Cecilia Van Cauwenberghe from Frost & Sullivan’s TechCasting Group, provides several perspectives on dehydration in older adults in care homes, starting with a general overview
Dehydration refers to as hypertonic, hyperosmotic, or water-loss and an uncompensated, predominantly pure water deficit (Lacey et al., 2019). The underlying cause of such decompensation is generally a beverage intake insufficiency to balance potential fluid losses through urine, faeces, breath, and/or sweat.
An interdisciplinary team of researchers working at the Department of Dietetic and Nutritional Research of the Copenhagen University Hospital Herlev and Gentofte in Denmark, and the Institute of Nursing and Nutrition of the Faculty of Health, University College Copenhagen, also in Denmark, along with a group of investigators from the Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, in Germany (Beck et al., 2021), state that low-intake dehydration is a common and often chronic condition in older adults.
Consequently, the concentration of metabolites within body fluids increases while extracellular fluid volume diminishes, increasing serum osmolality (Wham et al., 2021). According to the researchers, the problem can be chronic, and the authors emphasise and raise awareness of this. The levels of osmolality associated with low-intake dehydration are lower among older adults living at home with their families than long-term care residents and hospitalised older people record significantly higher levels.
European initiatives to deal with high prevalence of dehydration in older adults
The European Society for Clinical Nutrition and Metabolism (ESPEN) performs a systematic guideline on nutrition and hydration in geriatrics, with the purpose to get objective evidence to make further recommendations around this problem (Volkert et al., 2019). Among the principal reasons for a high prevalence of low-intake dehydration among older adults, the diminution in the recovery capability of the physiological mechanisms with age would be the most notable fact.
In addition to physiological causes, other risk factors, including the side-effects of certain medicines, especially those causing diuresis; disabilities related to functional and cognitive impairment and poor nutrition; other physical issues impacting the access to beverages; unwillingness to fluid intake due to fear of incontinence; social isolation; among many others. Adverse effects related to low-intake dehydration in older adults are multiple; however, cognitive performance, heart failures, kidney diseases, which used to derive in hospitalisation with an increased likelihood of mortality, are of note.
Another team of researchers working at the Department of Health Services Research, Care Public Health Research Institute (CAPHRI) of the Maastricht University, in The Netherlands, carried out a study to examine dehydration in older adults from a different standpoint. The investigation focused on signs and symptoms of the presumption phase from the early diagnostic strategies associated with dehydration in older adults. Those signs and symptoms were observed by registered nurses (RNs) and certified nurse assistants (CNAs) in Dutch nursing homes in daily practice and their recommended actions (Paulis et al., 2021).
The study creates awareness concerning the critical need for interdisciplinary collaboration and communication with family members in care homes, establishing clear roles and responsibilities for the nursing teams.
Innovative point of care tests for preventive care
Regarding diagnostics, researchers working at the Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology of the University of Oxford, along with the medical staff from the Ophthalmology Research Hinchingbrooke Hospital of the North West Anglia, both in the UK (Bron and Willshire, 2021), have worked in the development of a simple point-of-care test for dehydration among older adults in care homes. According to the investigators, systemic dehydration due to low-water intake/excessive water loss, which leads to high morbidity and significant mortality in the elderly, may be prevented by increasing early-stage simple, bedside diagnostic tests in at-risk populations.
Precisely, the measurement of the plasma mentioned above osmolality (pOsm), tightly controlled over a wide range of physiological conditions, could provide a shred of reasonable evidence to take action before life-threatening conditions onset. Indeed, plasma hyperosmolality constitutes a robust diagnostic feature of systemic dehydration. In particular, the authors propose using basal tear osmolarity (BTO) to diagnose systemic dehydration due to the role of BTO as a surrogate for pOsm. This finding may significantly help the nursing profession, including those who care for older adults.
Final remarks
Dehydration constitutes an increasing concern in older adults, especially in care homes and hospitals. Comprehensive regional studies reveal the underlying aspects of this problem in Europe to provide more preventive care to older people.
Different public organisations in Europe designed and implemented a spectrum of effective interventions in the routine clinical practice to support adequate nutrition and hydration in older adults living at care homes to raise the nutritional status and improve their quality of life.
Innovations in diagnostics may offer meaningful solutions to the early detection of dehydration signs.
Acknowledgements
I want to thank all contributors from the industry involved with developing and delivering this article from Frost & Sullivan.
Further reading
- Beck, A.M., Seemer, J., Knudsen, A.W. and Munk, T., 2021. Narrative Review of Low-Intake Dehydration in Older Adults. Nutrients, 13(9), p.3142.
- Bron, A.J. and Willshire, C., 2021. Tear Osmolarity in the Diagnosis of Systemic Dehydration and Dry Eye Disease. Diagnostics, 11(3), p.387.
- Lacey, J., Corbett, J., Forni, L., Hooper, L., Hughes, F., Minto, G., Moss, C., Price, S., Whyte, G., Woodcock, T. and Mythen, M., 2019. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Annals of medicine, 51(3-4), pp.232-251.
- Paulis, S.J., Everink, I.H., Halfens, R.J., Lohrmann, C. and Schols, J.M., 2021. Dehydration in the nursing home: Recognition and interventions taken by Dutch nursing staff. Journal of Advanced Nursing.
- Volkert, D., Beck, A.M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C.C. and Sobotka, L., 2019. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical nutrition, 38(1), pp.10-47.
- Wham, C., Smithers, A., Kruger, R., Mazahery, H. and Richter, M., 2021. Factors associated with low‐intake dehydration among older inpatients: A pilot study. Australasian Journal on Ageing, 40(2), pp.e163-e172.
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