This is the most difficult thing for people to grasp. When an elderly person goes from their normal demeanor to falling off a cliff, not in the literal sense, it is very likely that they may be dehydrated and could have a bladder infection. Recently, we visited a family who's mother was declining very quickly. Her regular caregiver had left for a short trip and on her return the woman had gone from walking and showering on her own to, terrible pain, total incontinence, fainting and unable to walk or stand. That was in a period of just four days. We had the family call 911 because of this rapid decline and fainting. The paramedics came quickly and, per usual, they brought with them an amazing presence and reassurance. They took her vitals and she seemed to be doing better. As incredible as they are, even Dr.'s, Nurses, and paramedics don't always grasp the reality of extreme dehydration for the elderly. It seems to us that it would be a normal response, but it is not. They decided not to take her to the hospital.
We ended up caring for this lovely woman for the next few days and in that time she continued to worsen. It got to the point on the last day that we couldn't even touch her, just removing her blanket caused her a great deal of pain. Needless to say, the paramedics came back and, this time, had a difficult time even putting her on the gurney due to pain. During her hospital stay they found that she was indeed dehydrated and had a bladder infection.
One time when my grandmother became extremely dehydrated, it was during a period when we had both come down with a horrible cold. My trying to not get her sicker and her not eating and drinking properly made for disaster. Just as I thought we were both getting over our colds she became frantic and her skin seemed to hurt to the touch. She couldn't keep her dentures in because she insisted they didn't fit (this we realized was a sure sign of dehydration) As a couple days passed we woke up to her telling us to call the doctor. Somehow we were able to calm her down but her frantic state continued again in the morning. Her face was seeming gaunt, she was in pain and her speech was slurred. Was she having a stroke? We called 911....They came quickly and took her to the hospital. Within an hour and a half, after being rehydrated intravenously, her skin glowed, her speech was clear and she seemed to no longer be in pain. All just a matter of fluid. It was miraculous!!!
Why we push this so much is because, we found, that so often people assume that it is just a natural progression to stop eating and drinking and the rapid decline is just a part of growing old. But, in our situation, we found that to not be true. When they are dehydrated and no longer have a lot of saliva in their mouth, eating and swallowing becomes difficult, so they stop eating and drinking. They tend to become very constipated, their dentures no longer seem to fit., they may slur their words, their skin loses elasticity and they become gaunt. Basically everything becomes a chore for them and instead of thinking it could just be a matter of fluid we think it is a normal part of aging. I stress this because, especially for those with dementia, they can't always communicate what they need and how they feel. Please don't assume that they are checking out .... assume instead they need fluid. At a certain point they must be hydrated intravenously. Here are suggestions for daily monitoring....
Any of these are considered liquid...pudding, Juice, icecream, yogurt ..... Though it might be the best, it is definitely not limited to just water.
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