British Study Shows Higher Risk for Dehydration in Nursing Home ResidentsAug 19, 2015
A recently published British study found a higher incidence of dehydration in older people in hospitals and nursing homes, who may not be getting the help they need to achieve adequate fluid intake.
Older people, particularly those who are infirm, are at risk for dehydration, especially those in nursing homes or hospitals, who may require assistance drinking. Nursing home staff sometimes neglect to give people the necessary help in drinking, Nursing Times (nursingtimes.net) reports.
Mild-to-moderate dehydration in older people is easily missed and often it is detected only on admission to a hospital, where tests reveal hypernatremia (high plasma sodium), a common sign of dehydration. A recent study in the Journal of the Royal Society of Medicine linked hospital admissions with nursing home residency to see whether patients from nursing homes are at higher risk for hypernatremia than those living in their own homes. The researchers reviewed records of all patients age 65 and over on first admission to Barnet and Chase Farm Hospitals Trust between January 2011 and December 2013. The data included age, gender, admission type (emergency or planned), presence of dementia, and residence (nursing home or own home).
Laboratory data was used to assess whether patients were dehydrated on admission and whether they subsequently died in hospital. The presence of hypernatremia in the first 24 hours after admission was used to measure dehydration. The authors reviewed 21,610 admissions and 432 cases of hypernatremia; 1,413 hospital deaths were recorded. People living in nursing homes were 10 times more likely to be admitted to the hospital with dehydration than patients who lived in their own homes. Only 1.3 percent of patients from their own homes had high plasma sodium levels caused by dehydration, compared with 12 percent of patients from nursing homes, according to Nursing Times. The hospital patients who came from nursing homes were older and more likely to have dementia. After adjusting for age, gender, admission type and presence of dementia, the researchers found the risk of high sodium was still more than five times higher for nursing home residents. While admission from a nursing home was not inevitably associated with hypernatremia, the probability was significantly increased in about a third of nursing homes. The lowest probability of hypernatremia on admission was for people who lived in their own homes and had no diagnosis of dementia, followed by own-home residents with dementia. Next were nursing home residents with no dementia followed by nursing home residents with dementia. The adjusted figures also showed nursing home residents were about twice as likely to die while in the hospital. Hypernatremia itself was associated with a five-fold greater risk of in-hospital mortality.
The study results confirmed the risk of hypernatremia was higher in patients who lived in nursing homes than those living independently, and its presence on admission is an important predictor of in-hospital mortality. The reasons for this are not clear, but the authors suggest it could be that nursing home residents choose to drink less than they should, or staff members are not offering them enough water in order to reduce incontinence. The authors conclude that too many patients admitted to hospitals from nursing homes are dehydrated on admission, leading to unnecessary loss of life, according to Nursing Times.