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We are in and out of the hospital with multiple issues mostly stemming from the lack of wanting to drink. UTIs, pneumonia, dehydration, falls from dehydration, low blood pressure issues stemming from dehydration.
The assisted living home will encourage fluids but they don’t sit there to see that they are not being fully used. There’s no explaining the importance of hydration because there are a million excuses as to why she has more than enough (possibly drinks 2-8 ounces a day!) I understand this is her disease making things difficult but does anyone else have any experience with this? Any advice appreciated!

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We have had the same issue for about 5 years. My father is 94. He has had several low blood pressure incidents, bowel obstructions and a fall due to dehydration. He does not eat fruit. Period. Fruit flavored anything. He eats no vegetables except onions in cooked food. Nothing green. No tomatoes. He will only drink whiskey and beer.

He has a tremor, so he uses a straw. Because of the tremor, he will not eat soup. The closest "wet" food was a chunky soup, but the doctor said it is too much sodium. He used to drink Boost every day, but now doesn't like that either.

The furthest I got was refusing to give him his whiskey or beer until he drank a glass of water. That backfires cause if he gets annoyed he stops eating altogether. 5 years ago he got depressed and would not eat or drink and went from 130 to 110 pounds. I told him if he did not want to live, we should get hospice for him. When the man came in and explained that he was there because Dad wanted to die, Dad changed his mind. We got him on antidepressants (mirtazipine) which got him eating again.

The advice here to try to feed her foods that are high in water content is really the best. Ice pops are usually well received. I look for chocolate ice pops or sometimes the Dollar store has rootbeer.

Otherwise, I think that on many levels, Dad behaves like a toddler. Maybe you can offer rewards if she drinks? Does she have any favorite foods or activities? If she drinks a glass of water, she gets a ride, you will do her nails, get her her favorite movie or listen to her favorite music. You don't have to make it a threat. Just say "I was going to read you your book /give you your magazine/give you this cookie. We can start right after you finish your water."

We moved my brother in with Dad to be there full time. That makes it easier to keep up and plead/cajole/reward.
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I not sure if you have them where you live but a young man by the name of Lewis hornby come up with jelly drops I seen the video a few years ago , truly amazing they eat these chocolate sized gummy drops that a loaded with water so that they get the water needed to stay hydrated . You can find him on YouTube check them out , even if they dont have them available you can make them yourself or someone else could there are lots of recipes for water drops , gummy drops made from agar which has a high volume of water when mixed . I have been meaning to make them myself for my mum as it is so important that people stay hydrated and we cant get them here so I will be making them . Every care facility and hospital should be having these on board as they are one of the best and most important things i have seen when it comes to hydration.
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Did you talk about end of life before the dementia? If they ever said something like, if I can't do such and such anymore just shoot me, then I would get hospice in and let them do what they want. Thirst is a natural instinct for self-preservation, so if someone is refusing to drink to the point of dehydration, that is the choice they are making. I am not saying this to be callous. It just seems to me that pushing ensure and water are postponing a natural death.
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Ricky6 Mar 2020
It is not a “choice” to not drink fluids. Elderly people do not know or do not feel if they are thirsty, and therefore do not drink.
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Does not dehydration lead to high lactic acidosis which is dangerous to internal organs?
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Careblazer310 Mar 2020
I don’t know about that but I can tell
you that MIL dehydration and lack of drinking has led to UTI, Pneumonia, low kidney function and excessive low blood pressure.
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I agree that dehydration starts many other issues like UTI's, dizziness, headaches, confusion, and blood pressure. Flavored beverages might be more enticing to them or foods like jello, soups, fruits like watermelon or cantelope. My Mom didn't like to drink because she was incontintent and if she drank, then she would complain that she would have to go to the bathroom more; she didn't realize that not doing that one thing of getting hydrated causes many other issues.
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The things that worked for my parents were the flavored packets, Minute man and Cystal light are two, that you can put in water, and the flavored popsicles. My aunt was in assisted living and they would come and leave a small pitcher of water up on the chest of drawers where she couldn't even reach it! Crazy. She fell at least once from being dehydrated. So I don't know if the staff would give the flavored water if you bought the packets, but it would be worth a try. Dealing with the UTI's alone is bad enough.
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watermelon has lost of water and so does cantelope and other fruits it helps some
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Hello,
I understand your frustration! My grandma who has dementia also does not drink like to drink water. When I first arrive for the day to take care of her, I open a water bottle and give it to her. She takes a couple of small sips and that’s it for hours! And she hands it back to me so I put it on the table next to her so she can reach it easily. During the day, I will remind her that it’s there, but she just looks at it and goes, “yeah...”. She definitely does not drink enough water. She has even got mad at me for reminding her about the water. So I really don’t know what to do. Maybe try putting the water in a different container? I think my grandma sometimes doesn’t like the plastic water bottle and would prefer a cup instead. I haven’t tried it yet because she spills a lot and is messy with food but maybe it’s worth the try. As they say, you can lead a horse to water but you can’t make it drink!
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Careblazer310 Feb 2020
This is identical to what happens when I am with my MIL. What I’m learning from everyone here is that it is common and sometimes there is nothing that can be done.
my MIL won’t drink water, only ginger ale and only a few sips.
she won’t eat very much now but at least she will have some soup but only at meal times will she eat. So fruit and other hydrating foods are only an option if they are offered to her at AL at meal times.
I pray everyday that we don’t go to the emergency room again. It’s very traumatizing for her and time consuming for me and the other family members. We do our best!
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It may sound mean but at this stage of life, it would be better to let them go. Keeping them alive is only for the kids sake not theirs.
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The diseased brain is not going to understand that they need to hydrate. They will have to be reminded every day.
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I have had the same problem with both my parents! As you probably already know, lack of adequate hydration CAUSES UTIs, which causes dementia like symptoms, which causes fall, and the vicious cycle goes on! When I am at their home I push push push water on both of them. Unfortunately, I do not live there so I have little effect there. In addition, they put the heat on 90 and have a huge electric fireplace heater cranking in their small den, also on 90. They overdress and use blankets, too. Why they are not thirsty, I don't know.
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Careblazer310 Feb 2020
Our stories sound very similar.
So very sorry you have to go through this.
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I had the same issue with my mom. I got a feeding tube in place. She is on continuous feedings on a pump she gets ongoing flushes with water and stays hydrated. No uti's, no hospital visits, weight and nutrition are successfully maintained.
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Yes; my mom (now deceased) and the mom of a friend (92, mild dementia). It is like pulling teeth to get them to hydrate. No matter how much we explain, cajole, etc. it is a problem. And then there are the health issues by the dehydration.

