A typology of oral hydration problems exhibited by frail nursing home residents

Dehydration remains a substantial problem for nursing home residents, often with poor health outcomes. The purpose of this investigation was to establish 6-month prevalence of dehydration events in nursing home residents and to describe common hydration problems of nursing home residents. In this prospective observational study, 35 nursing home residents were followed for 6 months to assess problems with hydration and to evaluate the presence of dehydration. Urine specific gravity and color, bioimpedance measurements, meal intake recordings, and chart abstraction were used to assess hydration status. Field notes and informal staff interviews were used to describe specific hydration problems and clinically relevant interventions. Dehydration events occurred in 31% (11 of 35) of residents during the 6-month period. A typology of hydration problems was developed from the field observations. The typology consists of four groups (i.e., Can Drink, Can't Drink, Won't Drink, End of Life) and six corresponding subgroups. Demographic and hydration characteristics of the subgroups were compared and contrasted. Comparisons revealed the Won't Drink group is most vulnerable to dehydration events because this group has the highest percentage of dehydration events (58%, 4 of 7), the highest average specific gravity, and the lowest consumption of fluids during meals. Nursing interventions for the subgroups are discussed. Targeting nursing interventions to the specific hydration problem exhibited is proposed.