Dehydration

Dehydration is the most common fluid disorder of frail older people. Malnutrition in nursing home residents can occur for a variety of reasons, including the patient’s inability to process food and ill-fitting dentures. Dehydration can occur for a variety of reasons as well, including diarrhoea and the effects of medication.

Unfortunately, malnutrition and dehydration can also occur due to a facilitiy's negligence in a variety of situations, including:

• Failure of the facility to employ adequate staff (which results in the staff’s inability to properly feed the residents)
• Failure of the facility to pay adequate attention to those residents needing assistance with eating
• Failure of the facility to properly educate the staff on nutrition and feeding methods
• Failure of the facility to provide proper supervision over those who provide nutritional services
• Reliance on liquid supplements as opposed to making sure each resident eats enough food to get necessary vitamins, minerals, protein, and calories

If you notice that your loved one has signs of malnutrition or dehydration or if you think that they are not getting enough food or fluids, you should immediately notify the carer/nursing staff and the physician to prevent potentially serious, life-threatening consequences.

Dehydration

Dehydration, or inadequate hydration, occurs when a person’s loss of body fluids is more than his or her intake of fluids. Like malnutrition, dehydration can lead to a variety of serious health problems, like:

• Confusion and disorientation
• Urinary tract infections
• Bedsores
• Pneumonia
• Death

Increasing age is one of the major risk factors for dehydration. In fact, those persons between the ages of 85 and 99 years are six times more likely to be hospitalised for dehydration. It is very important that healthcare providers in nursing homes recognise that elderly are at risk for developing dehydration. When a person is recognised as being at risk for dehydration, preventative measures should be taken from the offset to avoid dehydration.

A person "at risk" for dehydration should have a hydration program in place at the nursing facility. A hydration program would include assisting the person with drinking, offering fluids at mealtime and in between meals, looking for signs and symptoms of dehydration, notifying the physician if such signs and symptoms are present, recording the residents and intravenous fluid replacement when the physician deems it necessary.

Signs of Dehydration

Many thanks to Ila Swan for providing the following information:

"I will first give you what I have seen happen, then I will give you the clinical version of it - When a person's fluid level drops, either due to: inadequate fluid intake, vomiting, sweating or diarrhea, the first indications of not enough fluid in the system would be:

1.	darkened yellow-amber colored urine.
2.	strong smelling or foul smelling urine.
3.	the appearance of the skin loses its normal appearance, scaly skin. The thing I look for in the skin, is extended normal veins under the skin. A person who is not dehydrated has veins that pop right back in place when you press gently on them. If you look at the back of your hand, you can see where the blood vessels sort of sit up above the basic skin. When a person is dehydrated, GENTLY using your thumb and pointer finger, pinch the skin together on the back of the hand to form a peak. In a person who is suffering dehydration, the peak will stay up in the peak position about twice as long as the skin of a person who is not dehydrated. The reason for this is the volume of blood in the blood vessels and volume of fluid in the tissues under the skin is insufficient to stretch the skin back to it's normal place.
4.	urinary tract infection.
5.	poor posture: the patient's posture changes from sitting upright to drooping at the shoulders, leaning to one side or the other, basically slumped over.
6.	"cotton mouth.' White sputum in the corners of their mouth and a white marbled tongue, the spit seems too stringy.
7.	confusion.
8.	feeling faint or even fainting and falling down.
9.	gasping for air (air hunger): most often in severe cases of dehydration, the blood becomes thickened and does not carry enough oxygen through the vessels to oxygenate the person. So you will see the person gasping for air. It's a horrible site and death can take hours, while you watch the person struggling to get air.
	Clinical Version: The principal physical signs are decreased skin turgor, a shrunken and corrugated tongue, postural hypotension, in severe cases there is shock, lethargy, weakness, confusion and oliguria (little urine). Plasma protein concentration and hematocrit are increased or decreased, depending on the proportions of sodium and water loss. Renal function is always compromised."

I hope this will help you,
Ila Swan