Dehydration

Dehydration, or inadequate hydration, occurs when a person's loss of body fluids is more than his or her intake of fluids. Like malnutrition, dehydration can lead to a variety of serious health problems, like:

• Confusion and disorientation
• Urinary tract infections
• Bedsores
• Pneumonia
• Death

According to the Health Care Financing Administration, dehydration was ranked one of the ten most frequent admitting diagnoses in a study on Medicare hospitalizations. Increasing age is one of the major risk factors for dehydration. In fact, those persons between the ages of 85 and 99 years are six times more likely to be hospitalized for dehydration. It is very important that healthcare providers in nursing homes recognize that elderly are at risk for developing dehydration. When a person is recognized as being at risk for dehydration, preventative measures should be taken from the offset to avoid dehydration.

A person at risk for dehydration should have a hydration program in place at the nursing home. A hydration program would include assisting the person with drinking, offering fluids at mealtime and in between meals, looking for signs and symptoms of dehydration, notifying the physician if such signs and symptoms are present, recording the residents and intravenous fluid replacement when the physician deems it necessary.

Negligence Related to Malnutrition and Dehydration

Two out of five nursing home residents suffer from malnutrition, and dehydration is the most common fluid and electrolyte disorder of frail older people. Malnutrition in nursing home residents can occur for a variety of reasons, including the resident's inability to process food and ill-fitting dentures. Dehydration can occur for a variety of reasons as well, including diarrhea and the effects of medication. Unfortunately, malnutrition and dehydration can also occur due to a nursing home's negligence in a variety of situations, including:

• Failure of the nursing home to employ adequate staff, which results in the staff's inability to properly feed the residents
• Failure of the staff members to pay adequate attention to those residents needing assistance with eating
• Failure of the nursing home to properly educate the staff on nutrition and feeding methods
• Failure of the nursing home to provide proper supervision over those who provide nutritional services
• Reliance on liquid supplements as opposed to making sure each resident eats enough food to get necessary vitamins, minerals, protein, and calories

If you notice that your loved one has signs of malnutrition or dehydration or if you think that they are not getting enough food or fluids at the nursing home, you should immediately notify the nursing staff and the physician to prevent potentially serious, life-threatening consequences.

Effects of Understaffing

Government statistics show that 47% of residents in nursing homes need assistance with eating. 21% of residents are completely dependent for help. In addition, patients in nursing homes often need more water than the average person because of the medications they are taking. If the nursing home is understaffed, then there may not be anyone available to take the time to see that the patient has had enough to eat or to drink.

Tips to prevent malnutrition and dehydration

• Make sure your loved one in a nursing home drinks plenty of water. Eight glasses a day is recommended, unless there is a medical reason for restricting fluids. In addition to water, your loved one should drink plenty of juice.
• Insist on a pitcher of water and cups in the room. Make sure the resident can handle the pitcher and cups. If needed, insist on oversized cups with lids and built-in straws.
• Make sure your loved one eats three well-balanced meals per day.
• Insist on a daily weigh-in with accurate record keeping. Review weight records to monitor gain or loss.
• Make sure the resident's food tray hasn't been placed too far away so that it is difficult to reach.

Signs that may indicate that your loved one is suffering from malnutrition and/or dehydration:

• Weight loss
• Cracks around the mouth
• Pale lips and mouth
• Complaints that dentures no longer fit
• Unexplained confusion
• Mouth sores
• Thinning hair
• Loose, flappy skin
• Dry skin
• Sunken eyes
• Urinary tract infection
• When the resident eats or drinks more when a friend or family member assists with feeding
• If you observe patients being fed in a circle by one nurse's aide. This could indicate that there is not enough staff to properly ensure all residents are eating enough food and drinking enough liquids.

If your loved one shows even one of these signs, you should:

• Immediately inform the doctor and staff members of your observations
• Immediately request a care planning conference with the physician to discuss possible causes for the symptoms and to set up a plan for meals and feeding assistance
• Monitor the situation. If it does not improve within days, you should contact authorities

If you even remotely suspect the situation may be life-threatening, take immediate steps to get your loved one to a hospital emergency room.

Legal evaluation of dehydration claims

Nursing home residents should not suffer unnecessarily from dehydration which can be prevented with proper care.

In reviewing your potential case, we will look for the following predisposing factors in the medical records that should have prompted the health care providers to take measures to prevent dehydration:

• Age greater than 85 years
• Diseases that may promote dehydration such as pneumonia, chronic obstructive pulmonary disease, diabetes, urinary tract infections, congestive heart failure, high blood pressure, and kidney disease
• Physical limitations which prevent the person from drinking enough fluids. For example, persons that have had a stroke, suffer from arthritis, have difficulty swallowing, loss of vision, or are confined to bed, may not have the ability to drink enough fluids themselves without assistance from a care giver
• Some prescriptions drugs can predispose the elderly to dehydration. For example, people that take diuretics (water pills), those who take sedatives and excessive use of laxatives may contribute to dehydration
• Weight loss and dehydration usually go hand in hand

In reviewing the medical chart, we will look for the following indicators of dehydration:

• Dry mouth
• Sunken eyes
• Concentrated urine
• Dry skin
• Lab values obtained through blood work that show signs of dehydration