Himali Weerahandi, M.D.

Fully 59% of nursing home residents with symptomatic COVID-19 experienced clinically significant dehydration, according to a new study in a New York City facility. 

Nursing homes may be the best care setting for these patients — if providers are ready with plenty of IV fluids and a standardized clinical care protocol, investigators said.

The researchers zeroed in on symptoms, geriatric syndromes (such as falls and pressure sores) and dehydration factors in 314 NH residents with symptomatic COVID-19 early in the pandemic. They also examined whether dehydration was associated with dementia, delirium and other conditions.

Residents with COVID-19 had very high rates of dehydration when compared with nursing home peers diagnosed with urinary, skin and respiratory infections before the pandemic. In those cases, only 9% experienced significant dehydration, Himali Weerahandi, M.D., MPH, and colleagues, reported.

Reasons for this relatively high rate of dehydration with COVID-19 include the following, the authors said:

  • Higher and more persistent fever, a known risk factor for dehydration in nursing home residents
  • Difficulty maintaining oral hydration, even with human assistance, from acute declines in alertness and strength

In addition, residents with moderate-to-severe cognitive impairment or COVID-19-associated delirium had a 37% greater risk of dehydration than residents with neither condition, the researchers found.

Dehydration was also associated with a higher risk of resident falls and death. But 30-day mortality was relatively lower in the participant nursing home — at 14% — relative to other facilities at the time (when there was not yet a COVID-19 vaccine), the authors noted.

IV fluid requirements elevated 

Dehydration levels were deemed clinically significant based not only on the link to increased falls and death, but the frequent need to provide IV fluids, Weerahandi, of NYU Grossman School of Medicine, reported. Approximately 110 residents received IV fluids in the participating facility for an average of 4.9 days. Another 50 received IV fluids at the hospital prior to nursing home admission.

The findings suggest that nursing home facilities should be prepared to administer IV fluids to as many as half of COVID-19-affected residents, the researchers wrote. And the results of the study support those of other recent research suggesting that standardized medical care for SARS-CoV-2 infections in nursing homes is tied to improved outcomes, they added. In the current study, more than 90% of residents with COVID-19 were managed in the nursing home and 9% were transferred to the hospital. 

In fact, prior research has found that older adults with any infection may be better managed in a nursing home than an acute care hospital, the researchers noted.

“Given the continued risk of COVID-19 in skilled nursing facilities, it is imperative to identify interventions consistent with goals of care that may lead to better outcomes,” they concluded.

Long-term care clinicians who wish to do so can look to care pathways for infection and dehydration such as the Interventions to Reduce Acute Care Transfers (INTERACT) program, they advised.

Full findings were published online before print in JAMDA.

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