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?

It’s often a combination of what meds they might be on, not wanting to get up to go to the loo, being even slightly incontinent, and you can add lack of understanding, forgetfulness and sheer stubbornness into the equation as well. Unless you are old, infirm, it’s hard to contemplate just how difficult, possibly frightening it can be to try and get up out of bed to make it to the loo, even an ensuite. It’s very had work getting fluids in, but can help hugely in other ways if you can. Doesn’t have to be 3 litres of all water, but can be things like soup, glass of milk, tea, coffee, hot choc, shakes, those little health drinks. Consider making one meal soup and a sandwich each day. Look at how easy it is to go to the loo, can he wear incontinence pads to avoid embarrassing accidents, try to coax, don’t show anger.

Because they are scared of being incontinent.
That is it
Especially elderly men they want to go to the toilet a lot and are scared of the shame if they have an accident because they cannot get there in time.
Tell them there will be toilets, at home encourage them to drink am when they are more mobile

If he will have soup you can have some version at every meal. Will he eat cereal with milk? Ice lollies? Applesauce?

Thank you everyone who has been so supportive, there are some really helpful ideas here which I will definitely try. I will try the jelly drops too, although are they full of sugar? He is T2 diabetic.

to be clear the medical information is definitely 3L, this has been stated on numerous appointments, by numerous medical professionals, so I know I am not mistaken. I easily drink 2 plus L a day, as does my DH and DC (grown DC).

people who are saying that this is too much, or suggesting alcohol, may have missed that he has had multiple kidney failure and UTIs.

i think i am just overwhelmed with it all at the moment - to me it’s so simple, the water is there (ours is filtered and chilled), it’s free and easy to drink. Being a carer is a big responsibility, especially when it’s someone you care about, and when that person isn’t willing to make the effort and you can see their quality of life disappearing you feel responsible for that.

To the poster who felt I was generalising about elderly people - I am sorry that’s what you perceived, please believe me anyone who cares (as in being a carer) for an elderly person fully understands that they are individuals.

The nature of the conversations I have had with him about water have been wide and varied, but I do confess that at times I am a bit bossy - because it has such an impact on the rest of the household. I will reflect on this and see if I can temper discussion on the matter in a more positive direction. FIL agrees with everything I say BTW, but doesn’t follow it up with action.

Very grateful for everyone’s input.

Oh and just to add - those saying it’s a fear of accidents are very valid - however he recently had a catheter (which I changed and emptied, so required no effort from him) for four months and the situation did not improve.

The thirst impulse deadens with age and certain medications , we had similar issues with my dad and found that presenting different types of fluids was more successful than large quantities of water , so things like cups of tea , flavoured sparkling water , cordial but also supplementing with ice lollies and soups or a bovril drink. Just be careful not to give a lot of dark drinks as they need more processing by kidneys.

If he's got capacity (and I'm sure you would have mentioned if he hadn't), I can't see how you'd think it was in any way your responsibility if he gets kidney failure as a result of his decision not to drink sufficient.

Lots of older people don’t like the taste of plain water — it just wasn’t a thing to drink plain water in their youth and (like my dad and my MIL) they associate it with school.

It also wasn’t the custom, especially in working class families, to drink water with a meal (my father’s family firmly believed that it gave you indigestion to drink fluids at the same time as eating!) Having glasses of water or a jug of water on the table with a meal just wasn’t a thing for lots of British people in the 20th century. Tea or squash were sometimes permitted, but my paternal grandmother had a horror of plain water and also genuinely thought something quite dreadful would happen to you if you had soup and a drink at the same time, which she thought especially dangerous 😆

I’ve seen quite a few threads on MN about this thing about not drinking while eating. Some older people still don’t do it! My dad still goes on about how we’re all mad for taking water bottles around and nobody needs to drink water.

I have honestly never seen my MIL drink a glass of water — ever. She seems to get all her fluids from weak sugary Nescafé and a (very) occasional Tesco cola.

Would he perhaps drink the Orange juice with either still or sparkling water added?
I drink half and half fruit juice and water in the summer as I find it very refreshing and it would increase his amount he drank a bit.

What about other hot drinks people used to drink more often like Bovril or Camp Coffee?
You can get Horlicks or Ovaltine in mixes you just make with hot water.
If he has a sweet tooth, would he drink a slushie in the summer?

