The Prevalence of Dehydration

Dehydration is usually marked by aberrations in serum sodium concentrations. More than 50 percent of nursing home residents had at least one episode of hyponatremia during a 12 month study period (2). Among nursing home residents who require acute hospitalization, the prevalence of hypernatremia has been reported to be more than 30 percent (3). The 2000 National Hospital Discharge Survey reported that 261,000 people 65 years and older were discharged with a primary diagnosis of volume depletion (4).

Dehydration is such a persistent problem among institutionalized elderly people that, in 1999, the Healthcare Financing Administration [now the Center for Medicare & Medicaid Services (CMS)] identified hydration as one of four quality indicators (QI) to be especially scrutinized during surveys of long-term care facilities. Hydration has been identified by CMS as a sentinel event. A sentinel event is a QI that represents a significant problem, even if it affects only one or a few residents.

There are 17 triggers (Table 1) that if noted by nursing home surveyors, signal further investigation for problems related to dehydration/fluid maintenance. Because dehydration is a sentinel event, if problems are noted, surveyors can cite long-term care facilities and impose penalties including denial of payment, civil monetary penalties and termination from participation in the Medicare and Medicaid programs.

Table 1.  OBRA MDS-2 Dehydration/Fluid Maintenance Triggers