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Seniors Living Dangerously at Home

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Seniors Living Dangerously…

It is no secret that most seniors want to stay in their homes for the duration of their lives. Although this may be a good idea for some, it is a bad idea for others. Every week I hear a story that boggles my mind. Just recently I heard the story of prescription theft by neighbor.

Prescription Thief Story…

Jan is 83 and her neighbor next door has helped her carry groceries in her home. This one day, he notices that Jan just got her prescriptions refilled. As he is helping Jan bring in the groceries, he steals her whole bag of prescriptions while Jan was not looking. Jan was traumatized and in pain because her pain medication was stolen.  She told me no longer fell safe in her home.

Basement Squatter Story…

Last month I heard another story of a squatter. John is an 87 year old man. His knees hurt him so he avoids stairs. Because of the stairs, John does not go down to his basement. It turns out that a squatter broke into John’s basement through the window and was living there. The squatter was discovered by John’s daughter who heard noises coming from the basement. John did not hear those noises because he is hard of hearing. When she went down to John’s basement she found a squatter was living there. The basement was trashed, and John’s tools were missing. When police came, they found illegal drugs,  and used needles all over the basement, along with a fire arm.

Question is: Are You Living Dangerously at Home?

Poisoning..

I recently came across some very disturbing statistics while taking a safety class. Did you know that more than 14% of all deaths reported to Poison Centers each year are in persons over 60 years of age. Most of these are from unintentional exposures to medications or household chemicals. One would think that it is young kids that are most prone to ingesting toxic chemicals, however older adults are also at risk. Many seniors have at least some dementia and many experience some loss of vision. These are two of the most common conditions that put the elderly at risk for severe or fatal poisoning.

Falls…

Among older adults over 65, falls are the leading cause of injury death. Falls can result in sprains, fractures, hip fracture, or head injury. As we age, our bones become more brittle. Even a minor fall can result in a broken bone. Frail seniors should avoid stairs, uneven payment, uphill, and downhill walk ways, dark hallways. Climbing the stairs in your home becomes a dangerous and risky en devour for many. In many cases the fall results in a fracture, and could have been avoided.

Mixing Up Medications…

Seniors living at home manage their own medication. Missing a dose, or taking a duplicate dose is easy to do for anyone, however this is particularly detrimental to the elderly. Even one missed dose can result in dizziness and cause a fall. Many seniors suffer vision loss and it is difficult for them to see if they dropped a pill, which inadvertently can cause a missed dose and a setback.

Nutrition…

Poor Nutrition can easily become a problem when a senior lives alone. There is no one to prepare meals, which often results in seniors skipping meals, eating snacks, or high sodium processed foods. Once seniors consistently cut back on meals due to the hassle, their appetite decrease which often leads to severe weight loss, under nutrition, or malnutrition.

Living Dangerously

Living Dangerously

Crime..

We know that unfortunately many criminals target the elderly for a variety of crimes. Thieves are more likely to target an elderly person living alone for a variety of scams and crimes. Seniors living alone are targeted at higher rates by criminals, because the elderly are considered easy targets. People 60 and over are almost 30% of all fraud complaints, the most of any age group. Aside students, the elderly are the most likely to get burglarized. The elderly are targeted not only for material possessions, but also their prescription drugs.

The Takeaway…

Although some seniors are able to safely stay in their home, others are not. I hope this article gives seniors and their families something to think about. Many of the stories I hear are very avoidable, and cause the seniors immense stress and trauma.

Orchard at Tucker Unveils 4 Tier Nutrition Therapy Program!

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There is Such a Thing as Being Too Thin…

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Improved Nutrition outcomes are within reach for those living with Dementia and other chronic illnesses.

A popular saying says, “We are what we eat.” A good diet is vital to everyone’s health, well-being, and quality of life.  A person needs carbohydrates, protein, fat, fiber, minerals, vitamins, electrolytes, and water to survive. Obtaining the correct balance and quantities of these nutrients is essential.  Insufficient nutrition and hydration can lead to deterioration of overall health, including mental health, as well as weight loss, dehydration, dizziness, increased risk of falls, prolonged recovery after surgery, change of mood, frequent colds, reduced strength, reduced mobility, reduced communication abilities, difficulty keeping warm, infections, as well as prolonged healing.  Cognitive deficits such as Dementia, have a direct effect on a person’s nutrition. Malnutrition or under nutrition may occur at any stage of dementia. It is important to detect it and try to remedy this as early as possible.

