Sep 19, 2018

Dementia: What happens when someone refuses to drink – should we provide IV Fluids?

Many families are finding themselves in the difficult situation of having to make decisions for a loved one that is living with some form of dementia.

As the person living with dementia begins to deteriorate, multiple decisions need to be made by family members, who want to do their best, but don’t have a clear understanding of the paths that they can take in order to make those decisions.

One of the decisions that demand our attention and decision making is whether to opt for the use of intravenous (IV) fluids for hydration, or not.

Unfortunately for families and aged care homes alike, the task of simply asking someone with advanced dementia how they are feeling, is not an option.

In the case of a person who has full use of their mind, they are able to alert family members and medical staff as to any discomfort, problem areas and perception of what is going on in their body.

Residents living with dementia are unable to convey this information, so family members and medical professionals have to make decisions regarding their care, on information gleaned externally.

It is utterly understandable that family members would be concerned about making decisions for their loved one.

Keeping it in context

As a person living with dementia symptoms progress, particularly in the later stages of their condition, the ability to imbibe and sustain an adequate hydration level decreases. It is common for family members of a resident to be asked if they want their loved one to receive hydration through the intravenous fluids.

Understanding IV fluids

Intravenous fluids come through a small tube that is inserted into the arm or top of the hand. The fluid is then propelled through the tube into the body to prevent dehydration.

Early And Middle Stages Of Dementia

Using IV fluids to ensure hydration is a common approach for residents in both early and middle stages of dementia and is not unreasonable if they are unable to take fluids orally, and will tolerate it without making them more distressed.

Usually the IV is inserted for a day or two to replenish fluids. If your loved one has had a stomach flu or any other ailment that has caused the loss of fluids, IV can be an efficient and relatively non invasive way to bring hydration levels back up.

As residents in these stages still have the ability to maintain their own nutrient and hydration levels, the IV is not usually required  for longer periods.

What about people with later stage dementia?

Later stage dementia can be a particularly difficult time for both a resident and family.

Due to their decline in health, the resident may refuse to consume food or water, with some residents coughing in an attempt to prevent swallowing.

Others may have developed swallowing problems or have difficulty swallowing.

Many families have opted to put in an IV so that they don’t have to worry about whether their loved one is thirsty or in pain due to lack of hydration.

While a residents health should always be the top priority, providing someone with treatment that is medically appropriate, yet against their will, blurs the line between medical care and what is deemed ethical.

Medical staff and family members may not be ever able to understand why a resident is refusing to drink or is hesitant about an IV and so the question remains as to what to do.

The difficult reality is that there might not actually be a right or wrong decision here – the helpful thing is to consider ‘how much will this decision impact the person living with dementia?’, is it making them more distressed than it is doing good? Are we potentially introducing other complications as a result of treating them with an IV?

These are simply things to consider when making a decision. Remembering every person is different and so is their situation.

What are the downsides?

i) The possibility of over-hydration (and develop excess fluid on their lungs or peripherals.)

ii) Irritation at the IV insert site, and also unsettling for the person living with dementia as they may not be aware of what’s happening and why they have the IV in the first place.

iii) Infection from attempts to pull out the IV and/or infection from other sources.

Alternatives

There are always alternatives than opting for an IV

  1. Ice chips
  2. Damp cloths applied to forehead
  3. Damp swab within the mouth to ensure moisture

From the perspective of both medical professionals and family experiences, there are many opinions on whether to hydrate the person or not.

At the end of the day, it is always best to consult with your trusted medical professional for the best approach for your loved one.

Keeping in mind their personal wishes, along with their medical needs.

 

Disclaimer: Please be aware the above article is merely information – not advice. If you need medical advice, please consult your doctor or another healthcare professional.

 

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  1. My mother went into renal failure and then died after she refused to drink and the staff did nothing about it. I have no problem with people refusing oral hydration if they are palliative but this requires discussion and consent. Not hydrating someone who is not palliative is criminal neglect and the fact that nothing can be done about this after someone dies is not just sad but unbelievable.

    1. I am immensely reassured to find words now in my vocabulary are used by others, in context of aged care in Australia. WHAT words? preventable death, criminal neglect, culpable homicide.

      That care providers are not charged with the foregoing following coronial enquiry is an indictment upon all who are aware of major causes of death for senior Australians… decubitus ulcers (bedsores), sepsis (blood-poisoning), CAP (community acquired pneumonia), UTI’s or urinary tract and kidney infection from catheter misuse and the always preventable DEHYDRATION also malnutrition.

      Being those who know of such and do nothing are COMPLICIT in each and every death. THOSE WHO DO NOT UNDERSTAND, please re-read the above until you do.

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