Why do elderly people refuse to drink sufficient fluid?

[Disscombobulated]

I care for my FIL, who lives with us. He has a number of complex medical issues, the most recent being kidney failure and the a UTI.

Despite years of nagging I simply can’t get him to take in sufficient fluids to stay hydrated. He is perfectly lucid (most of the time) but can’t grasp the concept of water improving his quality of life. I have tried literally every angle of discussion… including having pretty brutal conversations about him, his clothes and my house smelling because his urine is so concentrated. He just doesn’t seem to care, or have any respect for me who is dealing with the consequences, such as hospital admissions, clearing up after ‘accidents’ and all the additional cleaning involved.

numerous medical professionals have told him that he must drink 3L a day.

I am now at the stage where I am so frustrated that I don’t know if I can continue to do this.

Any advice would be appreciated, or do I simply let it go and let the worst happen?

Sneak in the extra fluid, jelly, custard, yogurt/mousse, ice lollies, milkshake with ice cream, cereal and milk. As many have said it might be a toileting issue. Sometimes the issue is water, add some elderflower cordial, caffeine free tea/coffee. I completely agree, really frustrating! Good luck

Definitely try a mix of things

breakfast - cereal with milk or porridge, add some fruit, orange juice on the side
lunch - soup with sandwich
tea - casseroles with veg, jelly, sorbet, ice cream, apple crumble with custard, alcohol free beer

I’m not sure why doctors have recommended 3 litres of water in this particular case, that seems incredibly excessive but I do know that what we’ve been brainwashed into believing about our water intake by the companies who want to sell us bottled water is false. Most of us only need 1,2 litres of water per day, and this can come from food, soups and a variety of different beverages. Also in terms of most hydrating drinks, skimmed milk scores higher than plain water.
www.deliciousmagazine.co.uk/do-you-really-need-to-drink-two-litres-of-water-a-day-2/

Have you tried jelly drops? they’re 95% water, and taste like sweets so the person doesn’t feel like they’re drinking.

Not sure if someone already mentioned this as haven't RTFT but for UTIs I've always found DMannose helpful (so before any antibiotics prescribed) - if given early enough or used daily as a preventative it seems to do the trick. And is natural sugar so can just dissolve in a cup of tea / squash.

Sorry ! Replied to wrong person 🤦‍♀️

U.K. tap water is not usually heavily chlorinated - it’s generally perfectly palatable, Maybe you’re thinking of somewhere else. I certainly remember tap water in a Miami hotel tasting of nothing but chlorine! 🤮

No, anaesthetist. Urologists don't mange renal failure, nephrologists do.

I'm not saying I know more than anyone. I'm just saying that fluid restriction is more common in advanced renal failure, so it's worth someone going with your relative to appointments as it's v likely that at some point in their disease process they'll be swapped over and it will be useful for you to know when as fluid overload in advanced ckd is quite dangerous

You obviously don’t live in the same part of the UK as me.

Because most of our water has been through the ground, it contains bacteria that needs to be treated by chlorine. You can smell the chlorine when you run the tap. On our water company’s web site they tell you to leave the water to stand in a jug to get rid of some of the chlorine. Really it just tastes horrible. We have found if we buy bottled water we drink twice as much.

Not sure if you’re still checking this but another variation on water is to put a splash of milk in it - a hot drink is best! Gran has drunk this for 60+ years instead of tea or coffee.

Thanks - certainly worth a try. Have had success over the last couple of days with custard and soup.

That 2.5L includes the water content of food.

Absolutely agree with this - we live in the Severn-Trent area and the water that comes from the tap is all but undrinkable even though we installed a water purifier at great expense!

Whether a person is drinking enough or not can be seen by the colour of the urine. The lighter it is, the more water is being drunk.

3L a day is unnecessary if his urine is pale. Only if it is dark should you worry about not drinking enough. Do you drink 3L a day? There are quite a few mugs of tea in 3L.

The taste of chemicals in tap water is quite concentrated unless the tap is run a lot of the time.

Many people living alone buy bottled water. The disabled cannot handle large bottles, and sometimes screw caps on small bottles.

Find out what he likes, it can change from day to day, and get it for him, so that he knows you are thinking the best for him.