Did you know? Up to 45 per cent of people living with dementia experience clinically significant weight loss over one year, and up to half of people with moderate or severe dementia have an inadequate food and nutritional intake. Some experience very quick weight loss, dropping to a withering 70-90 lbs. in a span of several months.  As dementia advances, it’s difficult to ensure that those living with dementia are eating and drinking enough. Eating difficulties are also very common in those living with Alzheimer’s Disease. These challenges increase the risk for malnutrition and can worsen other health conditions a person may already have. There are numerous reasons for poor appetite to develop, including depression, communication problems, sensory impairments, change in taste and smell, pain, tiredness, medication side effects, physical inactivity, and constipation.  Some people with dementia may lose their ability to concentrate, so they become distracted while eating and stop eating as a result. Other people may have trouble using utensils or raising a glass. It may also be challenging to bring the food from the plate to their mouth. Some people may need to be reminded to open their mouths to put food in it or even to chew. Another common problem in more severe dementia cases is dysphagia, which is difficulty swallowing. Dysphagia can lead to weight loss, malnutrition, or dehydration. Over time you may find that your loved one’s appetite declines or the taste of food doesn’t appeal to them. Sensory changes in sight and smell can impact their ability to enjoy food and mealtimes. Their likes and dislikes for food and drink may be quite dramatic and different from the ones they held for many years. They may also find it difficult to tell you what they want to eat.

Dementia and Alzheimer’s Disease are not the chronic conditions that often cause malnutrition or under nutrition. Other chronic conditions often impact a person’s nutrition. Many illnesses cause what is called disease-related malnutrition. Many people living with Parkinson’s disease, suffer from muscle weakness or tremors, which can make eating very challenging. Other diseases that often cause nutrition deficiencies are cancer, liver disease, COPD, and CHF to name a few.

In many of these cases, the malnutrition and under nutrition are severe, and all conventional methods have failed. Orchard’s State of the Art Nutrition Therapy Program offers hope for this group, a group that has not responded to traditional nutrition methods. Orchard has partnered with Gordon Foods and their team of experts and dieticians, as well as with dementia specialists to bring this revolutionary nutrition therapy to the community.

Join us on February 27th 4 pm-6 pm as we unveil our Nutrition Therapy Program to area professionals who are interested in helping our community battle this difficult problem. This event will be held at; Orchard at Tucker, 2060 Idlewood Rd, Tucker GA 30084. For questions or to RSVP for the event please email marketing@orchardseniorliving.com. 

Improved Nutrition outcomes are within reach for those living with Dementia and other chronic illnesses.

Improved Nutrition outcomes are within reach for those living with Dementia and other chronic illnesses.

Nutrition Therapy at Each Level of Dementia Care

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mousse-desserts-square.dlWhat is a common challenge for those with Dementia?

Challenges at mealtime are extremely common for those with dementia. These mealtime challenges will change as dementia progresses. There are distinct and separate challenges that are associated with early, middle and late stage dementia.

What are the common mealtime challenges for those in the Early Stage of Dementia?

  • Forgetfulness
  • Loss of concentration
  • Changes in food preferences
  • Reporting that foods taste bland (foods previously enjoyed)
  • No longer enjoying favorite restaurants
  • Unable to hold attention through a meal
  • Distracted by the environment at mealtime

What are the common mealtime challenges for those in the Moderate Stage of Dementia?

  • Confusion and unawareness of surroundings, place and time
  • Appetite increase and weight gain
  • Decreased appetite and weight loss
  • Failure to understand proper use of utensils
  • Refusal to sit during meal times- pacing, wandering
  • Increased difficulty with word finding and decision making
  • Unable to recognize food temperatures
  • Unable to see food as food (may think food is poisoned)
  • Unable to recognize food items once liked
  • Hiding of food

What are the common mealtime challenges for those in the Severe Stage of Dementia?

  • Preference for liquids over solids, due to appetite change or lack of swallowing ability
  • Aggressive or combative behaviors during a mealSmoothies
  • Clenches jaw, or closed fist when attempting to feed or be fed
  • Refusal to eat due to unknown reasons (variety reasons could be at play)
  • Inability to self feed, not being used to being fed
  • Swallowing impairments ranging from mild to severe
  • Weight loss despite regular caloric intake (can also be due to increase activity due to increased anxiety)

What are some important tips for a creating a dining environment for those with Dementia?

