Today, at least 50% of nursing home patients are at risk of dehydration. Many are struggling to hydrate enough orally by
drinking water which could lead to comorbidities and a risk of early death. But exactly how serious is this problem?
Dehydration usually affects patients with weight loss/malnutrition risks, wounds, or infections. It is important to note
that water intake is not the same thing as hydration. Water intake is the water the body absorbs while hydration is the
water the cells in your body absorb. Hydration specifically requires electrolytes, which are the vitamins and minerals
the body needs, but some patients can’t get them from diets and water alone. These patients therefore need more
attention than others and might even include hospital stays. In fact, patients that are admitted to hospitals from
nursing homes are ten times more likely to be dehydrated than those who came directly from their own homes.
Drinking even 5% less water can lead to dehydration, which is referred to as a dehydration cascade. To balance the
extracellular fluid, the body moves water out of the organs and into the bloodstream. As the water exits vital organs
like the brain, the patient could experience worsened mood, high levels of fatigue, and reduced cognitive ability. Now
the patient is severely dehydrated and withdraws into their room, feeling less willing to get involved in personal care.
Eventually the patient could experience worse outcomes and require more reactive interventions.
From the outside, dehydration may seem like a simple problem, but there is no easy solution. 51% of nursing home
residents can be considered dehydrated while 89% may be seriously dehydrated according to plasma osmolality. The
dehydration cascade is posing a huge threat to nursing homes as dehydration continues to cause poor patient outcomes.
The issue unequally affects the patients in the hydration gap while increasing risks for falls. More falls means
prolonged surgical recovery leading to longer hospital stays and eventually higher mortality rates.
However, dehydration does not start with lab values. Medications could actually make dehydration worse, especially those
that are known to deplete fluids like antidiabetics, anticonvulsants, and antidepressants. These could leave patients at
higher risk. Lab values are only used to confirm dehydration, not prevent it. Some blood conditions can worsen the
effects of dehydration. This includes elevated hemoglobin, low potassium, and elevated sodium levels.
Many patients today are unaware that they are dehydrated or understand the signs. Cognitive decline is one that involves
patients being unable to communicate their needs effectively with caregivers. Physical markers are another sign with the
body’s signals for thirst declining with age. With salt loss, patients could drink enough water but not be hydrated
effectively because it is prevented by the imbalanced electrolytes and micronutrients in the body. As a person ages,
their kidneys lose the ability to concentrate urine, meaning that larger amounts of water is needed to flush them out.
Nonetheless there are ways to fight the hydration gap. One is through the use of micronutrient supplementation.
Micronutrient supplementation provides the body with important micronutrients to improve dehydration and therapeutic
outcomes. This can help rebalance intracellular fluid, reset the baseline for sustained oral hydration, and reduce risks
while improving cognitive function.
The proper infusion of vitamins and minerals for micronutrient supplementation addresses hydration for at-risk patients,
the derma for chronic wounds, nutrition for nutritionally deficient patients, cognition for those with cognitive
impairments, and infection for patients who are prone to getting infections or are immunocompromised. These infusions
can include vitamin C, biotin, magnesium chloride, glycine, and glutathione.
Closing the hydration gap in nursing homes is a tough challenge today, but with the use of advanced technology, we can develop science-backed treatments that can
solve the dehydration issue.