1. RM VANDEE RN, MSN 2015 Procare Hospice of Nevada 1 Did you know by the time your lips feel dry, you are already dehydrated? Dehydration Recognizing signs and symptoms in the elderly

2. Did you know by the time your lips feel dry you are already in first stages of dehydration? Are you drinking enough? Take 1/3 of your weight and drink the equivalent number of ounces of water daily RM VANDEE RN, MSN 2015 PROCARE HOSPICE 2

3.  Dry mouth and tongue  Thick saliva  Small amounts of urine, dark yellow  Muscle cramps  Headache  Weakness  Sleepy  Irritable  Constipation Avoidable and reversible RM VANDEE RN, MSN 2015 PROCARE HOSPICE 3 Mild Dehydration

4. Serious Dehydration  Low blood pressure  Convulsions  Severe muscle cramps in arms, legs back and stomach  Eyes sunken in with few tears  Wrinkled skin poor turgor  Rapid respirations RM VANDEE RN, MSN 2015 PROCARE HOSPICE 4

5. Managing Dehydration in the Elderly 48% of senior citizens admitted in hospital show signs of dehydration Thirst receptors in elderly are blunted Medications that cause dehydration Diuretics Thyroid medication Cholesterol lowering medications RM VANDEE RN, MSN 2015 PROCARE HOSPICE 5

6. Early Intervention the Key to Prevention Identify Factors Reversible  Nausea/vomiting (reduced intake)  Diarrhea (malabsorption)  Anorexia (reduced intake)  Infection  Medications Thyroid medications Diuretic medications Cholesterol lowering Treatment  Educate family  Offer preferred drink  Provide wet foods  Jell-O, yogurt, ice-pops  Provide easy to handle cups  Provide straws RM VANDEE RN, MSN 2015 PROCARE HOSPICE 6

7. Non- Reversible Terminal End of Life Dehydration acts as a natural anesthetic to reduce the patient’s suffering Intravenous hydration contraindicated Increases respiratory secretions Increases GI secretions causing nausea/vomiting Prolongs agonal period without prolonging life RM VANDEE RN, MSN 2015 PROCARE HOSPICE 7

8. Fighting the Battle Families need to feel they are doing everything they can. What ideas, suggestions do you have addressing this? RM VANDEE RN, MSN 2015 PROCARE HOSPICE 8

9. References Hospice Palliative Care Program (2011) Symptom guidelines Fraserhealthhttp://www.fraserhealth.ca/media/06FH SymptomGuidelinesDehydration. Ibrahim JE PhD ) Dehydration the hidden epidemic http://www.parentgiving.com/elder-care/dehydration-a- hidden-risk-to-the-elderly/ RM VANDEE RN, MSN 2015 PROCARE HOSPICE 9