  • Tableware contrast ( avoid white plates on white linens)
  • Too many utensils
  • Avoid high gloss floors
  • Natural light is best
  • Avoid a distracting dining environment with too many items on the table
  • Make sure the table and chair is sturdy, and of the right height
  • Simplified dining room is best
  • All food served at once is usually best (although there are some exceptions)
  • Offer finger foods (avoid finger food that are too intricate or rare)

What if the above tips do not work?

If the above tips do not help with the challenges presented at mealtime, your team needs to take further steps to make sure that nutritional needs are met and your resident with Dementia is getting adequate caloric intake and the necessary nutrition.

The first thing your team needs to do is to do a full assessment of each person’s unique situation and determine the specific deficiencies caused by the mealtime challenges.  During the assessment your team must set goals and prioritize the deficiencies, identify resources needed based on the severity of a person’s challenges. Your team needs to also identify possible behavioral and nutrition interventions such as a change of dining environment. Finally your team should specify the time and frequency of the intervention.

What’s Next?

Please check back soon for Part II of this article

 

The Biggest Misconception about the Dementia Brain in Dementia Care

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Why is our brain so important?

The brain is the most important organ in the human body. It controls and coordinates actions and reactions, allows us to think and feel, and enables us to have memories and feelings.  Furthermore the brain runs everything. It is the guiding, maintenance, and managing system for hundreds of a human beings needed abilities.

When does dementia occur? The quick answer…

Dementia occurs when the brain is damaged by disease. Sometimes it is one part of the brain, sometimes it is multiple parts.

To understand dementia, we must first understand the brain…

The brain can be divided into different parts: the brain stem and cerebellum, the limbic system, and the cerebral hemispheres.  Each part has different functions.

Brain stem and cerebellum…

The brain stem is at the base of the brain. It controls basic bodily functions such as heartbeat and breathing. The cerebellum
controls balance and posture. Breathing and staying upright are things that we normally do automatically.

The limbic system…

The limbic system is deep inside the brain. It links the brain stem and the cerebral hemispheres. The limbic system includes structures with key roles in memory (the hippocampus) and emotions (the amygdala). The limbic system is the first part of the brain to develop and is sometim6bb16d242f0a68490dfe0106d79a5168es referred to as our “primal brain” and manages many of our survival reflexes. It includes the amygdala which is in charge of the “flight, fright, fight response.

Cerebral hemispheres…

The tissue that makes up three-quarters of the brain is called the cerebrum. It is responsible for consciousness, memory, reasoning, language and social skills. A deep groove that runs from the front to the back of the cerebrum divides it into left and right halves: the two cerebral hemispheres.
The left and right cerebral hemispheres have different functions. For example, language is usually dealt with mainly by the left hemisphere. In contrast, awareness of where things are around us is usually dealt with mainly by the right hemisphere.

The lobes….

The four lobes are: occipital, temporal, parietal and frontal lobes. Each lobe does different things, though they also work closely together.The lobes are responsible for our senses. There are 5 ways human beings take in information (data) about the world through their nervous system.. WhatPrint you see, hear, touch/feel, smell, and taste.

The lobes are some of the first areas effected by Dementia..

Dementia diseases often impact abilities in the occipital lobe of the brain which affect a person’s visual field.  Dementia commonly affect the temporal lobes asymmetrically; typically attacking left temporal lobes before the right. This means more loss in language stored on the left, and more preserved skills for much longer. In dementia, different forms of damage to the lobes in the brain can cause someone to become either over-emotional or lacking in feelings. This is one of the reasons that a person with dementia exhibits changes in behavior along with memory loss. Sometimes the changes in behavior may be more pronounced than the memory loss. In these cases, many times dementia gets misdiagnosed since common thinking is, that dementia causes just memory loss.

What is the biggest misconception about the dementia brain  and those with dementia?

Emotional memory is stored in the hippocampal area and is commonly a  preserved skill.  Persons living with dementia may not remember the details of what happened, but will almost always remember how an experience made them feel. Traditional thinking is if someone does not remember what they did specifically shortly after they did it, their day has less relevance, their life should be less purposeful. This is the biggest misconception in traditional dementia care. Those with dementia may get to a point that they don’t remember going to a great concert the next day, or helping to bake and delivering cookies to a police department, but they remember till almost the very end how much they enjoyed the concert, and how good they felt delivering those cookies over to those officers.

