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Fart smeller
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Arnaldo Liechtenstein, physician.

Whenever I teach clinical medicine to students in the fourth year of medicine, I ask the following question:

What are the causes of mental confusion in the elderly?

Some offer: "Tumors in the head". I answer: No!

Others suggest: "Early symptoms of Alzheimer's". I answer again: No!

With each rejection of their answers, their responses dry up.

And they are even more open-mouthed when I list the three most common causes:

-uncontrolled diabetes;

-urinary infection;

-dehydration.

It may sound like a joke, but it isn't. People over 60 constantly stop feeling thirsty and consequently stop drinking fluids.

When no one is around to remind them to drink fluids, they quickly dehydrate. Dehydration is severe and affects the entire body It may cause abrupt mental confusion, a drop in blood pressure, increased heart palpitations, angina (chest pain), coma and even death

This habit of forgetting to drink fluids begins at age 60, when we have just over 50% of the water we should have in our bodies. People over 60 have a lower water reserve. This is part of the natural aging process.

But there are more complications. Although they are dehydrated, they don't feel like drinking water, because their internal balance mechanisms don't work very well.

In Conclusion:

People over 60 years old dehydrate easily, not only because they have a smaller water supply, but also because they do not feel the lack of water in the body.

Although people over 60 may look healthy, the performance of reactions and chemical functions can damage their entire body

So here are two alerts:

1) Get into the habit of drinking liquids. Liquids include water, juices, teas, coconut water, milk, soups, and water-rich fruits, such as watermelon, melon, peaches and pineapple; Orange and tangerine also work.

The important thing is that, every two hours, you must drink some liquid. Remember this!

2) Alert for family members: constantly offer fluids to people over 60. At the same time, observe them.

If you realize that they are rejecting liquids and, from one day to the next, they are irritable, breathless or display a lack of attention, these are almost certainly recurrent symptoms of dehydration.

So spread it around! Don't Forget, Do It Now! Your friends and family need to know for themselves and you too, to be healthier and happier.

It's great advice to share with people over 60.
 

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Yup! my job, all day, every day, is looking at the nutrition/hydration status of my elderly patients. UTI's impact the elderly psych status viciously. Don't fear coffee or tea as they are NOT a diuretic, reduce booze intake, increase high moisture foods intake like fruits, soups, and veggies, make fluids a part of every part of the day. Also, as a casual observation, I see an increase in UTI's and dehydration AEB labs, with significant weather changes that require forced air temp control. When it starts to get hot and muggy the A/C dries the air. When it gets cold the forced air heater dries the air.

Crockpot RD, CSG
 

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Just wanted to chime in here that my grandmother got delerium (different than dementia but the same) from a UTI that was undiagnosed for years and also caused her to not drink water. She did not recover.
Sorry for your loss. I wish I could say that scenario is rare. I typically see the lack of hydration results in the UTI. Chicken and egg, right?
 

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Sorry for your loss. I wish I could say that scenario is rare. I typically see the lack of hydration results in the UTI. Chicken and egg, right?
Thank you.

We actually don't know which came first because she also didn't tell anyone what was going on. I suspect it was a UTI resulting from dehydration but then the UTI also prevented rehydration because the urges were unpredictable (I think). We didn't find out about any of this until she was in a full blown delerium episode and had to go to the hospital because she also hid it all (I understand this is pretty typical too). They never could get the UTI cleared up but the care she was getting in the assisted living place she was in was subpar also. It was a bad situation all around.

Drink that water people!
 

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Nurse Ben
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So Arnaldo missed one:

Depression.

I see a lot of older folks who complain of increased confusion and memory issues, they come in with concerns that they are developing dementia. The rule outs include delirium, depression, insomnia, and substance abuse.

In delirium we're looking at metabolic issues, infection, diet, hydration, medications/interactions, etc...

It's not that folks don't feel the need to drink; though in dementia that is common, but they feel like they can get away with it like they did when they were younger (but they can't).

So yeah, drink more, eat right, and get some exercise.

As long as you can remember how to get to the trail head (and get home), you are good (y) (y)
 

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Nurse Ben
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Just wanted to chime in here that my grandmother got delerium (different than dementia but the same) from a UTI that was undiagnosed for years and also caused her to not drink water. She did not recover.
Some folks have chronic UTI, esp. in the elderly and frail, in your grandmother's case it probably wasn't undiagnosed so much as either hard to treat or recurrent. It's easy enough to hydrate someone, just give them an IV, but changing habits is a whole other thing.
 

