Prevalence of Dehydration in Older Adults Rehospitalized from a Long Term Care Facility

Background:

Today, up to 90% of rehospitalizations from long term care facilities appear to be unplanned. The presence of dehydration in the rehospitalization process has rarely been specifically explored. The study’s objective was to identify the presence of dehydration, a potentially treatable condition.

Methods:

A retrospective chart review of patients rehospitalized within 30 days of admission to long term care. Data included demographics, admission diagnosis, co‐morbid conditions, electrolytic values (Serum Na, BUN, Creatinine, and BUN:Cr ratio), and reason for transfer. For the purposes of this study, dehydration was defined as a Serum Na >145 mg/dl or a BUN/Cr ratio of >20:1.

Results:

There were a total of 261 subjects rehospitalized during the six month study period. Their average age was 79 years (± 10.4) and 42% were male. The principle diagnoses/reasons for transfer from LTC back to the hospital were: cardiovascular (34%), infection (20%), neurological (14%), gastrointestinal (13%), gynecological (4%), pulmonary (3%), fall (2%), electrolyte abnormality (including documented dehydration, 2%), hematology (1%) and other (6%). The principle diagnoses recorded in the ED at time of hospital readmission were: infection (31%), cardiovascular (23%), pulmonary (12%), gastrointestinal (10%), neurological (9%), hematology (4%), gynecological (3%), electrolyte abnormality (including documented dehydration, 3%), fall (2%), and other (2%). For these subjects, the prevalence of dehydration at time of LTC admission was 60.5% (95% CI: 54.3% to 66.5%), at time of rehospitalization, dehydration prevalence had increased to 67.4% (95% CI: 61.4% to 73.1%).

Conclusions:

Though multiple factors can lead to readmissions, dehydration appears to be an unrecognized, yet very common, clinical issue in the readmission process in older adults. Increasing physicians’ awareness with regard to this potentially treatable condition, might assist in meeting new CMS benchmarks for excess readmissions two‐fold; by improving the patient’s fluid status prior to discharge from the hospital and buying more time in the skilled nursing facility to treat underlying conditions thereby preventing readmissions.