The Take Away…..

Orchard Senior Living is determined to bring a new type of dementia care to those inflicted with dementia. It is an engagement focused cognitive care model, where we focus on activities that will be stored in our residents’ emotional memories which they will have with them till they take their last breath.

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The Subtle Signs of Swallowing Problems for Those with Dementia and Other Diseases

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How does swallowing actually occur?

The oral phase of swallowing requires a complex interplay of chewing, food bolus formation, and push of the bolus to the back of the throat for the process of swallowing and movement to the esophagus and stomach. Multiple facial and oral muscles, such as the tongue, are responsible for this phase. Once the food bolus is to the back of the throat a series of muscular contractions occur to move the bolus into the esophagus and away from the airway. The airway is temporarily closed as the food bolus is pushed past the tracheal opening and into the esophagus. The food bolus then makes its way to the stomach through another series of coordinated muscular contractions within the esophagus.

Sounds Complicated Right? It is and lots can go wrong..

Due to the complexity of the swallow mechanism, a multitude of problems that can arise. The most common cause of oral dysphagia (swallowing trouble) is stroke, with up to 45 percent of stroke patients develop swallowing problems following the stroke. Other neurological diseases such as Parkinson’s disease, Multiple Sclerosis, Dementia, and Alzheimer’s disease are known to cause swallowing difficulties. Lesions, re flux conditions, and cancer have also caused swallowing troubles but to a lesser extent.

There are obvious and less obvious signs of swallowing difficulties…

Everyone knows that if a person coughs up food or gags while eating, they likely have swallowing troubles. However there are other more subtle signs that can go easily unnoticed such as long breaks between bites, being horse, drooling, frequent heartburn,  and acid re-flux.

What can happen if these subtle signs are ignored?

If subtle signs are ignored they can result in choking, where food partially or fully obstructs a person’s airway, aspiration or inhalation of food or liquids, oral secretions or gastric secretions into the airway and lungs. Also gastric secretions may be inhaled without bacteria causing aspiration pneumonia. A person may aspirate not only food or fluids that are introduced into the mouth but also their own saliva or any gastric secretions, which may be re-fluxed into the airway.

What can be done?

In a community setting, all care partners must be trained to carefully observe each resident for not blatant signs such as chocking, but for the subtle signs such as drooling, and long pauses and usually get confused for something other than swallowing challenges. When a person lives alone, the signs of swallowing trouble usually go ignored until they end up in the hospital. In many setting, little attention is paid to dining room observation. Orchard at Tucker understands the importance of monitoring these subtle symptoms and finding the problem while it is minor,Nutella-Stuffed-French-Toast-with-Strawberries and before it causes a resident irreversible harm.

Transition Care Giving is Essential in Dementia Care

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Transition and change in general is hard on everyone…

Have you ever moved into a new house? Started a new job? If you answered yes than you can recall your first week.  Do you recall how stressed out you were with the change? Change of location, change of routine is hard on everyone, however having Dementia and Alzheimer’s makes change about 10 times harder.

Transitioning While Having Dementia? About as Hard as Sky Diving While Being Afraid of Heights..

Dealing with an aging loved one that has dementia or Alzheimer’s can be very stressful, especially when it is time to move that senior into an Assisted Living or Memory Care Community. Many families see how important a familiar environment is to their loved one. Being in a familiar place with a familiar daily routine is something that many with Dementia come to rely on. Families worry about the stress that can happen with their loved one during the transition. Stress is escalated in seniors whose cognitive capacity is limited by their Dementia or Alzheimer’s disease. This is a very real fear. Depending on the progression of disease, changes can be very upsetting and disruptive to the patient. Seniors suffering with progressive degenerative brain disease cannot frame their fears and anxiety with logic, as the rest of us can.  A change in environment can often cause tremendous stress for the senior.

What is Transitional Care?

A private duty caregiver meets the senior prior to the move into a community and accompanies them to the community. The caregiver than spends between 4-12 hours each day for 3-14 days with the senior. They accompany them to activities and trips. The caregiver helps a senior learn their new environment. The caregiver stays with the resident for the scheduled hours. The caregiver is there at arm’s length if a senior gets anxious, confused, or stressed out. The amount of hours and days of transitional care depends on the seniors’ cognitive level,  as well as their stress and anxiety threshold.

