Factors contributing to dehydration in nursing homes: Inadequate staffing and lack of professional supervision

OBJECTIVE: To investigate the factors that influenced fluid intake among nu rsing home residents who were not eating well. DESIGN: A prospective, descriptive, anthropological study. SETTING: Two proprietary nursing homes with 105 and 138 beds, respectively. PARTICIPANTS: Forty nursing home residents. MEASUREMENTS: Participant observation, event analysis, bedside dysphagia sc reening, mental and functional status evaluation, assessment of level of fa mily/advocate involvement, and chart review were used to collect data. Data were gathered on the amount of liquid served and consumed over a 3- day pe riod. Daily fluid intake was compared with three established standards: Sta ndard 1 (30 mL/kg body weight), Standard 2 (1 mL/kcal/energy consumed), and Standard 3 (100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, 15 mL/kg for the remaining kg). RESULTS: The residents' mean fluid intake was inadequate; 39 of the 40 resi dents consumed less than 1500 mL/day. Using three established standards, we found that the fluid intake was inadequate for nearly all of the residents . The amount of fluid consumed with and between meals was low. Some residen ts took no fluids for extended periods of time, which resulted in their flu id intake being erratic and inadequate even when it was resumed. Clinical ( undiagnosed dysphagia, cognitive and functional impairment, lack of pain ma nagement), sociocultural (lack of social support, inability to speak Englis h, and lack of attention to individual beverage preferences), and instituti onal factors (an inadequate number of knowledgeable staff and lack of super vision of certified nursing assistants by professional staff) contributed t o low fluid intake. During the data collection, 25 of the 40 residents had illnesses/conditions that may have been related to dehydration. CONCLUSIONS: When staffing is inadequate and supervision is poor, residents with moderate to severe dysphagia, severe cognitive and functional impairm ent, aphasia or inability to speak English, and a lack of family or friends to assist them at mealtime are at great risk for dehydration. Adequate flu id intake can be achieved by simple interventions such as offering resident s preferred liquids systematically and by having an adequate number of supe rvised staff help them to drink while properly positioned.