Dehydration Common Among Care Home Patients

Patients admitted to hospital from care homes are commonly dehydrated on admission and face significantly greater risks of in-hospital mortality, according to a new study.

Researchers at Barnet and Chase Farm NHS Trust (London, United Kingdom), the London School of Hygiene and Tropical Medicine (LSHTM; London, United Kingdom), and other institutions conducted a retrospective observational study involving 21,610 patients aged over 65 years to compare the risks of hypernatraemia on admission to hospital, and evaluate the association of hypernatraemia (plasma Na higher than 145 mmol/L) with in-hospital mortality among those identified as care home residents.

The results showed that while just 1% of patients admitted from their own home were found to have high sodium levels, 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. Compared with own-home residents, care home residents were also at about a two-fold higher risk of in-hospital mortality. The study was published on January 15, 2015, in the Journal of the Royal Society of Medicine.

“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,” said lead author Anthony Wolff, MD, of Barnet and Chase Farm Hospitals. “High sodium levels in care home residents should raise questions about adequate support for drinking.”

“This raises serious concerns about the quality of care provided in some care homes,” added senior author Prof. Martin McKee, MD, of the LSHTM. “When a care home has more than a few residents admitted to hospital with high sodium levels this may well be indicative of a systematic problem at the care home and the issue should be raised formally.”

Old and infirm people are at increased risk of dehydration, especially if they require assistance with drinking and, left to themselves, may not drink enough to avoid dehydration. Another explanation could be that nursing home staff do not offer patients enough water to reduce incontinence and the amount of assistance residents require. Dehydration leads to high sodium levels, which can have severe consequences and which are an independent predictor of in-hospital mortality.

Related Links:
Barnet and Chase Farm NHS Trust
London School of Hygiene and Tropical Medicine