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So Arnaldo missed one:

Depression.

I see a lot of older folks who complain of increased confusion and memory issues, they come in with concerns that they are developing dementia. The rule outs include delirium, depression, insomnia, and substance abuse.

In delirium we're looking at metabolic issues, infection, diet, hydration, medications/interactions, etc...

It's not that folks don't feel the need to drink; though in dementia that is common, but they feel like they can get away with it like they did when they were younger (but they can't).

So yeah, drink more, eat right, and get some exercise.

As long as you can remember how to get to the trail head (and get home), you are good (y) (y)
Well said.
 

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Good to know. No wonder I couldn't find the rice in the storage room the other day when I was making dinner after my long ride. Ha ha. Kidding, aside, I do sometimes forget to drink enough water. My wife measures her water out every day and makes sure she gets it all. I should probably follow suit. (60 now)
 

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My understanding is that caffeine in of itself is a mild diuretic just that the body adapts to it so quickly that we build a tolerance and the diuretic effect goes away.



Sent from my Pixel 4a (5G) using Tapatalk
 

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My understanding is that caffeine in of itself is a mild diuretic just that the body adapts to it so quickly that we build a tolerance and the diuretic effect goes away.

Sent from my Pixel 4a (5G) using Tapatalk
Yup, very mild. I would rather an elderly person drink as much coffee or tea as they like than have them suffer from decaf death ;) Alcohol is a much stronger diuretic and a more significant concern when considering hydration status.
 

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Feel free to post them. Caffeine does increase the sense of urgency and does stimulate the peristalsis of the bowels but output of urine is not significantly more then the added input of the fluid.
"Doses of caffeine equivalent to the amount normally found in standard servings of tea, coffee and carbonated soft drinks appear to have no diuretic action."

This one is specific to exercise and caffeine.
"Caffeine exerted a minor diuretic effect which was negated by exercise. Concerns regarding unwanted fluid loss associated with caffeine consumption are unwarranted particularly when ingestion precedes exercise."

"Our data show that there were no significant differences across a wide range of haematological and urinary markers of hydration status between trials. These data suggest that coffee, when consumed in moderation by caffeine habituated males provides similar hydrating qualities to water."

The Mayo clinic.
"While caffeinated drinks may have a mild diuretic effect - meaning that they may cause the need to urinate - they don't appear to increase the risk of dehydration."

It appears that the body acclimates to caffeine in regular users such that the small diuretic effects are mitigated.
I'm thinking in terms of healthy individuals and exercise, though.

I think these studies need to be looked at in context. I can hydrate pretty quickly if I drink 20 to 30 ounces of water, or a hydrating electrolyte mixture if I'm already dehydrated. I doubt I could drink that much coffee or iced coffee, but probably could drink that much iced tea.
In the elderly, particularly if they have recently started or increased caffeine intake, I would be more alert to the possibility that there could be a more pronounced diuretic effect.
If I knew an older person in this category, I'd keep an eye on them.

This is the abstract of a study I haven't read, but it addresses mechanisms and is interesting, at least.
"Caffeine is an alkaloid which belongs to the family of methylxanthines and is present in beverages, food and drugs. Caffeine competitively antagonizes the adenosine receptors (AR), which are G protein-coupled receptors largely distributed throughout the body, including brain, heart, vessels and kidneys. Caffeine consumption has a well-known diuretic effect. The homeostasis of salt and water involves different segments of the nephron, in which adenosine plays complex roles depending on the differential expression of AR. Hence, caffeine increases glomerular filtration rate by opposing the vasoconstriction of renal afferent arteriole mediated by adenosine via type 1 AR during the tubuloglomerular feedback. Caffeine also inhibits Na(+) reabsorption at the level of renal proximal tubules. In addition, caffeine perturbs the hepatorenal reflex via sensory nerves in Mall's intrahepatic spaces. Here, we review the physiology of caffeine-induced natriuresis and diuresis, as well as the putative pathological implications.
 

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Fart smeller
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I did not know that, but there are plenty of studies out there that substantiate that this is true.
I thought if you regularly drank coffee/tea is was not, but if you go above what you usually drink, then it's a diuretic. No?

That's what happens to me, anyhoo. I have a cup of coffee in the a.m., then if I drink more, I p!ss like a racehorse.
 

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