Elderly people are more likely to suffer from dehydration than younger people. Dehydration occurs when the body has too little fluids because more fluids are lost than are taken in. Dehydration can result in an overall decline in health, headaches, urinary tract infections, constipation, bedsores, kidney damage, and death. Dehydration is particularly problematic at nursing homes because nursing homes control the amount and types of fluids that are available to residents. Dehydration in nursing home residents is often a sign of abuse and neglect.
Understaffing is a major contributor to dehydration in nursing homes. Studies have shown that insufficient staff and supervision directly lead to residents becoming dehydrated. Many nursing home residents need encouragement and assistance to drink fluids regularly. When staff are unavailable to provide this help, residents may not get the necessary fluids.
Infections, such as viral and bacterial gastrointestinal infections, or conditions like C. diff colitis, often result in vomiting and diarrhea, leading to significant fluid loss. As the body expels the infection, it loses more water than is being taken in, increasing the risk of dehydration.
Medications, both prescription and over-the-counter, can also cause dehydration. Examples include potassium supplements, migraine medications containing caffeine, some diabetes medications, and various mental health drugs. Cancer treatments can further complicate matters, as certain medications cause excessive sweating, which leads to dehydration.
Dementia is another risk factor for dehydration, as individuals with dementia often struggle to recognize or communicate their thirst. This can result in insufficient fluid intake, even when water is available.
Certain medications, such as diuretics like Lasix and Bumex, prescribed for heart failure, flush excess fluids from the body. While this helps relieve stress on the heart, it can also cause dehydration due to the significant loss of water.
Laxatives are frequently administered to nursing home residents to treat constipation, which itself may be a sign of dehydration. However, the use of laxatives can further increase the risk of dehydration, especially in elderly individuals.
Infections or injuries to the mouth can make swallowing painful, which discourages fluid intake and increases the risk of dehydration. Examples include oral infections, sore throats, or poor dentition.
People who have difficulty swallowing (dysphagia), whether from brain injuries, strokes, or aging, are particularly vulnerable to dehydration. These individuals struggle to ingest fluids adequately.
Nursing home residents are sometimes prescribed thickened liquids due to swallowing disorders. These liquids, thickened to the consistency of nectar or honey, can be unappetizing and discourage drinking, leading to dehydration.
Dehydration in the elderly can be extremely dangerous, so nursing homes must be vigilant in recognizing the early signs. As dehydration worsens, the risk of permanent damage increases. Early signs of dehydration include:
Late signs of dehydration are more severe and may require hospitalization. These signs include:
Dehydration can lead to serious and sometimes irreversible complications, including:
To treat dehydration, the initial step is to rehydrate the resident and restore electrolyte balance. Electrolytes are essential minerals like potassium, sodium, and calcium that the body needs to function correctly.
For mild to moderate dehydration, treatment usually involves encouraging the resident to drink more fluids, such as water or electrolyte-rich beverages like sports drinks or Pedialyte. These fluids help restore the necessary balance of electrolytes.
For more severe dehydration, intravenous (IV) fluid resuscitation is required. IV fluids, typically a saline solution with vital vitamins and minerals, are absorbed fully by the body, making them more effective than drinking water alone.
If dehydration causes complications, additional treatment may be required in an outpatient or hospital setting. For instance, if a resident suffers from hypovolemic shock, they will need IV hydration and medication to increase blood output from the heart. Infections like urinary tract infections or oral infections will require antibiotics, and any injuries from falls must also be addressed.
Nursing homes are responsible for creating an environment that promotes the health and well-being of their residents. This includes taking steps to prevent dehydration, such as:
When nursing homes fail to take these steps, they can be held liable for abuse and neglect.
