Hydration and daily health care

The problem

Many older adults drink little water, not because they do not want to, but because with age thirst is felt less. They can be dehydrated without feeling thirsty, and dehydration brings dizziness, falls, confusion, and kidney problems.

What is happening underneath

With the years, the body holds less water and the thirst signal weakens. That is why you cannot rely only on "if they are thirsty, they drink." You have to offer fluids during the day, without waiting for them to ask.

Step by step

1. Offer small amounts of fluid often throughout the day: with meals, with medication, and between activities.
2. Always leave a glass or a bottle within reach, near the bed or the chair where they spend the day.
3. Vary: water, mild infusions, broths, gelatins, and fruits with a lot of water (watermelon, melon, orange). Add fluid without it being only drinking water.
4. On hot days, with fever, or if they are unwell, offer more.
5. If they avoid drinking so as not to go to the bathroom so much, organize safe, scheduled bathroom trips instead of them drinking less.

The problem

Spending a long time in the same position, in bed or in a chair, can damage the skin where the bone presses against the surface. That is how pressure sores appear, which hurt, get infected, and are hard to heal.

What is happening underneath

The skin over the bony parts (the tailbone, the hips, the heels, the elbows, the shoulders, the back of the head) takes all the weight. If the pressure is not relieved now and then, the tissue is injured from inside. Changing position and checking the skin prevents it.

Step by step

1. Change position often: in bed, roughly every two hours; in the chair, relieve the weight every hour (or have them shift themselves now and then if they can).
2. Use pillows to separate the bony parts and so the heels do not rest against the mattress.
3. Check the skin every day, especially on the bony parts. The early sign is redness that does not fade when you press it (on darker skin, an area that is darker, warmer, or firmer).
4. Keep the skin clean and dry; pay special attention to moisture from incontinence (see the part on intimate dignity).
5. If they spend a lot of time in bed or a chair, a special cushion or mattress that distributes the pressure helps a great deal.

The problem

Many health problems give warning through small changes before becoming serious. The caregiver, who sees the person every day, is the one who can best notice them in time.

What is happening underneath

In older adults, an infection does not always bring a high fever: sometimes the first sign is new confusion, more sleepiness, less appetite, or a fall. Noticing the change and reporting it is what gets care started sooner.

Step by step

1. Observe the basics every day: how they eat and drink, the mood, the sleep, the urine and the stools, the breathing and the skin.
2. Keep a simple notebook and write down the changes: it helps you and helps to show the doctor.
3. Take seriously new confusion, more drowsiness, or a fall with no clear cause: they can be the first warning of an infection. Tell the doctor.
4. At a fever, do not give medication on your own (see the medication chapter): ask what to do.
5. Lack of fluid worsens constipation; if several days pass without a bowel movement, with pain or swelling, tell the doctor before giving anything.