Interdisciplinary

Approaches to

Hydration

Lindsey Callihan MS, RD, CD

Why Care about Hydration?

Maintains blood

pressure

Transports minerals

and salt in blood

Detoxifies and

provides waste

removal

Body temp regulation

http://www.onedayhike.org/training/firstaid/dehydration.html

Consequences and Symptoms

of Dehydration

Decreased energy

Increased temperature

Increased confusion

Increased risk of mortality

Muscle cramps

Dizziness

Headaches

Wt loss

Risk Factors for Dehydration

in Elderly

Altered thirst sensations

Impaired cognition/dementia

Increased fluid losses (vomiting, diarrhea, fever, uncontrolled Diabetes)

Medications

Fluid restrictions

Thickened liquids, assisted feeding

Clinical Signs of Dehydration

Decreased consciousness

Poor skin turgor

Dry mouth, lips, tongue

Confusion

Dizziness

Headaches

Dark (concentrated) urine

Rapid heart rate

Constipation

Diagnostic Tests for

Dehydration

Labs:

Serum osmolarity

Elevated BUN to creatinine ratio (BUN:Cr)

Increased serum sodium

Decreased blood pressure

Important to compare status with resident’s baseline cognition/alertness

How Much Fluid is Enough?

Determined by the Registered Dietitian

and listed in Nutrition Assessment

Based on body weight: ~30ml/kg

Adjusted based on clinical conditions,

swelling, edema, GI issues, fluid

restrictions

Hydration Team

Doctors

Dietitians

Speech Therapists

Nursing Staff

OT/PT/Restorative

Activities

Foodservice

Role of Nursing Staff

Identifies baseline and monitors

changes

Monitor daily signs of

dehydration

Records and monitors input and

output

Provide fluids with meds and

PRN

Assist with fluid intake when

needed

Role of Therapies:

OT/PT/Restorative

Works with resident to improve ADL’s to

increase independence as able

Prescribe adaptive equipment to improve

intake

Offers fluids before and after physical activity

Role of Activities

Incorporate fluids into

social experiences

Offers refreshments

during activities and

during day

Provides pleasurable

atmosphere for

food/fluid consumption

Role of Food Service

Provides beverages and foods which contribute to fluid status

Includes:

Water, coffee, tea, milk, juice, flavored waters, soda

Fruits and vegetables

Soups, broths, gravies, yogurt

Gelatin, popsicles, hot cereal

Provide culturally appropriate and preferred beverages and foods

ChallengesEducation to the resident and family is key!

Fluid Restrictions

Heart conditions/volume control

Electrolyte imbalances

Tips and tricks: ice cubes, mouth swabs, avoid sugary beverages

Thickened liquids

Swallowing difficulty

Aspiration pneumonia risk

Choking/coughing

Non-Compliance?

How Can We Help?

Identify needs and preferences

Ensure fluids are ready and appropriate to

drink

Make fluid intake pleasurable and varied

Encourage fluid intake multiple times per day

Encourage resident and family compliance to

restrictions and modifications

References

1. Godfrey, H., Cloete, J., Dymond , E. and Long, A. (2012) An exploration of the hydration care of older people: A qualitative study. International Journal of Nursing Studies, 49 (10). pp. 1200-1211.

2. Faes MC, MD, MSc, Spigt MG, PhD, Olde Rikkert MGM, MD, PhD. Geriatrics and Aging. 2007;10(9):590-596.

3. Ferry M. Strategies for ensuring good hydration in the elderly. Nutr Rev. 2005;63:S22–9

4. Maughan RJ, Griffin J: Caffeine ingestion and fluid balance: a review. J Hum Nutr Diet 2003, 16:411–420.,

5. Texas Department of Aging and Disability Services. Hydration Care: Preventing Dehydration in Long-Term Care Facilities. 2009. Web. <http://www.dads.state.tx.us/qualitymatters/qcp/hydration/hydrationcareppt.pdf>.

6. Ruxton CHS. The impact of caffeine on mood, cognitive function, performance and hydration: a review of benefits and risks. Nutr Bull 2008; 33: 15–25.

7. "Water: The Fountain of Life." Family Resource Center. Illinois Council on Long Term Care, n.d. Web. 8 Jul 2013. <http://www.nursinghome.org/fam/fam_018.html>.

8. Woodward, Michael. "Guidelines to Effective Hydration in Aged Care Facilities." . Hydralyte, n.d.Web. 8 Jul 2013. <http://www.hydralyte.com/pdf/aged_care_brochure.pdf>.

9. American Journal of Lifestyle Medicine, "Medications May Affect Hydration Status." Andrea N. Walter, MS, Thomas L. Lenz, MA, PAPHS. Am J Lifestyle Med. 2011;5(4):332-335. <http://www.medscape.com/viewarticle/747333_3>

10. National Guideline Clearinghouse, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. "Dehydration and fluid maintenance in the long-term care setting." <http://www.guideline.gov/content.aspx?id=15590>