Summary
Extreme heat can be especially dangerous for older adults, and even more so for people living with dementia. In this episode of CareLab, occupational therapists Emilia Bourland and Brandy Archie explain why individuals with dementia may not recognize when they're overheated, communicate that they're thirsty, or take the initiative to drink water and cool down. They share practical caregiving strategies to help prevent dehydration and heat-related illness during hot weather.
The conversation also covers simple but effective ways to encourage hydration, including using visual cues, offering sweetened beverages or hydrating snacks, simplifying communication, and recognizing signs that someone may be struggling. Caregivers will leave with actionable tips to help keep their loved ones safe, comfortable, and healthy during heat waves.
Key Questions Answered
-
Why are people with dementia at greater risk during extreme heat?
People with dementia may not recognize that they are overheated or thirsty, may struggle to communicate how they feel, and often need reminders or assistance to drink fluids and move to cooler environments, increasing their risk of dehydration and heat-related illness. -
What are some simple ways caregivers can encourage better hydration?
Keep drinks within the person's direct line of sight, offer fluids regularly instead of waiting for them to ask, use brightly colored cups to make drinks easier to notice, and consider naturally sweetened beverages or hydrating products that are more appealing to drink. -
How should caregivers talk to someone with dementia about drinking water?
Use simple, direct instructions instead of asking multiple questions. For example, handing someone a cup and saying, "Here, take a drink of water," is often more effective than asking if they're thirsty. -
Why might someone with dementia still not drink water even when it's available?
As dementia progresses, a person may no longer recognize what feelings like thirst mean or know how to respond to them. Even if they can see the drink, they may still need prompting or gentle assistance to begin drinking. -
What other health conditions make hot weather even more dangerous?
People with heart conditions, Parkinson's disease, multiple sclerosis, impaired temperature regulation, or other chronic illnesses may be especially vulnerable to heat. Caregivers should closely monitor hydration, breathing, swelling, and any changes in behavior or physical condition during periods of extreme heat.
Transcript
Emilia Bourland
Hey everyone, welcome to Care Lab. Today we're gonna be I know it's gonna listen, it's actually been a hot minute since Brandy and I have recorded together. We weren't sure we even knew each other where we were doing a podcast anymore. So, but but here, here we are, we're back. And we're gonna be talking about something that's pretty relevant to this moment right now. that is heat, but specifically heat and how does that affect the people with dementia?
Brandy Archie
Welcome to Care Lab, guys.
Brandy Archie
Mm-hmm.
Brandy Archie
Don't even know her. We're back.
Emilia Bourland
that you might be caring for. So a relevant topic. Should we jump right in?
Brandy Archie
Yeah, it's kind of crazy how most of the country is under this like heat dome. And I know you are new to Kansas City, but you're from you've lived so much time in Dallas and it's hot there and we're used to having heat, but seeing some of these other places have so much heat and also not be as used to it is a challenge for a lot of reasons. And I think one thing that hasn't gotten talked a ton about is how heat impacts us when we get older.
Emilia Bourland
Is it?
Emilia Bourland
Right. Yeah, that's a that's a great point. oftentimes we we c it's easy to think that, you know, we we know that people as they age, they tend to they lose muscle mass, right? We struggle with weakness, we can struggle with balance. people have more cardiovascular issues, which also is affected by heat. but something that we don't think about is just generally we're able to we have a harder time regulating our temperature and and coping with heat.
as we get older. And of course, that affects the people that we are caring for who have dementia as well. not necessarily more physiologically, right? Like it's not the people with dementia have a there's a higher impact of heat on them physiologically than other people of the same age. however, our folks with dementia do have one really big difference and that is that they cannot always
Brandy Archie
Mm-hmm.
Emilia Bourland
Well, there's a couple of big differences. One, let's talk about is they can't always communicate what they're feeling, right?
Brandy Archie
Yeah. Yeah, I think we are keen to pay attention to this with babies, right? 'Cause we know babies are not able to use their words yet. Or if they do, they don't have all of them to be able to tell you exactly what they're feeling and so they're crying and you're like, maybe they're hot 'cause you're outside and you're managing it, but they're a baby, right? and I think one thing that we maybe forget a little bit is like as when we're grown ups, like we're used to having our words, so you don't really think forwardly about that. But it's kind of
Emilia Bourland
Mm-hmm.
Brandy Archie
a really important thing to consider because if somebody's not able to communicate to you well that they are hot or overheating or need water, you just might not think about it 'cause there's probably other things going on too. And you can initiate to get yourself some water, get in the shade, or do what you need to do in order to protect yourself from the heat. And not everybody, especially if we have some advanced stages of dementia, are able to make those initi take that initiative in order to do that. And so being able to like
Pay attention to that, it's super important.
