Dehydration in Dysphagia

Posted on01 Aug 2021
Dehydration is a major problem for dysphagia patients. It occurs when the fluids necessary to maintain normal body functions are not replenished. Generally, dehydration is caused by patients not consuming sufficient fluids. Other reasons for dehydration include excessive loss of fluids due to specific chronic diseases or side effects of intake of certain medications which can lead to frequent urination, excessive sweating or uncontrolled vomiting.

Dehydration occurs more frequently in the elderly population due to aging. Aging may result in the decrease or even disappearance of the thirst sensation (adipsia). It is a condition that causes patients to have reduced or absent feelings of thirst, and thus forget to drink water throughout the day. Elderly who suffer from dementia will also need to be reminded by family and caregivers to eat and drink.

Swallowing disorders that accompany old age or associated chronic conditions also affect liquid intake greatly. Elderly with swallowing difficulties can only drink modified consistency fluids according to the advice of their physician and speech therapists. Many elderly on modified fluid consistency find it inconvenient to prepare thickened fluids and are not used to the texture and taste of such fluids. They need a lot of encouragement from family and caregivers to remember to have adequate fluid intake.

Besides ageing, the body may lose more water due to chronic conditions which result in frequent urination,diarrhea and vomiting. Some elderly with chronic conditions take medications that are diuretic in nature and can cause more fluids to be lost.  Also,elderly may not have easy access to water when they need it due to difficulties in mobility and inconvenience. Older people often avoid drinking more water so that they don’t have to use the toilets as they find it difficult and inconvenient to move around and go to the toilets.

Dehydration may complicate recovery, worsen health decline and alter metabolic functions. Hence, it is important for dysphagia patients to prevent dehydration. Fluid requirements vary for individuals according to age, physical activity and metabolism. However, the main recommendations for preventing dehydration are:

Drinking at least 8 glasses of water per day. It may be hard to keep track of the amount of water drunk. Caregivers may consider storing about 1L of water in a jug and serving the water in small cups to the elderly whenever necessary.  Do note that you should follow your doctor’s recommendation to keep to any fluid restriction(eg. 800ml or 1000ml/day) if you have chronic conditions like kidney diseases which do not allow you to have the usual amount of fluids. 

Ensure clean water is safely and easily accessible. For patients that face difficulties walking on their own, it is recommended to have drinking water placed near their activity areas. This will enable them to drink water even when the caregiver is busy attending to other matters.

Provide a variety of drinks and opt for foods with higher water content. Providing a wide range of drinks (tea, coffee, milo, juices, milk) and encouraging intake of food with high water content (soups, jellies, pudding,custard,yoghurt, ice creams, fruit) will help increase the fluid intake of the patients. Drinking plain water may not be as appetising for some patients. Encourage patients to drink by offering a range of drink selections to choose from. It is recommended to watch out for the water content in each drink. It is best to drink non-caffeinated drinks. Caffeinated drinks such as coffee and tea should be limited if you are already on diuretics as these drinks are also mild diuretics but they should not lead to dehydration if consumed in moderation.

For dysphagia patients, caregivers have to modify the texture and viscosity of the drinks before serving. Since dysphagia patients may not be able to drink water as easily, thickeners are often used in their drinks and diet in order to attain the right texture. Depending on the IDDSI levels prescribed by the speech therapist, GentleFoods offer a wide range of drinks that are suitable for dysphagia patients.



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