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Dehydration common in patients admitted from care homes


Patients admitted to hospital from care homes are commonly dehydrated on admission and consequently are at significantly greater risk of in-hospital mortality, according to a major UK study.

Although known to be a problem anecdotally, the new study has identified the risk of dehydration from care home patients to be five to 10 times that of patients living in their own home.

Researchers reviewed over 20,000 patients aged 65 years and over admitted to a London hospital for the first time between January 2011 and December 2013.

They found 1% of patients admitted from their own home were found to have high sodium levels – caused by dehydration – while the figure for patients admitted from care homes was 12%.

After adjustment for a number of possible explanatory factors, including age and dementia, the risk of high sodium levels was still over five times higher for those admitted from care homes.

“Clearly this level of dehydration is a problem. Further research is needed to understand why it is occurring”

David Stuckler

The study was carried out by researchers from Barnet and Chase Farm Hospitals NHS Trust – taken over by the Royal Free London NHS Foundation Trust in July 2014 – Oxford University and the London School of Hygiene and Tropical Medicine.

Lead author Dr Anthony Wolff, from the Royal Free, said: “Our study shows that too many patients admitted to hospital from a substantial number of care homes are dehydrated, leading to unnecessary loss of life.

“High sodium levels in care home residents should raise questions about adequate support for drinking,” he said.

Co-author Professor David Stuckler, from Oxford University, said that “clearly” the level of dehydration identified in the study was “a problem”.

He added: “Are care home residents choosing to drink less than they should? Or, as has been speculated, are care home staff not offering enough water to reduce incontinence and the amount of assistance their residents require?”

The findings were published today in the Journal of the Royal Society of Medicine.


Readers' comments (10)

  • Although anomalies have been taken into account to justify these elevated figures, I feel some relevant information is missing.Resident form care homes are adnmitted with a disease that cannot be reversed and there is an assumption their disease is therefore progresive. This would therefore point to them sitting under a palliative care diagnosis. if the study then did a like for like on palliative patients the figures would most likely be similar. There is probably 40% of residents suffer from a swallowing difficulty either through their progressive disease or dementia. I agree there is a large proportion of resident admitted with dehydration but trying to hydrate resident with end stage dementia is very challenging and NHS professionals such as the speach and language therapist are very thin on the ground therefore support and advise that is timely and local, results in these admissions.

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  • I agree with the above statement. Residents in care homes are only there because they are not capable of seeing to their selves. I mean would you pay £800 + per week if you could look after yourself in your own home? So therefore at home an elderly person is or should be able to make their own drinks and if not have rels or carers to ensure they are drinking. Elderly residents in a care home are only admitted to hospital if they or their relatives think their condition is treatable e.g. they would not go in if they were dying. When a resident is poorly they usually go off their food and drink. They cannot be forced to drink only encouraged. Even then encouragement must be with caution because if you tip a drink in someones mouth and they don't want it they could aspirate. Obviously there are no facilities to pop an IV in. So with that in mind of course they are going to be admitted to hospital with some degree of dehydration where maybe a course of IV abx and fluids may be enough to make them feel like eating and drinking again. If not maybe the elderly patient has given up and wants to die after all eating and drinking is their only control at that stage. I know that all residents who need assisting with diet and fluids are monitored via their charts so dehydration can be picked up quickly. But I think it is very unfair to make out that residents are not properly looked after in nursing or care homes as the latest news articles are suggesting.

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  • I'm surprised at the shallowness of the reporting here - and the callous attitude of the "researchers". Thank you for the two reasoned responses above - as a nursing home provider I can confirm the potential difficulties described, that fluid intake is monitored within the resident's care plan and that our experienced RNs will be fully aware of dehydration if it's occrring. It's also likely that a resident exhibiting signs of dehydration would have been seen by a visiting GP.

    If these researchers would climb down from their ivory tower they might discover that care homes are as committed (within our remit) to patient well-being as any other health provider.

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  • Anonymous | 19-Jan-2015 0:17 am

    hopefully your comment applies to the majority of care homes but what of all those reported and found by the QCC not to be up to standard?

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  • Let me tell you about CQC inspections at nursing homes! The inspectors are inexperienced, unqualified herberts who have only been schooled in the rigid application of an absurd assessment system. They are almost entirely focused on finding un-ticked tick boxes. They wouldn't notice GOOD care if it jumped up and bit them on the nose and they rarely uncover BAD care (the public generally does that for them).

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  • Anonymous | 20-Jan-2015 10:26 pm

    just as I had suspected from reports in the media. self regulated quality regulation and certification where every member of staff is involved and can communicate openly about their work motivates staff and gives them pride in what they do and anybody not up to standard can be supported and sacked if not successful or suited to the job.

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  • As a Proprietor of Nursing Homes, it warms my heart to read the above comments, at last you are showing how proud you are in your job, you should be !! it is specialist and I have been advicating that there ought to be specialist training organised and funded independantly to the NHS by the Private Sector. any constructive views on this would be welcomed .By the way I wonder why we are all Anonymouses ?

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  • To anonymous 19 Jan - From the above comments it would seem that some care home staff are conscientious about keeping people suffering from dementia hydrated but it definitely is not true for all homes. My mother had dementia and lived in a care home where she was at times dehydrated I am sure. Her swallow reflex was good but her neck was stiff and so she could not drink right to the bottom of the mug. She was sometimes missed out of drink rounds being in a side room. Sometimes medication seemed so heavy that she was too dopey to drink. There were not enough drinks rounds anyway- only 5 a day and the cups were small. Emphasis was put on feeding but they were definitely negligent about ensuring enough to drink. Giving her what she wanted, she could drink over 800 mls at a sitting. Discussion with management and GP was unfruitful. The home has rightly been classified by the CQC as inadequate and enforcement action is being taken eventually but it should not have registration for nursing care. She had numerous pressure sores when she died and was drastically underweight. But you don't want to eat if you are very very thirsty, do you?
    If you know anyone who could be an Expert by Experience for the CQC then do encourage them to volunteer. It's only long observation times that discover the omissions in bad care homes. Let the good care homes be proud but let the bad ones be if needs be, forced to improve.
    I do feel the CQC needs to move faster. Their empathy should be first and foremost with the service user not the business people. The service user is at end of life and cannot hang around waiting for providers to behave reasonably. They should not be experiencing prolonged neglect and abuse as my mother did. Properly channeled complaints from me meant I got abuse from the providers too, encouraged by the supervisory body. Whistleblowing is still attacked by some authorities.
    Where care is unlawful and making vulnerable people miserable in their final years it needs addressed. And being oversensitive to criticism can be unhelpful and cruel in outcome to people with complex needs and dementia. They come first!

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  • How often is the water placed on the nightstand next to a bed-bound patient's head? I challenge an able-bodied person to get a drink of water in that position! And someone who is older? Arthritic? Bad vision maybe? How about ANY level of dementia?

    Providing water requires caregiver TIME, so it simply doesn't happen as often as needed.

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  • I don't know why the emphasis is on care homes and their staff. I have been priviledged to manage a few care homes after working as a staff nurse in a few of them. And I must commend the staff I have worked with for the hard work they put into the care and saftety of the people in their care.
    I have made an observation, most elderly frail people admitted from hospital into care homes have also come in dehydarted! Is there any reason for this or are the care home staff expected to sort out this area of their care. Please don't get me wrong or misunderstand me here, why do we always blame these care homes and not look into the causes of these concerns. Researchers have a lot of work to do!

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