Dehydration

Under-recognised, easy to prevent, and a contributing factor in a great many care-related deaths.

What it is

Dehydration appears in this library for the same reason constipation does: it is trivial in a healthy adult and it kills vulnerable people.

Older people are at particular risk because the sense of thirst diminishes with age, kidneys concentrate urine less well, and total body water is lower. Add a diuretic, a hot day, a chest infection or a period of vomiting, and the margin disappears.

Care Quality Commission inspections and coroner reports have repeatedly identified inadequate hydration in care settings, and the most common contributing factor is staff limiting fluids to manage incontinence.

That trade-off is a false one. Concentrated urine irritates the bladder and makes incontinence worse, as well as causing urinary tract infections, constipation, falls, delirium and acute kidney injury.

Signs you might notice

Dark, strong-smelling urine, and passing less of it. This is the most practical daily indicator.

Dry mouth, cracked lips, sunken eyes.

Reduced skin turgor, though this is unreliable in older people.

Dizziness on standing, and a fast pulse.

New confusion, drowsiness or a fall. In an older person these may be the only signs.

Headache, constipation, and fatigue.

How it can affect day-to-day life

The people most at risk are the ones least able to get themselves a drink or to say they are thirsty: people with dementia, with dysphagia, with limited mobility, and with communication difficulties.

Thickened fluids for dysphagia reduce intake substantially, and that is a known and under-managed problem.

Fluid charts are frequently completed poorly, which means nobody actually knows what somebody drank.

Supporting someone well

Offer drinks proactively and often, rather than leaving a jug out of reach. A drink offered eight times a day gets drunk; a jug on a table does not.

Never restrict fluids to manage continence. Address continence properly instead.

Use what the person likes. Tea, squash, milk, soup, jelly, fruit. Water is not the only route and preference drives intake more than anything else.

Check urine colour as a daily practical measure.

Watch closely during hot weather, illness, vomiting and diarrhoea, and after any change in diuretic.

Record intake honestly and total it. Fiducia Together keeps fluid intake in the clinical record with the observations, so a two-day decline is visible rather than spread across three shift handovers.

Where to get help

Contact a GP for reduced urine output, new confusion, or dehydration that is not correcting with drinks.

Severe dehydration, drowsiness or an inability to keep fluids down needs urgent assessment.

For dysphagia, ask a speech and language therapist about ways to increase intake safely.