Why is Transitional Care Important?

Many seniors whose cognitive abilities are hampered by Dementia and Alzheimer’s, have heightened levels of anxiety. They also experience higher levels of stress in many situations. They also retain less new information, which makes change this much harder. The transitional care giver is there to help lessen the stress of transition by being there with the senior to guide them one on one. Once the senior is settled in their new home, the caregiver remains a part of their care plan until they have become accustomed to their new surroundings.  A transitional care taker may start out by spending 12 hours with the senior for the first 3 days. After the 3 days, they spend 8 hours for the next 4 days. After the first 7 days, the hours go to 4 hours for the next 3 days. After that the hours go to 4 hours a week. Each senior is different, however it is recommended that transitional care giver hours get cut slowly based on the seniors’ needs. It usually takes about 30 days to get adjusted to a new community and getting a transitional caregiver involved softens that blow.

Do Communities Offer Transitional Care?

Some corporate giants like Brookdale do have their own agencies. Most smaller companies partner with an agency so that transitional care is provided by a caregiver that is not employed by the company. Orchard Senior Living now has a sister company Peach Home Care which provides transitional caregivers and private duty caregivers to residents.

Nutrition Assessment is a Part of Dementia & Alzheimer’s Care

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Determining if your loved one needs additional nutrition care or nutrition therapy starts with a nutrition assessment.

What is Nutrition Assessment?

Nutrition assessment is a process that nutritionist or dietitian uses to evaluate your nutrition level and determining your current nutrition needs. Your nutrition level ranges from great to extremely deficient. The first step is to determine your individual nutrition needs for optimal health. This step includes knowing a thorough history of your diet, lifestyle, medical, chronic conditions.  The second step is the evaluation of your nutrition status, calorie, protein and nutrient needs, adequacy of your diet, possible deficiencies or food intolerance(s), need for further testing, recommendations for diet and lifestyle changes and supplements.

Your Nutrition Assessment looks at all these areas:

  • Diet history
  • History of Weight Loss
  • Recent illnesses or Diagnosisexps21585_THCA153054D10_15_4b
  • Lifestyle history
  • Medical history (such as Dementia or Alzheimer’s)
  • Evaluation of blood and diagnostic tests
  • Recommendations for testing (testing for allergies, for vitamin deficiencies)
  • Evaluation of nutrition status (how serious is the deficiency)
  • Calorie needs (based on height, weight, activity level, sex)
  • Protein needs
  • Nutrient needs
  • Adequacy of your diet
  • Possible diet deficiencies
  • Food intolerance

The Takeaway…

Identifying malnutrition is an important first step in identifying a problem. Eating and enjoying a meal is part of our everyday life and important to everybody, not least to people living with dementia. A healthy diet and nutrition is fundamental to well being at any stage of life and to helping to combat other life-threatening diseases. Under nutrition is common among older people generally, particularly common among people with dementia. Under nutrition tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace as the disease progresses. Although we can’t avoid these symptoms which lead to malnutrition and under nutrition, we can manage them with a variety of Nutrition Therapy Options. Orchard at Tucker’s 2018 Nutrition Therapy Program is designed to help combat under nutrition and bring back the joy of eating to those who have lost it. However it all starts with an nutrition assessment.

 

 

Dementia Care Combined with Comprehensive Nutrition Care

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What is Comprehensive Nutrition Care?

Comprehensive Nutrition Care is a creative and comprehensive way to provide care. It takes a complete approach to nutrition care with the purpose of supporting individuals with chronic or life-threatening disease, and healthcare providers who support them, to better manage their health through optimal nutrition.

Why is Nutrition Care Needed for Dementia Care?

Eating and enjoying a meal is part of our everyday life and important to everybody, not least to people living with dementia. A healthy diet and nutrition is fundamental to well being at any stage of life and to helping to combat other life-threatening diseases. We believe it plays as important a role in relation to dementia progression, and a resident’s quality of life. Under nutrition is common among older people generally, particularly common among people with dementia. Under nutrition tends to be progressive, with weight loss often preceding the onset of dementia and then increasing in pace as the disease progresses.

