1. 1 Hydration And The Older Adult Geriatric Aide Curriculum NC Division of Health Service Regulation Module 9

2. 2 Hydration And The Older Adult Objectives 1. Discuss body fluid balance. 2. State the minimum amount of fluids needed to keep an older adult hydrated. 3. State three reasons that older adults are at a greater risk for dehydration. 4. Recognize conditions associated with dehydration.

3. 3 Hydration And The Older Adult Objectives 5. State the best defense against dehydration. 6. Recognize potential risks for dehydration in the older adult. 7. Recognize signs of dehydration to watch for in the older adult.

4. 4 Hydration And The Older Adult Objectives 8. Discuss strategies to assist residents to drink adequate amounts of fluids. 9. Discuss risks for and signs of over- hydration. 10. Discuss tips to help a resident restrict fluid intake.

5. 5 Dehydration  Older adult problems  Increased hospitalization  Nursing home study findings* * Mentes J. (2006). Oral Hydration in Older Adults. American Journal of Nursing, 106(6), 40-49.

6. 6 Dehydration Nursing home study found:  Residents not positioned properly for drinking.  Residents rushed when given food and drink.  Residents who needed help to drink did not have access to fluids Mentes J. (2006). Oral Hydration in Older Adults. American Journal of Nursing, 106(6), 40-49.

7. 7 Dehydration  Can be avoided by constant attention by health care team  Nurse aides play major role in prevention of dehydration

8. 8 Water  Dissolves substances in body.  Acts as coolant, lubricant and transport agent.  Regulates body temperature  Carries nutrients  Removes toxins and waste materials.  Medium for cellular reactions. Illinois Council on Long Term Care. Water: The Fountain of Life. Retrieved March 30, 2007, http://www.nursinghome.org/fam/fam_018.htmlttp://www.nursinghome.org/fam/fam_018.html

9. 9 Fluid Balance

10. 10 Dehydration

11. 11 Over-hydration (fluid overload)

12. 12 Good hydration  Energy  Happy mood  Good function and mobility  Well functioning bowel and bladder  Supple skin and bright eyes

13. 13 Older Adult Fluid Requirements  Water is lost daily through the skin, breathing, sweat, urine, and feces.  Minimum of 1500 ml (6 8-ounce cups of water) needed daily.* *Chernoff R. (1995). Effects of age on nutrient requirements. Clinics in Geriatric Medicine, 11(4), 641-51.

14. 14 Why Older Adults Are At Risk for Dehydration  Lower water content than younger people  Decrease in sensation of thirst  Decline in kidney function

15. 15 DEHYDRATION ALERT Dehydration can happen in less than an eight hour shift and quickly result in a life-threatening situation. Illinois Council on Long Term Care. Water: The Fountain of Life. Retrieved March 30, 2007, http://www.nursinghome.org/fam/fam_018.htmlttp://www.nursinghome.org/fam/fam_018.html

16. 16 Dehydration Dehydration is linked with:  Falls  Confusion  Functional decline  Incontinence  Constipation  Death

17. 17 Medical Problems Associated with Dehydration  Dehydration can lead to: Kidney stones Kidney stones Heart problems Heart problems Infections in urinary tract, lungs and stomach Infections in urinary tract, lungs and stomach Pressure ulcers Pressure ulcers Changes in diabetes control Changes in diabetes control Wick J. Y. (1999). Prevention and Management of Dehydration. The Consultant Pharmacist, 14(8). Retrieved April 5, 2007, from http://www.ascp.com/publications/tcp/1999/aug/prevention.shtml

18. 18 How to Avoid Dehydration

19. 19 Potential Risks for Dehydration  Reduced mobility but cognitively intact  Cognitively impaired but very mobile  Dementia (forgets to drink)  Acute confusion  Depression  Anxiety

20. 20 Potential Risks for Dehydration  Drinks less than 6 cups of liquid a day  Needs help with ADLs  Swallowing problems  Loss of thirst  Fluids not available  Poor appetite  Malnutrition

21. 21 Potential Risks for Dehydration  Multiple chronic illnesses  Acute illnesses  Poor vision  Incontinence  Weight loss  Hot weather

22. 22 Potential Risks for Dehydration  Use of supplements  History of dehydration  NPO  Tube feedings  Certain medications  More than 4 medications

23. 23 Institutional Factors and Dehydration  Fluids mistakenly withheld to prevent incontinence  Staff assumes resident is hydrated when fluids are refused  Residents may feel rushed, be in wrong position, offered no additional fluids or assistance to pour drinks  Lack of hydration planning

24. 24 Signs of Dehydration  Drop in blood pressure  Rise in pulse  Weight loss.

