How dehydration influences cognitive status in aged-care residents

A 2020 study found that 60% of elderly participants overestimated how much fluid loss it takes for moderate-to-severe dehydration symptoms to occur, with the majority of the elderly participants unable to identify if they were dehydrated.

Dehydration is a precarious condition, and one that impacts each individual in different ways depending on their regular fluid intake. Ultimately, dehydration is an unnecessary and potentially dangerous state that can lead to serious illness if left untreated.

Poor hydration management was highlighted as a problem within aged-care facilities at the Royal Commission into Aged Care Quality and Safety last year.

For older people with cognitive impairment or other ailments, a hydration chart needs to be used and closely monitored by care staff. They should also be offering residents drinks with their medication, during foodservice and home activities, and on many other occasions.

While older people have similar fluid requirements to younger adults, age-related changes and conditions can put the elderly at risk of dehydration.

Adequate intake of ‘total water’ comes from the combined intake from drinking water, other beverages and food sources. Approximately 60% of total water intake comes from fluids, 30% comes from moist foods and the remaining 10% is produced by the body’s metabolism.¹ Optimal daily fluid intake depends on various factors such as weight, health status and energy expenditure. Therefore, there is no single recommended daily intake (RDI) for adults.² Current guidelines suggest a minimum of 1500 mL of daily fluid for an older person.³

The body is provided with a thirst signal to indicate when we need to drink more fluid. In older people, though, the thirst signal is often impaired, so they do not feel the sensation to drink.⁴ As a result, older people will often refuse drinks when they are dehydrated because they do not feel thirsty. Furthermore, a diminished appetite or poor nutrition may result in someone not eating or drinking adequately.

Cognitive function progressively deteriorates as the level of dehydration increases. Common symptoms of mild dehydration include headache, irritability, poor concentration and reduced alertness.^5,6 In an older person, this loss of cognitive function impacts any existing functional impairments and increases their levels of dependency, reducing their quality of life.

So, how exactly do we combat this and reduce the risk of dehydration in aged-care homes? There is no clear guideline on the specific amount of water consumed each day. In fact, of the 2–3 litres of water a day the body needs, about one litre is obtained from food, with the body producing another 250 mL when it metabolises the food. This leaves about 1.25–1.75 litres to physically drink. This is equal to about six 250 mL cups. Importantly, this fluid can be obtained from several sources, not just water.

Through digital technology, aged-care homes can immediately see which residents have not had sufficient fluids, enabling appropriate action to be taken. The fluid offered to a resident, and the amount of fluid intake in millimetres, is simply evidenced at the point of delivery on mobile clinical devices. Reminders to offer drinks can also be set up as part of a planned care routine, with a traffic light system of flags alerting staff to when a care task is due, or to a resident falling below the recommended fluid threshold for the rolling 24-hour period.

Technology can also help to monitor fluid intake via a percutaneous endoscopic gastrostomy (PEG) tube, which provides fluids to those who are unable to take in enough manually.

By introducing PEG fluids, Person Centred Software solved the problem of care providers not being able to show the fluids residents take on board through medication given via the feed tube. Aged-care homes want to show that residents who are nil by mouth are getting their fluids, even if they are prescribed. Our software can monitor a person’s intake of medication, fluids, nutritional supplements and food via a PEG.

As well as helping to improve resident hydration levels, technology can give providers the ability to analyse any incidents, trace what actions led up to them and prevent future incidents from occurring. For example, by documenting any symptoms of cognitive impairment, homes may be able to spot patterns and can adjust their practices to support residents better.

Overall, it’s clear to see that innovative digital technology is empowering care providers with the adequate tools to track and reduce underlying factors that lead to dehydration and, in turn, cognitive decline.

*Tammy Sherwood is the CEO of Person Centred Software Australia, a leading global technology company and developer. Its app-based Mobile Care Monitoring system allows aged-care staff to digitally plan, record and monitor the care of residents as it is given.

References

1. Tortora, G., and B. Derrickson. 2010. Introduction to the human body: the essentials of anatomy and physiology. 8th ed. New York: John Wiley & Sons
2. Godfrey, H., J. Cloete, E. Dymond, and A.Long. 2012. An exploration of hydration care of older people: a qualitative study. International Journal of Nursing Studies 49: 1200-11.
3. Mentes, J. 2006. Oral hydration in older adults, greater awareness is needed in preventing, recognizing, and treating dehydration. American Journal of Nursing 106 (6): 40-9.
4. Scales, K. 2011. Use of hypodermoclysis to manage dehydration. Nursing Older People 23 (5): 16-22.
5. Wilson, M., and J. Morley. 2003. Impaired cognitive function and mental performance in mild dehydration. European Journal of Clinical Nutrition 57 (2): S24-9.
6. Rogers, P., A. Kainth, and H. Smit. 2001. A drink of water can improve or impair mental performance depending on small differences in thirst. Appetite 36: 57-9.

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