It's not a complete solution but soups, broths, and other "watery" foods can help.
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Doctor says Mother has age related decline not early dementia. Mother only drinks Dr. Pepper, coffee, or sweet tea. Time and again I explain it's not the same as drinking water and that is why she tends to choke when she eats. She seems to agree, but her excuse for not drinking water is that it makes her have to go to the bathroom. I'm certain not consuming water has a lot to do with her mental state like forgetfulness and depression.
I have tried fruit juices, breakfast drinks, boost and flavored water, but she turns her nose up.
Depending on the person, you can lead a horse to water...
As for a person with dementia, the brain basically dies, so they just forget how to survive. 😢
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BarbBrooklyn Feb 2020
Has your mom ever had a swallow study? Choking while eating shoukd be investigated by a speech pathologist.
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My 88 year old mom was in/out of hospital with dehydration a few times. She too refused to drink water to help. We made her slushees and tried some smoothies which she was crazy about. At first she declined them so I left it and said, “It’s ok if you only want a sip, you decide.” She’d try it and ended up loving it. She later enjoyed protein shakes with a scoop of ice cream and macro greens powder. When I quit forcing it on her she came around. Not sure if it’ll work for you, but might be worth a try?
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Davenport Feb 2020
Good for you for being resourceful, and congratulations on being so lucky that you and your mom have a solution!
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You have to be around to remind them to drink. Eventually they will need thickened liquids. Then it will come down to either a feeding tube, or hospice and let them die of dehydration (can take 2 weeks to die that way even with hospice). They forget how to drink.