I think you need to come up with lots of little ways to add a bit more liquid here and there to get it up overall, so some in foods, some in drinks or desserts.
Jelly is mostly water, Angel Delight is mostly milk.
Maybe start by trying to get him to have 1 litre a day then slowly aim higher over time if/as he gets used to it, rather than going straight for 3 litres.

That really does seem like an awful lot and the sheer amount would put me off even trying.

Oh and the 3L thing is standard for kidney issues , I have CKD and a very active stoma so tend to drink 4L a day to stay ok top of things

Are you sure he's been told to drink 3 litres a day?
3 litres is what you need when you're ill in hospital and eating nothing.
Most younger people drink way more than they actually need, because of a myth promulgated by bottled water companies.

@Disscombobulated - the jelly sweets are usually sugar free. My mum had them too in the summer and she was diabetic. Your FIL's GP should have heard of them, I believe mum had them in hospital too although I can't be too sure about that, so they're very well known.

I remember in the ortho trauma ward all my mates were elderly. Everyone was always getting told off when the nurse checked the catheter. 'your urine is too dark! Drink some water!' we all started doing it to eachother and watching the pee get lighter!
It is definitely partly to do with not wanting to have to go to the toilet, either because of it being uncomfortable and taking ages mobility wise, or that they can't hold it in and don't want to be wet.

I would really struggle to drink 3l water even on days I've exercised a lot.
Generally (not all) elderly people are potentially more sedentary so won't be working up a sweat or feeling thirsty.
I'm pretty sure the signals or feeling of thirst decreases with age as well.
I never drank water as a kid, and never saw my parents drink it. I have to really persuade myself to drink a litre of water a day.

In answer to the query about types of jelly drops, @Disscombobulated : there appear to be several different brands. As you'll know, it's best to avoid those with artificial sweeteners since they can have a laxative effect.

This one claims not to have a laxative effective.

https://www.jellydrops.com/

Or rather, when you were growing up, people had some commonsense, and drank when they felt thirsty.

A drink with meals (which in the 70s were highly unlikely to be manufactured crap with loads of salt, but probably contained vegetables and fruit), plus a few cups of tea and coffee is probably all you need in moderate temperatures when you're not exercising hard.

It's usually having to get to the loo - be that an issue with mobility, speed getting there, incontinence, pain when mobilising.....

I get what you're saying, but it likely won't change
I see this every day (I work in a nursing home)

But 3L is a LOT,even for someone a lot younger, are you sure on the amount?

Bottled water is readily available in the UK- but it's not true that the tap water is 'heavily chlorinated' anyway- the levels are some of the lowest in the world.

He also has a stoma

I would go with food with lots of fluids, so soup as pp suggested, would he eat yoghurt, that's fluid rich, will he eat hot vegetables with a meal? I'm awful at drinking water but do try to eat lots of veg for the water. I also love a hot ribena. McDonald's milkshake? Obviously not very healthy but may be worth a go.

Because I love him and want him to have the best life possible..

Even people in their mid 40s weren't brought up to have bottles of water and to drink two litres a day etc.

We definitely were - am mid 40s and when we were small kids my mum used to have bottles of diluted squash with her everywhere we went (very diluted warm squash was what everyone drank in the 80s) — but by the 90s we were carrying bottles around school every day as teens (usually just reusing plastic 1L drinks bottles rather than all the nice water bottles today); but we would freeze them and carry them around school all day for ice water as they melted. Same for always having water at meals and so on. I’d say it was around the end of the 80s/beginning of the 90s that the water thing was already taking off.

@Disscombobulated OP would he drink a nice flavour of diluted squash, eg different flavours of Robinsons like lemon barley water or interesting fruit squashes?

3L is a huge amount, especially if he's never been a big drinker. Can you try not to focus on the end goal straight away and just build up to it slowly? Does he still have good hand strength and grip? If not, what if you put the water in smaller bottles, that are easier and less heavy to hold, like the 330ml kids' water bottles? Or use glasses that are easy to grip?

Could plain milk or milkshakes be an alternative drink for him? Or home made smoothies made from frozen fruit and water/milk?

It's also worth remembering, as others have highlighted, that some of the fluid we need comes from food.

https://www.bupa.co.uk/newsroom/ourviews/ten-water-rich-foods-hydration

Other than this, I don't think you can do much, OP. He needs to want to do it for himself and, if he doesn't, well, it's his choice.

I heard on the radio that there is a very tasty alcoholic free stout, would that do?
No alcohol.

He might just genuinely not feel thirsty so doesn’t feel like he needs to drink?