Generation of thirst: a critical review of dehydration amongst older adults living in residential care

Dehydration is common amongst older adults and exacerbated in residential care. Herein we summarise the reported prevalence of dehydration in this sub-population group and evaluate the associated risks before reviewing interventions designed to improve hydration. Heterogeneity in methods to assess dehydration inhibits interpretation of both prevalence and intervention studies (primarily small randomised control trials and case-control observational studies). The estimated prevalence of dehydration amongst older adults in residential care is 20-38%, with further increased prevalence of inadequate fluid intake, leading to increased urological, gastrointestinal, circulatory and neurological disorders or, in extreme cases, death. Multi-component interventions that include changes to drinks, vessels, placement and drinking opportunity alongside staff training and support are most effective in tackling dehydration in residential care. The detection and prevention of dehydration is crucial and a practical, population-specific reference standard for adequate fluid intake is warranted. Future research should prioritise interventions that are individualised to residents’ needs according to dehydration typology. Ongoing investment in the care sector should address staff-to-resident ratios and enhance staff training on the detection and prevention of dehydration.