2 to 8 ounces a day will kill her kidneys not to mention infections, constipation and UTIs.
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I have the same problem with my LO. They seem to be always dehydrated and will faint sometimes. There is no easy answer to get the patient to drink. You have to try a variety of different drinks. I have found that grapes and apples help. Also, different fruit drinks. Also, ensure or boost, and crystal light.
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Every person needs 2 liters (8 8 ounce glasses full) of non-caffeinated fluids a day. Water can be boring to drink and some folks have difficulty with liquids. Ideas to increase hydration: jello, popsicles, broth-based soups, watermelon, applesauce, juice, flavored drops to add to water (like Mio)… Also consider drinks that boost nutrition: Ensure, Boost, Glucerna... Making meals a social occasion helps everybody to eat and drink more. Plan a schedule of snacks with drinks between meals to increase nutrition and fluids: something when reading the news, something during games or social activities, something during TV or movies, and something before bed.
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I have to repeat the case for putting in a G-tube for nutrition and hydration and medication.
My wife went thru stages of regaining body functions coming back from a stroke with 4 months in rehabilitation. The G-tube did solve all the problems of not being able to swallow anything.
Now that she is at home under my care, swallowing pill has become a real issue that I am thinking of having the G-tube inserted if the pill-gate gets worse.(some pills cannot be crushed and mixed with yogurt)
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Davenport Feb 2020
God bless you and good luck!
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It may be swallowing problems with thin liquids.

Might try Nestle's Instant Breakfast in whole milk. Whole milk is twice the viscosity of water and powder will also make it more dense as well as sweet. They make Boost. So it comes in chocolate, vanilla, and strawberry.

I would give it to him with a drinking straw so he can control the flow.
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My dad put himself in the hospital a few times just from being so dehydrated he could barely function, but got very interested in sodas toward the end. We brought him a Sprite within a few weeks of his death, and he was absolutely amazed! Like he had never had anything so delicious. It was adorable. So maybe you can find some beverages that are more exciting than others? Water might be a tough sell, but try different things and maybe you'll hit on a winner.
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If you are visiting her and sit there with her you could try swabing her mouth with some fresh cool water around inside her mouth dipping the pink spunky mouth swabs in cool water around in her mouth so she can suck the moisture from the water out of the spunky pink mouth swabs that you can get from the pharmacy, ask the pharmacist behind the counter about the pink mouth swabs. They can be used to clean her mouth and or to jousting her mouth with the water. Try crushed ice if she'll eat it. Any kind of moisture is better than no moisture. But I wouldn't let her do it herself if she has dementia or Alzheimer's disease because you don't want her to stick the plastic stick down her throat or get choked on it. But if you take the swab and dip it in cool water and you swab her mouth like you're cleaning her mouth or moisturizing her lips she may suck the water from it and keep doing it or offer her crushed ice. But you sit there with her and. do it for her. Give her lot's of attention and Love and encouragement. Talk to her Primary Care Doctor to make sure there's no risk of aspiration before you do it though. Alzheimer's is a dreadful disease! My Daddy had it and My Aunt. It's not there fault. They can't help it. One moment they may or not remember something. I would not leave those laying around for her to forget what they're for or get choked on it trying to do it herself. But if you do it for her or tell her it's to moisting her lips she may suck the water out of the sponge while You hold it for her. You may try Apple sauce or the thicknened tea or juices or shakes or milk. Even cherry Italian Icies Try Ensure Chocolate or vanilla or strawberry shakes for Nourishment. Encourage her like it's a treat. Assist her with it. Hope this helps!
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We deal with this every day. Our mom too has been in and out with all the symptoms your mom has. It is one of the hardest issues to deal with. She is getting pedialyte now as well as fruit, jello and whatever has fluid. Bone broth too. Nothing easy about this disease. A new roadblock every day.
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In my mother's facility, if people are having difficulty swallowing they get thickened fluids. This may not be the situation of the person you are caring for, but it might be something to check.
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Hello,Yes,in my line of duty as a HHA since the 1980,s I have seen it till this day.Not only with the Alzheimer's population but even with everyone in my path. It's thru lots of Patience that can be achieved.
The way I do it with my client right now with dementia .In the morning she likes coffee with every Breakfast.I bring one cup with the coffee.Once she finishes I bring her 6 morning pills to the table with water ...IN..the same cup she drinks coffee. WHY?...with clients with brain issues we need First see their necessities. Then make it easy on them.My client DO NOT LIKE to drink water.But with the cup she is comfortable to do so it's with the coffee one. WE BOUGHT 12 of the same cup.When they see different items around the table or different dishes they get confused.So when breakfast is done we start with her meds.Our goal in my 12 hour shift from 9am to 9pm it's...minimum 8 cups. During each hour I bring to her half cup of water.When the first round finishes...THE NEGOTIATION START.
I will bring the Newspaper...and together we start going thru the news paper.I tell her ....I'm bringing a cup of water for me and one for you because we are going to be sitting for long and the kidney needs to work while we are reading.WE start reading and talking and drinking water by11AM she and I had one cup of coffee and two cups of water.Then by close to 1pm I walk her to the bathroom the she finishes and I invite her to walk to the building elevators like a 12 minute walk in total. When we come back another cup of water the same cup...and as days progresses I do my best to assist with such important task.NOT only for the client but for all around them.The aide or visitors can also bring their water.WHY if they see only them have to drink water they might think we are going to harm them.When she needs to drink water...it be nice someone sits with her and also drink water to bring her some kind of security that water it's not POISON.Their brains doesn't funtinon the way we would like for them to funtinon.REMEMBER is their brain and they controle it.We just work around it.It will take a lots of negotiation but it's duable.Little sips on a nice Cup that she can feel comfortable like with beautiful roses of maybe animal print.My client loves Cat's .PLEASE let us know how it's going.Wish you all a very nice journey.Good luck.
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Careblazer310 Feb 2020
Thank you so much!!!!
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Have a G- tube
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My 95 yr old Dad hardly drinks any water.