Emilia Bourland
Right. something that I'm sure again, if you are someone who's caring for someone with dementia, this is something you're probably familiar with anyway, what I'm about to say, which is that a lot of times our older population or people with dementia, they may they may want to be in a sweater, they may want to have extra blankets on, they may feel more cold than you do all the time, right? it's really important to keep in mind that even th especially in this heat wave.
that we're having, you know, if you are overheated, there's a good chance that this person is is also potentially dangerously overheated. So of course we want people to you know, we want people to feel comfortable in in their clothing and their like other sensory issues why why folks might want to have that sweater or have that blanket or something like that. But keeping in mind that just because someone is cold all the time normally does not necessarily mean that they're cold right now.
In this moment. So really being aware of that. I think one of the other issues too is that oftentimes hydration can be a challenge for people with them with dementia. Yeah, anyway, doesn't matter what time of year, it doesn't mind matter the weather. and there are some reasons for this. One is because people simply forget to hydrate, right? if they if that glass of water is not right there in front of them.
Brandy Archie
Just anyway.
Brandy Archie
Mm.
Emilia Bourland
Often they're literally not going to see that that glass of water or that you know, that cup of juice or whatever it is, they may not be aware it's there. So they might feel thirst, but they might not A, have the community the ability to communicate that thirst. And they might not, they might not be have the ability to see that that beverage is actually there in front, is actually there within their reach. So it's important to make sure one, that that whatever someone has
something to drink, that it's right there in that direct visual field, so that they can actually see it and reach out and grab it.
Brandy Archie
I mean, literally we are using these same techniques for our own selves. Like I have water on my desk. I have water in my car. I have water in my refrigerator so that every time I go to those places I see it, I'm like, I should drink some more water. Right? Like this is why people carry huge jugs so they can see like how much water they drink all day. So if we need to do that and we are intentional about doing that, how much more so do p maybe a person who doesn't have that level of initiative need to have that? And
Emilia Bourland
Mm-hmm.
Brandy Archie
To your point about having it directly in front of you as a cue to like actually drink it, sometimes even that's not enough. And so that's why the well, one, you might need to prop somebody. But two, this is part of the reason why red dishes help people to more intake. So we talk about a lot for plates, but the same mechanism is still true for the drinks. So having a red glass or a red cup sitting there is even more like
attractive to the eye if that makes sense. Like it catches your attention more. And so that's what ends up having people who have dementia drink 30% more when they're doing it from a red cup. Because the contrast, right? Not most people's homes and most places, you don't have a ton of red things happening in the kitchen and it's just or on the dining table or wherever you're sitting at. and so it stands out and so it helps to cue somebody to actually take that drink of water. So if that's happening in everyday life, consider what
That means for today when it is a hundred degrees outside, you're already probably a little bit dehydrated and even more so 'cause we're sweating. So it's like so important that we're like kind of force not forcing, that's not the right word. But you know, like being real intentional about like offering a a drink. Can you talk a little bit about like ways to offer a drink that might work better than others in order to actually have that drink be taken?
Emilia Bourland
Yeah, well, partly I think that depends on it depends on the the person and what they are used to, right? so for example, some people might do better with straws because they have trouble like tilting the cup. on the other hand, some people might not do well with straws because maybe they have a swallowing issue or it's hard for them to get that lip closure on there. I think the most important thing is, as you said, to make it something
that is in their visual field that they can actually see, and you're providing prompting if needed to get them to engage in in actually in actually drinking. Ideally we would love for people to be able to pick up the cup or whatever it is and bring it to their mouth on their on their own. People have a tendency to kind of have a little bit better success swallowing that way.
But if we need to assist someone by helping to place the cup in their hands and bring it to their mouth to kind of cue that initiation, that beginning to drink. or if we need to help someone by bringing it to the their mouth, then we definitely can do that too. I do think I like what you said before. We never want to force anyone to to eat or drink. Like we don't want, we don't want to force things into people's mouth, right? That's sort of a recipe for aggression.
Agitation, not to mention choking. so we want to be intentional about how we're doing that, but trying to make it as as much part of a natural process as we as we possibly can that feels regular to that person, I think is really important. The other thing that I would kind of want to add as an aside is, you know, again, we can't overstate the importance of making this something that people can actually see and get to in front of them. but
Brandy Archie
Mm.
Emilia Bourland
As as you said, Brandy, sometimes people still won't realize that they are thirsty. When people progress through dementia, sometimes they lose lose awareness of what some of their of what some of the sensations that their body is telling them actually means. So for example, sometimes people might need to have a bowel movement and they feel that sensation, but they're not really sure what that means, and that can be distressing.
So on the flip side, someone could be thirsty and know they were th and feel that thirst, but not necessarily equate that with the need to take a drink. So just being aware, monitoring people's what fluid intake so that you are aware how much they are or are not drinking is really important. And then I think the last thing that I would add is taste matters too, right? So a lot and
Brandy Archie
A lot.
Emilia Bourland
What is Brandy, tell us what is the last what is the last taste bud that lives in our mouths? It keeps going till the end.
