Every year, over a million patients are hospitalized for sepsis.
Dehydration occurs when the body is losing more water than it is taking in. For elderly nursing home residents, the dehydration is associated with higher mortality rates. Common causes of dehydration in the elderly include:
● Medications that act as diuretics, such as some medications for high blood pressure or antidepressants
● Loss of the sense of thirst due to advanced age or cognitive impairment
● Loss of mobility that prevents obtaining fluids when thirsty
● Loss of cognitive ability to notify a caregiver of their fluid needs
● Loss of the kidney’s ability to conserve fluid
● Acute illnesses, especially one that causes fever, vomiting and/or diarrhea, also can cause elderly dehydration.
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Causes of Dehydration
While not all instances of dehydration are preventable, some nursing homes neglect to provide care that meets established standards to avoid dehydration. Understaffing in nursing homes is frequently a culprit of neglect that results in dehydration and its complications. Certified Nursing Assistants (CNAs) are often responsible for 10 or more residents during their shift. In these situations, adequate oversight and assistance with obtaining fluids, both at mealtimes and throughout the shift, are overlooked. Some CNAs have even admitted to restricting fluids in order to decrease the instances of incontinence so that they have to change the residents’ briefs less frequently.
Uneducated staff are to blame for some instances of dehydration. Nursing home staff who are unaware of the signs and symptoms of dehydration can fail to intervene. Symptoms of dehydration may vary, but most symptoms in the elderly are consistent among cultures and health co-morbidities Staff members should be able to identify early symptoms of dehydration, such as a dry, sticky mouth, expressing thirst, dry skin, and decreased urine output and frequency. Left unaddressed, in the later stages of dehydration symptoms may develop such as confusion and irritability, the inability to perspire, sunken eyes and cheeks, low blood pressure, tachycardia, delirium, and unconsciousness. Nursing home nurses and CNAs should be able to recognize these signs and symptoms and intervene efficiently.
Complications of Dehydration
When dehydration is not quickly recognized and addressed, it can quickly spiral into medical complications. Kidney failure a common complication of dehydration. Another complication is shock, in which the fluid loss results in compromised delivery of blood and oxygen that can result in organ failure. Finally, dehydration can result in electrolyte imbalances that cause muscle weakness and cardiac issues. Death is a real and unfortunate reality when dehydration causes these severe complications.
If you are concerned whether your loved one is getting adequate fluids while in a nursing home, there are some indicators to look for:
Is fresh water provided at bedside each shift that is within reach of the resident? Residents on thickened liquids are an exception; they may not be able to have unattended bedside fluids. In this case, even greater attention must be paid to staff offering and supervising fluid intake throughout the day.
Are aides and nurses attentive to residents at mealtimes? Is adequate physical assistance or verbal cues provided to encourage optimal fluid intake?
Does the facility maintain a list of resident drink preferences? Are staff knowledgeable about resident drink preferences and offer the drinks most enjoyed by the resident?
Are residents accurately and regularly assessed by a registered nurse knowledgeable of the signs and symptoms of dehydration? Is the physician involved in monitoring lab values as needed?
If you are concerned whether your loved one is getting adequate fluids while in a nursing home, there are some indicators to look for:
Is fresh water provided at bedside each shift that is within reach of the resident? Residents on thickened liquids are an exception; they may not be able to have unattended bedside fluids. In this case, even greater attention must be paid to staff offering and supervising fluid intake throughout the day.
Are aides and nurses attentive to residents at mealtimes? Is adequate physical assistance or verbal cues provided to encourage optimal fluid intake?
Does the facility maintain a list of resident drink preferences? Are staff knowledgeable about resident drink preferences and offer the drinks most enjoyed by the resident?
Are residents accurately and regularly assessed by a registered nurse knowledgeable of the signs and symptoms of dehydration? Is the physician involved in monitoring lab values as needed?