Generation of thirst: a critical review of dehydration among older adults living in residential care

Abstract

Dehydration is common among older adults and exacerbated in residential care. In this article, the authors summarise the reported prevalence of dehydration in this sub-population group and evaluate the associated risks before reviewing interventions designed to improve hydration. Heterogeneity in methods to assess dehydration inhibits interpretation of both prevalence and intervention studies (primarily small randomised control trials and case-control observational studies). The estimated prevalence of dehydration among older adults in residential care is 20-38%, with further increased prevalence of inadequate fluid intake, leading to increased urological, gastrointestinal, circulatory and neurological disorders or, in extreme cases, death. Multi-component interventions that include changes to drinks, vessels, placement and drinking opportunity, alongside staff training and support, are most effective in tackling dehydration in residential care. The detection and prevention of dehydration is crucial, and a practical, population-specific reference standard for adequate fluid intake is warranted. Future research should prioritise interventions that are individualised to residents' needs, according to dehydration typology. Ongoing investment in the care sector should address staff-to-resident ratios and enhance staff training on the detection and prevention of dehydration.

An exploration of hydration practices in Maltese residential care homes for older people

“…The latter was particularly prominent in helping address refusal of fluids and often resulted in positive outcomes. These findings support a body of work that highlights the importance and benefits of a person-centred approach in promoting hydration in older persons (Bunn et al 2015;Wilson and Dewing 2019;Hart et al 2020). Fundamental to this approach is the consideration of residents' preferences with regards to beverage choice (Mentes 2006;Shaw and Cook 2017;Jimoh et al 2019;Volkert et al 2019).…”

“…They noted that there is a strong social aspect when promoting hydration, as many hydration strategies were linked to social activities and/or gatherings. Other researchers have made similar observations and have highlighted the importance of staff regularly offering beverages and diligently prompting residents to drink (Shaw and Cook 2017;Bunn 2019;Hart et al 2020). Potential successful hydration strategies found in recent literature include the use of equipment, such as specialised beakers, increased staff awareness of the importance of hydration, the use of feeding assistants, improved atmosphere and environment design at mealtimes, greater choice and availability of beverages, and increased frequency of routine offers (Kingston 2017;Allen et al 2014).…”

Dehydration in geriatrics: consequences and practical guidelines

“…This distinction is important because treatment of dehydration depends greatly on understanding the aetiology. Dehydration is an enormous health problem for older people, with the prevalence ranging from 60% in community settings [2], to 58% on admission to hospital [3], and up to 100% of elders who reside in long-term care depending on which assessment tool is used [4,5]. The purpose of this paper is to describe the causes and consequences of dehydration, and provide updated practical guidance for identification, treatment and management of dehydration in geriatric populations, with a particular emphasis on papers published in the previous 2 years.…”

Wet Your Whistle with Water (W3) to Improve Water Intake in Seniors’ Care

“…Dehydration is associated with poor health outcomes that range from delirium, constipation, urinary tract infections, reduced quality of life, increased risk for falls, increased number of hospitalizations, morbidity, and mortality (Edmonds et al, 2021;Hart, Marsden & Paxman, 2020;Hooper et al, 2015;Lean et al, 2019). Due to a lack of a gold standard to determine dehydration in LTC and RH, fluid promotion is considered a reliable approach to prevent dehydration (Hooper et al, 2015;Keller et al, 2022).…”