Dehydration is the abnormal loss of body fluids and if not corrected can lead to electrolyte imbalance. It is caused by increased fluid loss or decreased fluid intake and is a common occurrence for residents in Long Term Care (LTC) facilities. The advancement of disease is a major cause of dehydration in residents.
The Mayo Clinic’s definition: Dehydration occurs when you use or lose more fluid than you take in and your body does not have enough water or other fluids to carry out its normal functions. If you don’t replace lost fluids, you will become dehydrated
Nurses need to be aware that aging causes change in the body’s water composition. Thirst perception and renal function decline among older adults. Age related changes make older adults more vulnerable to shifts in water balance that can result in overhydration but more commonly in dehydration. Also, the thirst center does not function as well in geriatric residents. Dehydration can also cause the delayed healing of wounds as the wound bed requires adequate moisture to granulate.
Approximately 50% of elderly people have chronic kidney disease (CKD).
Usually, elderly people can maintain normal electrolyte balance. However, under stressful conditions hyponatremia, hypernatremia, volume depletion, hyperkalemia and metabolic acidosis can occur and if not quickly corrected can lead to high rates of morbidity and mortality.
It is also important that direct care staff know the residents who are at high risk for dehydration and recognize the risk factors, assess those risk factors and develop a care plan with measurable goals.
In order to maintain a good hydration program in a LTC facility, the following factors must be in place:
- Staff education: the direct care staff must know the risks of dehydration and the signs and symptoms associated with the condition. Make the staff realize that restricting fluids, does not decrease episodes of incontinence. Fever, infections, intense diarrhea, vomiting, excessive sweating in hot weather, inadequate intake and profuse wound drainage can all lead to dehydration.
- Staff assistance: you must have adequate staff and must give them enough time to feed residents as necessary and provide adequate fluids. Staff should also be aware of residents’ preference ( use of a straw, water temperature, ice etc.)
- A beverage cart during rounds should be used at least twice daily and between meals to provide water, fruit juice, watermelon and/or jello to provide additional hydration. The Activity department may be employed for that task.
- During the medication pass, 4-6 ounces of fluid should be provided to the patient. The staff should always be assisting, encouraging, providing verbal prompts and praise for the patient’s fluid intake.
- Nurses need to be aware of any medication or other situations that can cause increased output (diuretics or profuse diaphoresis in hypoglycemia).
- Water pitchers must be replenished as needed, placed within reach of the patient and be light enough for easy lifting. Clean cups or glasses should be provided.
- Fluids may also be provided during group activities and therapies and ambulatory residents should be provided with a water bottle.
Many of the residents in LTC facilities may be on thickened liquids. I have never found a resident who liked them. Neither taste nor consistency are very palatable. There are some that are fruit flavored but they are more costly. However with the help of the dietician and an order from the physician, naturally thick beverages may be substituted. Nectars, tomato juice, buttermilk, drinkable yogurt, ice cream, soups, jello and milk shakes offered frequently and in small volume may be an appropriate alternative.