Brandy Archie
Is it sour? It's sweet. yeah, it's sweet. It's sweet. And the reason that's so ridiculous that I forgot is because I've had wanted to talk about jelly drops. which is like a product that exists in which essentially it looks like kind of like a gummy bear but bigger and it carries water, but it's sweet. And so if it's I can't remember how many you need, but basically there's a certain number of these little pieces that equal a glass of water.
Emilia Bourland
It's sweet. It
Emilia Bourland
Mm.
Brandy Archie
functionally to your body and they're easier to take in because of all the physical challenges you just talked about. Picking up the cup, maybe doing a straw is hard, or, you know, any number of things, right? this is like red and colorful, easy to pick up with your fingers, sweet, so it tastes good because sweet lasts the our sweet taste buds last the longest. and then they're getting water with it. So it's like pretty ingenious and another way to like get more water into the system.
Emilia Bourland
Yep, absolutely. Think about it. If you have something that tastes good, you are more likely to want to put that thing in your mouth, right? That doesn't change when we have dementia. And the last thing that people can taste is sweet. So if you have someone who like just really doesn't seem like they want to drink their water, think about ways that you can maybe safely jelly drops are great idea, that you can safely sweeten that beverage for that person. And that can often help with that fluid intake as well.
Brandy Archie
There's a lot of really easy ways to do that too. Like, I'm trying to get us to have more water at our house and so we do sugar free water enhancers that we put into the water or sparkling water. It doesn't add any more sugar, but it tastes sweet. You know, there's lots of good ways to do it without feeling like you gotta intake actual more sugar. and the other thing I wanted to say, like you brought up a lot of the important features about physically what might make it hard to take a drink. But one time I I was seeing a client and the
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie
Mom had dementia and was living at home and had so many challenges that they it was communication challenges essentially. And I came in and used my words differently than they're using their words. And come and that's all we changed was like how I was talking to her. And she completely performed differently, right? And like was able to engage in the things they wanted her to engage in. And they're like, You're like a miracle worker. And I'm like, I'm not a miracle worker. It is like really clear.
Emilia Bourland
Mm-hmm.
Brandy Archie
the difference between a couple of small phrases that can help people initiate and take action. So if it's about water, so that's what we're talking about, as opposed to are you thirsty? Do you want some water? Number one, that's two questions in one time, right? I would say, here go, drink some water. And just hand them the cup, right? Like there's no decision to be made. It's just like, water, drink, right? You just do the thing as opposed to like, what was the first question?
Emilia Bourland
Uh-huh.
Brandy Archie
What was the second question? What does that mean? Am I thirsty? Like there's all these things that your brain does just like that now, but if you have dementia, those processes are way slowed down. And so you're getting frozen. And that frozness essentially is read by a lot of us as refusal, right? And as opposed to, I literally don't know how to process this information. And so changing the phrasing of the way you do things.
Emilia Bourland
Mm.
Brandy Archie
can make all the difference. And so that's super important with water, right? Especially 'cause all the things you just said and the taste aspect. and it might not be the first thing they're thinking about doing or want to do, especially if it doesn't feel good in their mouth. so prompting in that way can make a big difference.
Emilia Bourland
I'm so glad that you said that. Yeah, I'm so glad that you said that because it really does matter how we are talking to our folks with dementia that we care for and how we're asking them to do things. Thank you for thank you for saying that. So well put. okay, there's one last thing that I want to talk about here before we wrap up this quick episode. And that is that our folks with dementia can also, as we know, have other diseases.
in conditions as well, right? And again, their ability to communicate, people's ability to communicate when they have dementia can be impaired. Some other diseases and conditions are really, really affected by this heat. So make sure that you're really keeping a close eye on things like how much someone again, how much someone is drinking, if they're s if they're swelling, if they're having
Brandy Archie
Mm.
Sure.
Emilia Bourland
more shortness of breath, other kind of things that just don't feel right. Because again, people with any kind of heart condition can really be affected by heat, people who have any kind of issue with with thermoregulation, so just regulating the temperature of your of your body, people with a history of burns, people with with multiple sclerosis, MS, right? folks with Parkinson's disease who
also often have a Parkinsonian type of dementia, right? These are folks who in addition to just the the if they have dementia as well in addition to the the regular symptoms and struggles of dementia they might also have other things going on in their body that make it hard to regulate heat or make the make the heat extra dangerous for them. So having an understanding what that is and keeping an eye on symptoms and just really being aware
Brandy Archie
Mm-hmm.
Emilia Bourland
of the need to keep people cool, keep them hydrated during this time is super, super important.
Brandy Archie
Yeah, I'm so glad you brought that up. hopefully this was helpful for everybody during this heat wave and let you keep an eye on everybody and get them their water and get them out of the sun. and if you have appreciated this, please share with somebody, like and subscribe, and then leave us a comment. and try to give us a rating because that helps other people who need this be able to find it. So until next time, we'll see ya.
Emilia Bourland
Bye.
Do us a favor and subscribe to the CareLab podcast on YouTube, Spotify or Apple Podcasts! It will help others find our conversations and grow the community and you’ll stay updated with the latest insights and expert advice on elder care.
