dinner; one at bedtime – and anytime you feel thirsty, such as after activity.
• Discovering that water is indeed the beverage of champions has helped me improve my overall nutrition and I have shared this idea with my grandkids. I used to serve lots of sugared drinks, but hardly ever do now. Water is best and I am happy to report that the grandkids seem to be accepting this fact. However, if your loved one balks at so much water, change things up with flavored waters, less-sweetened iced tea (I know few Southerners who are willing to give up all the sugar with their tea – or should I say tea with their sugar?) or occasionally a soda. Try adding lemon or lime slices to a glass of water; it may provide just enough flavor to encourage more consumption. Even though a serving of Coke has 10 teaspoons of sugar, it still may be healthier than one with artificial sweeteners – not that either should be considered a healthy beverage. Water is so good for you and has no negative side effects (such as coffee and tea which increase urination). If you have any concerns about the amount of fluids your recipient needs daily, ask his doctor. Some illnesses and or medications indicate restrictions.
• Do not forget to include high water content foods in your daily meal plan. These include fruits and vegetables, soups, gelatins, and popsicles. 
• Join the other 95% of the population and carry a water bottle when you go out. The more active your loved one is, the more water he will need. 
• An easy way to monitor hydration is to check urine color on a regular basis, aiming for a pale yellow and taking action when it is dark or amber.

Anyone can experience dehydration when their body takes in less water than it needs. Elderly folk are especially vulnerable, and every caregiver should know how to guard against this condition. When you take in an adequate amount of water, your entire body functions better. Here’s to the beverage of champions!

Caring Tip: After writing the above, I came across this information about wearing masks and dehydration:

While wearing a mask does not cause dehydration, you may drink less water when you are wearing one. It is important to take breaks, remove the mask (observing social distancing guidelines) and drink plenty of water, especially if you begin to feel fatigued or dizzy. Wearing a wet mask may make breathing difficult, so always keep your mask dry.