Dehydration: Therapy should help fight it
Shelly Mesure, MS, OTR/L
The elderly are very vulnerable to dehydration and more than just the nursing staff have to be concerned about it. Not keeping an eye on appropriate hydration can cause a variety of serious problems.
“As you age, your body's ability to conserve water, as well as its sensation for thirst declines, meaning it's easier to become dehydrated and more difficult to tell when your fluids are low,” notes Dietitian Jaime Mass, RD.
The most obvious cause of dehydration is not drinking enough fluids. However, there are many other reasons that may also contribute. A common side effect of many medications is dehydration. Diet, exercise, and many medical conditions such as diabetes also can contribute to it.
In our long-term care facilities, we try to monitor dehydration very closely from a nursing point of view. But we also have to ask: How many behavioral factors also influence daily hydration?
Depending on the resident, physical therapy, occupational therapy and a speech language pathologist can provide excellent solutions to help build better habits and safe swallowing programs for everyone. For example, OT might need to focus on the resident's ability to drink (hand-to-mouth patterns), as well as, his or her ability to access fluids.
Does the resident receive only water or juice from nursing? If so, do caregivers place it on the resident's bedside table? If so, can the resident easily access this location, or is there too much clutter or too many obstacles to make this convenient? Would the resident benefit from a cup holder attached to her wheelchair? Would an extended straw help?
Speech therapy might need to address very specific safe-swallowing techniques, while PT may focus on the strength and balance issues that could be a result of dehydration.
Other issues can relate to cognition — the resident might benefit from cognitive goals to prompt more frequent drinking. The other big factor is that the resident might choose not to drink as often out of fear of having to use the restroom too much. Addressing the toileting goals and concerns are very closely linked to residents limiting their fluid intake.
Dehydration is not just an issue for nursing to monitor and treat. It is an interdisciplinary issue that could require many levels of expertise in order to prevent and resolve a dangerous condition.
Shelly Mesure ("measure"), MS, OTR/L, is the senior vice president of Orchestrall Rehab Solutions and owner of A Mesured Solution Inc., a rehabilitation management consultancy with clients nationwide. A former corporate and program director for major long-term care providers, she is a veteran speaker and writer on therapy and reimbursement issues.