In what ways are the elderly susceptible?

  1. Age related changes in the gastrointestinal tract combined with changes in diet and immune system reactivity affect the composition of gut microbiota, leading to increased numbers of bad bacteria, decreased number of beneficial bacteria such as anaerobic lactobacilli and bifidobacteria.
  2. Osteoporosis is a disease which is characterized by decreasing bone density and increasing fragility of bones due to microexps21585_THCA153054D10_15_4b-architectural deterioration which increases the risk of fracture. Osteoporosis is exacerbated by malnutrition, low weight, poor intake of vitamin D and calcium, and in women, low levels of sex hormones.
  3. Older people need higher quantities of some nutrients, for example, calcium, vitamin D and vitamin B12 due to dementia and other physiological changes making absorption of nutrients more difficult. Studies show that calcium, vitamin D, folate, iron and vitamin B12 are the most important micro nutrients in which deficiencies commonly occur in older people.
  4. Physiological changes to the digestive system affect appetite which can affect nutrient intake. Protein energy malnutrition is common among older people with estimates that 1 in 10 people over 65 living in the community are malnourished. These numbers triple for the elderly with dementia.

     

How to Prevent Malnutrition in the Elderly with Dementia?

In order to prevent malnutrition in an elderly person with dementia, functional foods need to be added to their diet. Due to the age related changes that can make it more difficult for older people to obtain the nutrients they need from their diet, functional foods can have a role to play in improving nutrient intake.

What is a Functional Food?

Functional food is a conventional food product modified in some way to give a health benefit above and beyond basic nutrition. Functional foods can also be designed to fight a certain health condition. Functional foods are generally considered to be those food products which provide a specific health benefit over and above their basic/traditional nutritional value. Examples of functional foods are breakfast cereals with folic acid, yogurt with additional probiotic, vitamin D and calcium fortified orange juice are just a few examples.

The Takeaway..

An elderly person with dementia that has lost weight and is exhibiting symptoms of malnutrition, needs abundant additional assistance to get out of the malnutrition danger zone. Because of the chemical and physical changes, nutrition therapy may be the only option to help them stay healthy and thrive. Nutrition Therapy is a daily ongoing person centered care program that can change lives.

 

Proper Hydration Care is Essential in Dementia Care

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Why is Proper Hydration Important?

Drinking fluids is crucial to staying healthy and maintaining the function of every system in your body, including your heart, brain, and muscles. Water and fluids carry nutrients to your cells, flush bacteria from your bladder, and prevent constipation. Dehydration is the most common fluid and electrolyte problem and one that can have devastating long-term effects.

Who is most at risk of getting dehydrated?

Seniors often don’t get enough fluids and risk becoming dehydrated, especially during summer when it’s hotter and people perspire more. Older people don’t sense thirst as much as they did when they were younger. And that could be a problem if they’re on a medication that may cause fluid loss, such as a diuretic.

What are the Symptoms of Dehydration..

 

  • Increased thirst
  • Dry mouth
  • Tired or sleepy
  • Decreased urine output
  • Urine is low volume and more yellowish than normal
  • Headache
  • Shriveled Skin
  • Dizziness and Vomiting
  • Muscle Weakness/Muscle Cramps
  • Increased Pulse Rate

Why is Dehydration so detrimental to Proper Dementia Care?

Dehydration increasesdehydration-lead confusion, causes muscle weakness and extreme fatigue. Increasing confusion in a person with dementia may lead to a dangerous and a negative event such as falling and breaking a hip b405bf69ae40082ad930857892a8991a. Increased muscle weakness in a person who already has dementia makes them many times more likely to have a fall and end up in the hospital or rehab.

How to Defeat Dehydration?

In a Community caring for residents with Dementia or Alzheimer’s, who are normally confused or forgetful, extra diligence in providing proper hydration as well as monitoring for dehydration is essential. Those who have dementia, need to be reminded to drink fluids throughout the day. Fluids should also be brought directly to the person with dementia and they should be encouraged to drink. Flavored waters in pretty containers are helpful and yield a more positive outcome. A group hydration station is a fun activity that could be done daily. A variety of colors and flavors should be offered each week, to keep hydration fun. You should also remind those with dementia and their family members that fluids will decrease pain, keep them more alert, reduce constipation, and keep them out of the hospital. Dementia or not, no one wants to go to the hospital.