I am a healthy woman in my early 50s and I recently experienced what it feels like to have dementia!
With only 1.8 miles left of a 20 mile walk to support suicide prevention I began to notice swelling in my hands. Shortly thereafter my heart was racing and my mouth felt as if I was chewing on cotton balls. Over the course of the walk I had consumed 80 ounces of Gatorade and 40 ounces of water. Thinking this was more than adequate fluid consumption over a seven hour period on a balmy June evening, I couldn’t understand why I was feeling so out of sorts.
My hands continued to swell to the point of discoloration and confusion was starting to cloud my thoughts. There was no way I wasn’t going to finish this journey, I struggled to stay focused. With only blocks to the finish line, I pushed worry aside and continued my stride. Crossing the finish line I headed straight to the medical tent.
It’s now 2:30 in the morning and it occurred to me that over the course of the evening I hadn’t produced a bead of sweat or urinated…not since 4:00 the previous day had I voided. According to the physician, I was “seriously dehydrated”. I struggled to form a coherent sentence, the confusion was overwhelming. I could only muster random words. I can remember thinking “word salad”, a term we use in the dementia environment.
I was feeling anxious and agitated, I couldn’t answer their questions nor did I want to, I just wanted to be left alone. After three hours and forced fluids I was finally able to leave the medical tent. I remember thinking is this how dementia patients feel?
Dementia is all too common in the elderly. The Alzheimer’s Association reports every 68 seconds someone is diagnosed with dementia. It is important to know that the same conditions that can mimic dementia can also exacerbate behaviors in those with dementia. If you are caring for someone with dementia and you notice a sudden change in behaviors take into consideration that the culprit could be dehydration, urinary tract infection or side effects of anesthesia.
Seniors often intentionally restrict their fluid intake to reduce incontinence incidents or constant trips to the bathroom. Along with medications, the aging process also contributes to change in one’s water and sodium levels as well as a decreased sense of thirst. These factors along with the summer temperatures can all lead to dehydration.
Those with cognitive impairment and difficulties ambulating will require assistance staying hydrated. Even seniors who are considered independent need reminders to hydrate, as they may not recognize thirst. Offer fluids hourly keep beverages close at hand and eliminate beverages containing caffeine (coffee, tea, soft drinks). Eight glasses of water is the daily recommendation, but let’s be realistic…who really wants to drink 8 glasses of tasteless water. Mix it up by offering a variety of fruit juices, flavored water, sport drinks, fruits and veggies high in water content (melons, berries, oranges, grapes, cucumbers and tomatoes), offer fruit popsicles as well as low fat milk and yogurt, or whip up a fruit smoothie! And of course, if you suspect dehydration, consult a physician.
Urinary Tract Infection
One of the first things to test for in seniors who present a sudden change in mental status is a urinary tract infection (UTI). UTIs are a common cause of confusion in seniors and can wreak havoc on someone suffering with dementia. If you are caring for someone with dementia and notice a sudden change in behavior, consult a physician, as a course of antibiotics will clear up the infection and ease the behaviors. According to the NIH, UTIs in seniors are often mistaken as the early stages of dementia or Alzheimer’s, because symptoms include:
• Confusion, or delirium-like state
• Other behavioral changes
• Poor motor skills or dizziness
Often, these are the only symptoms of a UTI that are present in seniors. They experience no pain, no fever, or other classic symptoms of a UTI. According to the NIH, seniors are more susceptible to UTIs for a variety of reasons, including incontinence, a suppressed immune system and weakening of the bladder muscles, which results in urine retention.
To reduce the risk of a UTI, drink plenty of fluids to help flush the system, avoid alcohol and caffeinated drinks that irritate the bladder, change incontinence products frequently, women should avoid using feminine hygiene products and wipe from front to back after a bowel movement.
A significant number of seniors will experience what is called postoperative delirium. Those suffering from depression or dementia are at a higher risk of postoperative delirium. This condition is more prevalent after a major surgery, like a joint replacement, and can last several weeks. As published by NCBI Delirium prevention should start in the operating room by…administering appropriate drug dosages during the operation.
Prior to any surgery inquire about geriatric anesthesia, provide the anesthesiologist with a complete medical history including any mental and/or cognitive impairments and a list of all medications and supplements.