But he will drink milk and juice and I don't give him coffee, alcohol, sodas.

Find things that he likes to drink because even tho it's not water, it will hydrate

Also, I have a bottle of water sitting beside my Dad 24 7 and try unscrewing the lid and tell him to take a sip. Do this as often as you walk by him.
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Offer 4 ounces of water several times a day by placing the glass in there hand, and slowly guide the glass/cup to there mouth always remind them to drink. You have to be very patience.
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Do a simple test. Gently pinch dkin on yhe bsck of her hand & pull upwards 1/4-1/2 inch.
If so taught you can't easily pull it, she is fine. If bounces back to smooth immediately, she is fine.
If it's slow to rebound to smooth, she is dehydrated.

The first few times do this about 15-30 min after she has had a bunch of fluids...like with taking her medsor after a glass of her favorite drink... lemonade? Herb Tea? Decaf tea or coffee?
If the first couple of tests are when she is hydrated, confirming her opinion, she won't be resistant to the test. If it is positive..low on fluids, pick a couple of things she likes to drink and ask which she would like. You don't even have to mention the test was positive. Just offer or make a favorite.

Remember caffeine & alcohol dehydrate. So stock decaf/ herbal teas or flavored decaf coffee...her preferred brand also in decafe. If you have an empty coffee can, switch the container, but put a mark on it in case she has someone else get some for her.

Another note, Gatorade is high in salt, so water it down. I now drink 50/50 or even only 30% Gatorade & the rest water. She will get the electrolytes but less salt.

Sea Salt & low salt snacks in moderation will help trigger her thirst. No one wants to be reminded that their body is fsiling them...no matter what the age.
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Tiredandweary Feb 2020
The skin test is not a good indication in the elderly due to loss of elasticity in their skin. As with many other things in the elderly, the signs of dehydration are sometimes masked. The main thing to look for is more confusion or falls. Blood pressure is also lower and urine is more concentrated.
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Careblazer310, has anyone done a swallowing test on your Mom? My mother ended up in the hospital a couple of times with pneumonia, or what appeared to be pneumonia. After being released from the hospital she was placed in rehab for up to 20 days so that certain specialists could help her regain her strength, moderate and track her swallowing and intake. Discovered Mom was aspirating due to drinking from straws. Took those straws away and Mom recovered rather quickly and was able to return to her assisted living. Now, water is something my Mom will NOT drink for some strange reason, but she loves soda pop so we keep her fully supplied with that. I did try sending the flavor enhancers with the water bottles but she didn't care for that either. Personal opinion; after moving my Mom to a nursing home last July, she has become an entirely new person in a great way. Found out the hard way the assisted living had her on way too many drugs for an in general diagnoses. Turns out Mom has Parkinson's with a bit of dementia which changed the treatment meds considerably. My mom can actually talk now and is constantly on the "go."
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Careblazer310 Feb 2020
Great for your Mom! Im
glad she is happier and thriving where she is. My MIL just had pneumonia, UTI and a fall so she was hospitalized then send for 2 weeks to a rehab hospital. They did not see any swallow issues but I will follow up with her in house therapists at AL in case they see this as an issue.
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