Fluid Intakes and Hydration Status of Institutionalized Elderly Nursing Home Residents

Abstract

LEARNING OUTCOME: To define a range of fluid intakes at which institutionalized elderly display signs and symptoms of dehydration. Fluid status among the institutionalized elderly is an important area for dietitians working in long term care. Currently, there is a paucity of research that examines the actual fluid intake and prevalence of signs and symptoms of dehydration among nursing home residents. In this study, a five-day fluid intake and output was conducted on 42 newly admitted or readmitted nursing home residents. During this period, selected clinical and laboratory indices were measured. These included: skin turgor, urinary output, condition or oral membranes, blood urea nitrogen (BUN), serum sodium, serum osmolality, hemoglobin and hematocrit. Information was also gathered on factors believed to affect dehydration risk including age, gender, level of feeding ability, meal consumption, and ability of residents to access fluids freely. Subjects with low fluid intakes (20-24cc/kg body weight) were able to maintain adequate hydration status. However, impaired hydration status became evident with intakes less than 20 cc/kg body weight. Subjects with poor meal intake had significantly lower fluid intakes than those with fair or good meal intakes. Individuals receiving thickened fluids also were at greater risk for developing dehydration. Dietitians should individualize fluid intake recommendations for residents in a long term care setting. Recommendations should be based in part on specific signs and symptoms of dehydration.