It doesn't have to be water, does it? Find out what he likes to drink and give him that.So long as he isn't alcoholic, he could have some alcohol, four hours after meds and 4hrs before the next meds.

No one likes being bullied, especially when they are old.

Have you tried non alcoholic wine? If he likes whiskey, he might like ginger ale. You can get large bottles, but if he won't drink, best to get the individual cans as the are fresher. Open it in front of him so he knows it is only ginger wine.

A small drop of the hard stiff won't do him harm, just enough to taste. If he is old and disabled, how many years is he likely to have, doing without his favourite tipple?

You’ll have to live with him and give him tea constantly. Maybe he doesn’t like the water and would prefer something nicer

In that case, you should stop trying to force him to drink so much, especially if he is balking against it. Unless he has a choice of food and drink to choose from, and he can pick what he wants, you will find yourself fighting a losing battle.

Give him whatever he wants to drink. He is too disabled for restricting what he eats and drinks to matter all that much. You cannot make him live longer by not giving him what he wants. You will just wear yourself out. At least with a stoma you don't have to keep changing the sheets and washing them, that is so long as the fit is right. A catheta might be necessary, but that is how infection gets to the bladder and kidneys, so even if he drank more, it would not stop him having kidney failure.

If his temperature is raised, then he may need antibiotics. If you test his urine each day and observe the colour, and it is fine, he can really have what he wants, because some alcohol which he enjoys will not do much harm, unless he wants to live another 10 years or so!

I suppose he can swallow without difficulty?

What do you consider a 'good quality of life?'. Everyone likes to think they can give someone a good quality of life, but for what reason?

Do you want him to live longer? If you do, why? Have you discussed it with him? How much longer does he hope to live?

If you had the same physical problems when you age, what would you like others to do for you?

Sometimes we are so afraid of our loved ones dying, that we try to keep them alive by restricting the very things they want to enjoy.

At the moment, he is entirely dependent on you to provide all his needs, because he cannot go out and shop for himself. If he is not allowed to choose what he eats or drinks, and is made to eat and drink 'healthily' what good would that do him in the long run?

You have to make up your mind whether you are trying to prolong his life or help him enjoy what time he has left.

No one says that is easy. In fact, it is very difficult. You are right to care for him at home. Visiting him in a care home would be as stressful for you as caring for him at home. If he has any disability benefit, use if to buy help to do the things that are running you ragged. It is what it is given for. If he is living in your home, not his, then you should be able to get more benefit for him, which could relieve you of even more stress.

Keeping an elderly person alive isn't always the best thing. I don't know why people send their elderly loved ones to hospital. The NHS doesn't have to beds, staff, or inclination to look after the elderly. Visit a gerontology ward at your hosptial. Count how many patients and how many nurses/assistants there are. Look in the bathrooms: they are often used to store old equipment. There are not enough people to help the patients eat at mealtimes. A lick and a promise once a day is a wash. Non nursing staff come round with breakfast, usually a bowl of cornflakes, and often taken away again. Cups of tea and water rest on bedtables all day.

No one would ever say an elderly person is better off in hospital, and unless you are sure that in a care home each resident gets at least one hour one to one with an assistant (and often a language barrier) then paying someone for an hour or two a day to help you is more than the elderly get in hospital or care home. You cannot do better than your best, and if he wants something that might be bad for him, let him have it, because he is getting better care from you than anywhere else.

Any sign of weakness and the posters on here will have a go regardless. We could start our own club.

Thanks for your thoughtful response - I will keep it to reflect on in the future.

when he is well his quality of life is, I think, excellent. He is mobile and able to potter around, he lives in our comfortable house, with his loving family.

I don’t really have strong feelings about him living for a very long time, I am quite pragmatic in that respect, but he absolutely wants to live longer.

He has full agency over what he eats and drinks, subject to my preparing family meals which are suitable for everyone, although of course I make adjustments specific to his needs (for instance his kidney issues mean no tomatoes, his stoma no lentils etc), but there is always a full fridge and store cupboard and except when he is bed bound he is able to help himself. I do the food shop but always ask him what he would like adding, and will get him whatever he needs, other than alcohol (his kidney issues mean that he shouldn’t drink, and excessive alcohol consumption has contributed to his conditions).

the challenge is that when he becomes dehydrated (and this can happen very fast) he will become quite confused and seem in very low mood. His urine will also smell, and as a result he and the house will. I genuinely don’t care about the extra washing etc, and am extremely fortunate in that I don’t need to be too concerned about the additional costs, however, the smell can be horrendous, to the point that I can’t invite guests round.

