* ECPN * January/February 2001

Nutrition
Prevent Dehydration in Long-Term Care Settings

Annette M. Kobriger, RD, CD, MPH, MPA

Inadequate fluid intake is a common problem for long-term care residents, particularly the elderly. Older people simply do not feel as thirsty as younger people do, even when they are dehydrated. As we age, the thirst response decreases due to physiological changes. In other words, the receptor in the brain that signals the feeling of thirst becomes less effective as a person ages. It is up to long-term care clinicians to encourage fluid intake by their residents; the residents may not do it on their own. Here are some techniques that may promote hydration in long-term care residents.

Implement fluid assessment and care plans. Long-term care facilities should assess the residents, flagging those at risk for dehydration. A care plan of action for maintaining adequate hydration should be implemented for all residents. Each resident's care plan should tell staffers how many fluid ccs a resident should take, noting special requirements if the resident is at risk for dehydration.

Implement daily beverage/snack programs. Long-term care facilities may implement daily programs that encourage fluid intake. For example, clinicians can make several rounds throughout the day with a beverage cart containing a variety of liquids from which the resident can choose, e.g., juice, tea, coffee, soda, milk, water. Another example is to offer a daily snack time, i.e., teatime, during the mid-afternoon. This is not only an excellent opportunity to offer residents high-protein, high-calorie snacks and variety of beverages, but also an opportunity for residents to socialize with each other and with loved ones.

Offer interesting alternatives. Some residents may respond better to things like Jello, sherbet, popsicles, health shakes, or ice cream. Adding something like 7-Up to juice may improve the taste and appeal to some residents. Long-term care facilities should avoid offering the same choices to their residents day in and day out.

Use thickening agents. Frequently, the elderly have problems swallowing thin liquids. In cases like this, thickening agents may be useful. Frequently, however, residents will not accept commercial thickening agents. Try using yogurt or instant pudding mix to thicken milk or other beverages.

Increase fluid quantity at medication. Clinicians may want to increase the quantity of fluids offered to the residents during medication. For example, clinicians may offer six ounces of fluids instead of the typical two ounces when administering oral medications to residents.

Monitor fluid content in food. Food contains fluids too, and can contribute to the hydration maintenance care plan of residents. Cereal, fruit, and vegetables are all excellent sources of fluids. (See Tips on Hydrating Residents, September/October 2000, ECPN).

Be persistent. Persistence by the clinician is key when increasing fluid intake by residents. Clinicians should encourage and remind their residents throughout the day to drink fluids. Clinicians should carefully monitor fluid intake and output (I & O) on residents' care plans. Remember, just placing a glass of water in front of a resident is no guarantee the resident will drink it. ***