Dehydration and Malnutrition in Residential Care: Recommendations for Strategies for Improving Practice Derived from a Scoping Review of Existing Policies and Guidelines

Abstract

Preventing malnutrition and dehydration in older care home residents is complex, with both conditions remaining prevalent, despite numerous guidelines spanning several decades. This policy-mapping scoping review used snowballing search methods to locate publicly-available policies, reports and best practice guidelines relating to hydration and nutrition in UK residential care homes, to describe the existing knowledge base and pinpoint gaps in practice, interpretation and further investigation. Findings were synthesised narratively to identify solutions. Strategies for improvements to nutritional and hydration care include: development of age and population-specific nutrient and fluid intake guidelines; statutory regulation, contractual obligations for commissioners, appropriate menu-planning, implementation and auditing of care, acknowledgment of residents’ eating and drinking experiences, effective screening, monitoring and treatment and staff training. The considerable body of existing knowledge is failing to influence practice, relating to translational issues of implementing knowledge into care at the point of delivery, and this is where future research and actions should focus.

Beverage Intake and Drinking Patterns—Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies

“…Despite decades of good intentions and policy to reduce dehydration in older adults, at least one in five older adults living in long-term care in the US and UK has low-intake dehydration [ 1 , 2 , 3 , 4 ]. Low-intake dehydration is due to not drinking enough to replace obligatory fluid losses and is characterized by raised serum osmolality.…”

Dehydration in the nursing home: Recognition and interventions taken by Dutch nursing staff

“…The difficulty of identifying (a risk of) dehydration in nursing home residents is recognized internationally and requires knowledge of nursing staff (Bunn et al, 2018; Paulis et al, 2020). When asking Dutch registered nurses and CNAs using an open text question which signs and symptoms in a resident makes them think of dehydration, ‘confusion’, ‘change in urine colour’, ‘urinating less than normal’, ‘being drowsy’ and ‘decreased skin turgor’ were mentioned most often.…”

Lower Dietary and Circulating Vitamin C in Middle- and Older-Aged Men and Women Are Associated with Lower Estimated Skeletal Muscle Mass

“…In general terms, the prevalence of vitamin C deficiency is greater in men than in women and is high in low-income and vulnerable populations in care ( 38 – 41 ). Whereas the prevalence of very low plasma concentrations of vitamin C, indicative of scurvy, in our cohort population was 0.9% in men and 0.2% in women, more than one-third of men (35%) and one-sixth of women (17%) were vitamin C insufficient.…”