When dehydrated his basic personal hygiene goes out of the window, and he needs to be reminded to change his clothes, wash his hands, shower etc.

In terms of support I have a wonderful husband and son, both of whom do as much as they can to help. Unfortunately (although understandably) he will not accept ‘care’ from anyone other than me.

much of the time he doesn’t need personal care, but this is dependant (see above) on him not being dehydrated… hence my attempts to keep him hydrated.

anyway @llizzie I really appreciated your thoughts, particularly on the hospital / care home situation. I respect anyone’s right to manage as they see fit, but for us a care home isn’t an option at moment, and I will keep him here for as long as I can keep him well.

I have had some really stellar advice on this thread (as well as some pretty nasty and downright stupid comments 😂) much of which I am now implementing.
Thanks all

He lives with me.

He doesn’t drink tea.

He has water, milk, squash, juice and every other alcohol free liquid available to him.

He now also has 0% stout available, thanks to some great suggestions on this thread.

So an 88KG person does need 3L, including what is in food. I think this might be the trick to success, custard, soup etc

Ice cream worked with my late mother.

Gin and tonic with lots of ice and lemon. And without the gin?
Also - and this sounds horrible - I don't like the taste of water, but half water, half tonic and ice has a lovely 'bite' to it and is really refreshing!

Thank you for your reply. Have you thought about discussing with your GP about the surgery putting a line in for a saline drip when FIL is dehydrated? It would be helpful to you both, and you would not have to send him to hospital. Most surgeries have a phlebotanist who takes blood, and they should be trained to set up a saline solution, and you already have skill with emptying a catheter.

I think that would stop a whole lot of your stress and worry.

Smelly urine is a sign of infection. I can't remember what the drug is, but it comes in powder form which is dissolved and the dose repeated 72 hours later, and it works wonders. It means FIL won't need to take antibiotic pills for a week!

What about oral care? If he is not drinking much, his mouth will be very dry, and that causes difficulty in speaking. There are synthetic saliva sprays that help. The best one is Glandosane, but it is impossible to get in the UK now. It is aerosol spray. The other sprays can sting, and deposit it in one place. If he can clean his teeth now, and wash his mouth out, he may not be able to do that in the future, so to make sure he is cleaning his mouth properly, just have a check for a second to get him used to the idea of someone else having to do that.

There are some ear drops you can buy over the counter to control any build up of wax. If you see him 'banging' his ear with his hand, it could be earache, just as when a baby does it.

The same goes for temperature check: if the back of the neck is warm, then so is he, so extra covers are not necessary.

Dry skin acts like shrink wrap over the small bones of the feet and hands and that causes nerves to be trapped between them. Make sure his skin is always moisturised, so that his feet and hands stay moveable!

Also, and this applies to all ages, keep a jar of vaseline handy for shins and elbows. Those are areas without muscle, skin on bone. The shin bone gets knocked and very often when a lump is formed, the skin splits and it can take months to heal. If you keep a jar handy and apply it immediately, the skin will stretch with the bump and not split. It doesn't have to be vaseline: if you bark your shin in the kitchen, any oil will do. Cheap supermarket petroleum jelly is as good as vaseline, and a lot cheaper. It does so much good.

There are so many Victorian tried and tested cures. Bicarbonate of Soda is a Godsend, especially for bathing and washing, yet costs so little.

What you are doing is skilled work, and I am sure you would be welcomed as a carer anywhere. Get someone else to do your housework and take a training course for a certificate. You may think you will never, ever again, but chances are you will, because there are so few who can.

If FIL prefers you to care for him, then get someone in to relieve you of other work. A vacuum cleaner weighs a ton when you are caring for an elderly person, and a lot housework chores are formidable when you are caring for someone, and you don't have to do it if you claim the benefit.

Does your doctor test the rest of FIL's family for kidney problems? Sometimes it is genetic.