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144586 tn?1284666164

Keeping Track of Hydration in The Elderly

Caregiver222 has developed a system for insuring the elderly are properly hydrated. It is extremely important to make sure the elderly keep properly hydrated and in most places this is done by "guestimate".  Some nursing homes use astrology. Others use the Vulcan mind meld. I suggest there is a better way.  In most all facilities the aids arrive with a cup and straw or glass filled with a single flavor of drink. The system entails purchase of small plastic cups, in either a two-ounce or three-ounce size. You don't serve liquids in glasses.  The second part of the system is NEVER to serve only a single flavor of beverage. At meals I follow the "four-flavor" rule. Four cups containing four different flavors of beverage. Orange, banana, milk, water.  Chocolate milk, pineapple juice, tomato juice, iced tea. You get the idea. My little one always wanted at least one cup of plain old water. At snack time I change this to the two-flavor rule.  I like contrasting flavors of beverage. Orange juice and chocolate milk (in separate two-once servings) were a special hit.  The small quantities ensure that if the drink is not used expensive ensure or juice will not be wasted, and if there is a spill there will not be a great mess. Elderly patients satiate quite readily on a single flavor of beverage. As the cups are emptied they are stacked near the patient. At the end of the day the empty cups are counted and an exact measure of daily hydration is available. All patients should have a small permanently bound book by their side in which the aids make notations. I use the inexpensive marble grade-school notebooks. And every day is kept a written record of hydration.
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144586 tn?1284666164
Ad additional drink that your favorote camper might like is a cayenne pepper maple-syrup  lemonade. A traditional complimentary medicine cleanser. There are different recipes. You can use Tobasco sauce instead of cayenne pepper. Basically two tablespoons of freshly squeezed lemon, 2 tablespoons of natural maple syrup and 1/10 teaspoon of cayenne pepper (or a few drops of hot sauce to taste), in eight ounces of warm water. Stir thoroughly and then chill. Serve in the little two-ounce plastic cups. This is especially helpful for those with thin-liquid dysphagia. The hot sauce helps trigger the swallow reflex.
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144586 tn?1284666164
I have nothing bad to say about the commercial nutritional drinks, except to say that usually you can do a little better. Many have a somewhat "chemical" taste. In a home-care scenario the system works best when the attendant shows up and beverages are readily available, pre-made and stored in a large refrigerator. This should be done by a family member who has been designated the task. The beverages are purchased and prepared without involving the aides. Trust me on this one.  This means that someone must insure there is an appropriate inventory available. At least one shift each day should perform an inventory and be in contact by telephone with a responsible person to report shortfalls.  If there is thin-liquid dysphagia present you can add a bit of thickening agent (available at drugstores) to all thin liquids. Since the attendant may have a different idea of how thick the solution should be it is best you do this yourself.  I would store the beverages in 32 ounce Tropicana glass containers (They can be sterilized easily - plastic cannot) in a large family refrigerator. The orange juice with "lots of pulp" works best with elderly patients with thin-liquid dysphagia because the pulp promotes swallowing. All the attendant had to do was to open the door. I would supplement the 32 ounce orange juice with 2 grams (2000mg) of vitamin C, in crystaline form. The crystaline form is the only kind that readily dissolves. That provides about 62 mg per ounce of Vitamin C. Be very careful in providing too much vitamin C to an elderly patient because in addition to being an anti-oxidant C is a diuretic, and induces urination. If you do, insure that during that period hydration of the patient is carefully monitored. Tomato juice in metal cans was immediately transferred to a glass container, lemon juice and a few drops of tobasco aded, and the container shaken and returned to the refrigerator. I am a fan of malted milk powder, available in plain and chocolate. It makes an excellent shake with bananna, a cube or two of ice milk and maple syrup. It is expensive, but I always liked maple syrup as a sweetener. Sometimes I would use cane sugar. That means a small blender must be purchased. And ice-cubes kept available. I would usually flavor the milk with a few drops of vanilla or maple syrup. A chocolate "egg-cream" is a real treat, made from seltzer and chocolate milk. I would avoid soda, except on a special ocasion, such as a birthday.
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144586 tn?1284666164
There are also a few companies that sell pre-thickened fluids for those with swallowing difficulties, including thickened-water and thickened-coffee. You can find the source on the internet. They are all excellent, but I preferred to do the thickening myself. You can also purchase packets of powder that produce drinks with flavored electrolytes in many health food stores. I haven't mentioned warm beverages, such as broth and soup. When serving such beverages I also used the small cups and followed the "two-cup" rule. Thus a two or three-ounce cup of chicken broth and a two to three-ounce cup of split pea soup. Soup consumed is logged in the same manner as any other liquid. Whether you have someone helping you for four hours a day, twelve hours or have 24/7 care for your loved one one of the primary duties is not to have the floow swept. That duty is to insure hydration. At the brginning of the shift beverages should be offered and available, preferably on a tray placed front of the patient within a forty-degree line of their head. Not on an inaccessible table at the side of the chair or bed. The rule is "in view at all times".At the end of the shift there is a logged record of liquid consumed. I cannot emphazize how important this is. If there was a table extension I would put the beverage on a tray with an edge to prevent mess if the cup tipped. The cup of liquid should be offered to the patient, but the patient should take the cup and take the drink. This is a way to prevent laranygospasm when too much liquid goes down and ends up in the trachea. When going outside with the wheelchair to the park I always kept two small vaccuum flasks filled with different beverages and a supply of the small plasticn cups. Upon arrival at a destination the first thing after getting set up should be to offer a beverage to the patient. The paid caretakers should be instructed in this drill and it be made part of "Standard Operating Procedure".
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144586 tn?1284666164
Bear in mind the elderly I have cared for with have been very old and enfeebled. With a younger patient the problem may not be as severe. The main problem is that the "sense of thirst" tends to disappear in the 90's. They have to be encouraged to drink. The norms established for hydration of younger people don't apply. I see ninety ounces of fluid recommended for a hundred pound female. In an elderly patient you are lucky to get 28-32 ounces in them in the course of a day, even if you try youe best. Lack of hydration causes bowel impaction and increases the probability of a stroke, among other problems. So it is extremely important. One of my little girls is a hundred and eight years old. The super-elderly require care that is beyond the abilities of the average run-of-the-mill caregiver. And it is labor-intensive care. My little pal Claudine died a month ago because of a lack of that care. Care that I wasn't around to provide because I was in the hospital. Even the best nursing homes are understaffed. If you can afford it and cannot do so yourself, it is worthwhile to supplement nursing home care with someone else coming in to assist, especially during the evening feeding time, with your loved one.
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187666 tn?1331173345
Wonderful information on hydration and how to encourage the older folks to drink. My mom, 83, tends to live on Pepsi and Sierra Mist. It drives me nuts. She tells me she can't drink water because it "goes straight through" and within seconds she swears she has to run to the bathroom. But she'll down 16 oz of Pepsi and never piddle a drop. Well, that lovely reasoning goes with all her other biologic impossibilities. I only spend 2 days a week with her so whatever happens is beyond my control at this stage.
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