25. 25 Signs of Dehydration  Dizziness  Fatigue  Clumsiness  Aching joints  Falling

26. 26 Signs of Dehydration  Skin flushing  Shriveled skin  Dry skin, mouth or chapped lips  Furrowed tongue  Dry and/or sunken eyes

27. 27 Signs of Dehydration  Dark urine  Urine with strong odor  Painful urination  Decreased urine  Constipation/fecal impaction

28. 28 Signs of Dehydration  Loss of appetite  Difficulty swallowing  Lack of fluid intake

29. 29 Signs of Dehydration  Headache  Drowsiness  Heat intolerance  Nausea and vomiting  Absence of sweat  Changes in mental status

30. 30 Best Type of Fluid  Un-concentrated  Decaffeinated  Beverage resident will drink  Water is the best fluid for dehydration

31. 31 Fluids With Special Problems  Caffeine  Diet soft drinks  Grapefruit juice reacts  Alcohol

32. 32 Improving Fluids  Offer: Decaf or half decaf coffee Decaf or half decaf coffee Juice diluted with a little water Juice diluted with a little water Decaf and/or low sugar soda Decaf and/or low sugar soda Non-alcoholic sparkling waters Non-alcoholic sparkling waters Water flavored with lemon, or carbonated or fizzy water Water flavored with lemon, or carbonated or fizzy water Flavored milk Flavored milk

33. 33 Fluids Through Foods

34. 34 Some Facts About Hydration  Reminder: 1500 ml a day of fluid  The more a person weighs, the more fluid a person needs  Increased activity = increased fluids

35. 35 Some Facts About Hydration  Increase fluids with acute illness, outside in hot weather, following NPO  Spread out fluids during the day  Check with nurse for special needs

36. 36 Nurse aides play a very important role in keeping residents hydrated.

37. 37 Thickening Liquids  Swallowing problems  Choking  Prevents aspiration  Comes as a thickener or as pre-thickened liquid

38. 38 Strategies To Increase Fluids  Have fluids readily available  Encourage fluids  Offer choices  Offer fluids after providing care  Encourage ambulatory residents to drink plenty of fluids

39. 39 Strategies To Increase Fluids  Offer type/temperature of fluids resident likes  Involve family members  Offer small amounts of fluid frequently  Record I&O accurately  Weigh and record weight accurately  Offer ice chips

40. 40 Strategies To Increase Fluids  Offer sips of liquids between bites of food at meals and snacks.  Keep fresh, cool water at bedside.  Use lightweight pitcher and cup.

41. 41 Strategies To Increase Fluids  Use assistive devices.  Offer assistance to resident if needed.  Offer full cup of water with medications.  Offer fluids on set schedule.

42. 42 Strategies To Increase Fluids  Explain that decreasing fluid intake does not decrease incontinence.  Provide good oral hygiene.  Encourage resident to drink all fluids offered with meals.

43. 43 Strategies To Increase Fluids  Encourage fluid-rich foods.  Encourage resident to eat with others.  Use verbal prompts when needed.  Position resident properly to drink.  Monitor room temperature.

44. 44 Facility Strategies for Hydration  Add cup holders to wheelchairs.  Give residents water bottles to carry around facility.  Offer beverages from beverage carts.  Take fluids on outings and offer frequently.  Include beverage break in all activities.

45. 45 Facility Strategies for Hydration  Offer glasses of water in dining room while waiting for meals.  Have afternoon teas or “happy hours.”  Use any excuse to have a celebration and offer beverages and snacks.

46. 46 Over-hydration (fluid overload)

47. 47 Fluid Restrictions  Restrictions part of care plan and shared with all staff.  All staff, including nurse aide, must strictly adhere to fluid restrictions.  Type and amount of fluid spread out over day.  Check I&O sheet before giving fluids.  Record I&O immediately.

48. 48 Risk Factors for Over-Hydration  Congestive heart failure  Chronic lung disease  Kidney disease  Endocrine disease  Psychiatric illness  Certain medications  IV fluids/tube feedings  History of over-hydration

49. 49 Signs of Over-hydration  Bounding pulse  Bulging neck veins  Increased respirations  Shallow, labored respirations (shortness of breath)  Weight gain

50. 50 Signs of Over-hydration  Swelling of fingers, hands, ankles, and feet  Decreased urination  Fluid collecting in the abdomen (ascites)  Disorientation or confusion  Restlessness

51. 51 Fluids To Limit Or Avoid  Regular vegetable and tomato juices  Canned, dehydrated or instant soups  Regular bullion or broth  Commercially softened water Buttermilk  Sodas  All sports drinks such as Gatorade™ or Powerade™

52. 52 Tips For Fluid Restriction  Do not drink out of habit or to be sociable.  Eat less salt.  Suck on ice chips.  Brush teeth several times a day.  Suck on lemon wedge.  Chew sugarless gum.

53. 53 Tips For Fluid Restriction  Suck on sugarless candy.  Use breath spray.  Take meds with small amount of fluid.  Keep air humid.  Keep environment cool.

54. 54 Enlist family help with fluid restrictions.

55. 55 It takes a team, a plan, and each individual team member to keep residents hydrated.

56. 56