Spotting the signs: how to recognise dehydration in someone with dementia

When you're caring for someone with dementia, every day brings new challenges. One of the most overlooked yet critical issues is dehydration. Research presented at a Royal Society of Medicine conference revealed that people with dementia are six times more likely to become dehydrated compared to those without the condition. This isn't just a minor inconvenience – dehydration can significantly worsen dementia symptoms and create a cascade of health problems that affect quality of life.

The hidden danger lies in how dehydration can masquerade as worsening dementia symptoms. What appears to be a "bad day" might actually be your loved one's body crying out for fluids. Understanding the warning signs can help you intervene early and potentially prevent unnecessary distress for both you and the person you're caring for.

The tell-tale signs to watch for

Recognising dehydration in someone with dementia requires a keen eye, as the usual signals we rely on may not be present. The person may not express feeling thirsty, or they might not recognise the sensation at all. Here are the key signs that should raise your concern:

Increased confusion and disorientation is often the first sign something isn't right. If your loved one seems more confused than usual, struggles to recognise familiar faces or places, or appears to be "in a fog," dehydration could be the culprit. The brain needs adequate hydration to function properly, and even mild dehydration can significantly impact cognitive performance.

Balance problems and unsteadiness are particularly concerning as they increase the risk of falls. You might notice the person becoming wobbly on their feet, reaching out for support more frequently, or walking with less confidence. According to the NHS, dehydration can cause dizziness and light-headedness, making everyday movements feel uncertain and unsafe.

Changes in toilet habits can be a clear indicator that fluid intake isn't adequate. If the person isn't visiting the toilet as frequently as usual, or if their urine appears darker in colour, these are strong signals that their body is conserving water because there isn't enough coming in.

Physical symptoms can include a dry or sticky mouth, unusual fatigue, headaches, and in more severe cases, rapid heartbeat or breathing. The person might also complain of feeling unwell without being able to articulate exactly what's wrong.

The simple skin test everyone should know

There's a straightforward test you can perform at home that provides valuable insight into hydration levels. Healthcare professionals call it the "skin turgor test," but it's simple enough for anyone to do.

Gently lift the skin on the back of the person's hand between your thumb and forefinger, hold it for a few seconds, then release. In a well-hydrated person, the skin should snap back to its normal position almost immediately. If the skin remains "tented" or takes several seconds to return to normal, this suggests dehydration.

This test works because adequate hydration helps maintain skin elasticity. When the body is short of fluids, the skin loses some of its bounce-back quality. However, it's worth noting that as we age, skin naturally loses some elasticity, so this test should be considered alongside other signs rather than used in isolation.

If you notice the skin taking longer than usual to return to normal, combined with other symptoms mentioned above, it's time to take action to increase fluid intake and consider seeking medical advice.

Why dementia makes dehydration more likely

Understanding why people with dementia are at higher risk helps you stay vigilant and take preventive measures. The Alzheimer's Society explains that several factors contribute to this increased vulnerability.

Forgetting to drink is perhaps the most obvious reason. As dementia progresses, the person may simply forget that they need to drink regularly throughout the day. They might sit with a full glass of water beside them for hours without taking a sip, not because they're being difficult, but because the need to drink has slipped from their immediate awareness.

Not recognising thirst becomes increasingly common as the condition progresses. The brain's ability to interpret the body's signals becomes impaired, meaning the usual prompt to have a drink may not register. This is particularly problematic because we typically rely on feeling thirsty to remind us to drink.

Age-related changes compound the problem. As we get older, our bodies naturally contain less water – dropping from about 60% in younger adults to around 50% in older people. Additionally, kidney function may decline with age, making it harder for the body to conserve water effectively. The sense of thirst also diminishes naturally with age, creating a perfect storm of risk factors.

Medication effects can also play a role. Some medications commonly prescribed for older adults can increase fluid loss or affect the body's ability to regulate hydration. If you're unsure about medication effects, speak with the person's GP or pharmacist for guidance.

When to seek medical help

While mild dehydration can often be managed at home with increased fluid intake, certain warning signs require prompt medical attention. Contact a healthcare professional if you notice:

• Severe confusion or sudden changes in mental state

• Dizziness that doesn't improve with sitting down

• Rapid or weak pulse

• Very little or no urination for 8-12 hours

• Sunken eyes or cheeks

• Extreme fatigue or lethargy

Don't hesitate to call NHS 111 or visit your local A&E department if you're concerned about severe dehydration. When speaking with healthcare professionals, be specific about the symptoms you've observed and how long they've been present. Mention that the person has dementia, as this context helps medical staff understand the situation more clearly.

It's also worth having regular check-ups with the person's GP to discuss hydration strategies and any concerns you might have. Many GP surgeries offer annual dementia reviews, which provide an excellent opportunity to discuss practical care issues like maintaining adequate hydration.

Moving forward with confidence

Recognising the signs of dehydration is just the first step in keeping your loved one healthy and comfortable. Once you know what to look for, you can take proactive steps to prevent dehydration before it becomes a serious problem.

Remember that caring for someone with dementia is challenging work, and it's easy to feel overwhelmed when new concerns arise. The key is to stay observant without becoming anxious about every small change. Trust your instincts – you know the person better than anyone, and if something doesn't seem right, it's worth investigating further.

Regular monitoring, combined with practical strategies to encourage fluid intake, can make a significant difference to your loved one's comfort and wellbeing. By staying alert to these warning signs, you're taking an important step in providing the best possible care for someone navigating life with dementia.

Age UK provides additional resources on recognising health changes in older adults, whilst Dementia UK offers comprehensive guidance on managing daily care challenges.

For more practical advice on supporting someone with dementia, explore our comprehensive care guides and connect with others in similar situations through our community resources. If you're looking for structured support in organising care, our care planning tools can help you stay on top of all the important details.