Dehydration and Malnutrition in Alzheimer's Disease

Health Professional

Occasionally you read about people with dementia who have died from malnutrition or dehydration, even when being cared for in a nursing home, hospital, or by caregivers. You cannot believe that such a situation has occurred, that it must be an obvious case of abuse. However, dehydration and malnutrition can develop insidiously, especially where people are confused, unable to recognize the usual signals of hunger or thirst, or unable to communicate their needs. People with dementia are particularly at risk.

Dehydration

Often the causes of dehydration are complex. Confusion may be central but there are often other causes, some of which are easy to remedy or institute. Drinks being placed out of easy reach can be moved closer. Fluid charts can indicate the amount of fluid needed and then can be filled in whenever a drink is given.

Medical investigations into the cause of dehydration may be required. Someone may be taking medication that causes excessive fluid loss, they may have fluid loss through diarrhea and/or vomiting, all of which may lead to a life threatening situation.

Signs of dehydration may be difficult to identify, but an early sign is a slow spring back of the skin on the forehead after gently pinching it. Analysis of a blood sample, its electrolyte and urea concentration, will provide the evidence and contribute to an accurate diagnosis.

Weight loss

My dad has really lost lots of weight I had not seen him for a month and was shocked by his appearance. My sister, who had nursed him through his flu, recognized he had lost weight, but did not know just how much he had lost until she weighed him. She was amazed at his 28 pound loss. If you see someone every day the steady loss is much less apparent!

Causes of malnutrition

There is a danger of presuming that Alzheimer's, is the cause of weight loss. People with Alzheimer's disease get sick too, so it is very important that a doctor is consulted on causation.

Causes of malnutrition include:

Cognitive impairment

Diseases, both acute and chronic. Examples include gastro-intestinal diseases and swallowing disorders

Depression

Loss of interest in food

Isolation and living alone

Poverty

Bereavement

Poor mouth and tooth care , poorly fitted dentures/no dentures

Impaired taste, vision, smell, poor hearing

Lack of access to shops

Loss of manual dexterity

Malnutrition and dehydration can be multi causational and each one has to be addressed to improve and stabilize the health of someone with Alzheimer's disease.