Problem Extract back up;

The following are extracts from medical journals, reports and books which reinforce the need for a system, product or service to help prevent dehydration in institutions.

“Dehydration has been underappreciated as a cause of hospitalization and increased hospital-associated mortality in older people. This study used national data to analyze the burden and outcomes following hospitalizations with dehydration in the elderly. Data from 1991 Medicare files were used to calculate rates of hospitalization with dehydration, to examine demographic characteristics and concomitant diagnoses associated with dehydration, and to analyze the contribution of dehydration to mortality. In 1991, 6.7% (731,695) of Medicare hospitalizations had dehydration listed as one of the five reported diagnoses, a rate of 236.2/10,000 elderly Medicare beneficiaries. In 1991, Medicare reimbursed over $446 million for hospitalizations with dehydration as the principal diagnosis. Older people, men, and Blacks had elevated risks for hospitalization with dehydration. Acute infections, such as pneumonia and urinary tract infections, were frequent concomitant diagnoses. About 50% of elderly Medicare beneficiaries hospitalized with dehydration died within a year of admission. Hospitalization of elderly people with dehydration is a serious and costly medical problem. Attention should be focused on understanding predisposing factors and devising strategies for prevention.”

Warren JL; Bacon WE; Harris T; McBean AM; Foley DJ; Phillips C. The burden and outcomes associated with dehydration among US elderly, 1991.Am J Public Health, 84:1265-1269 1994

“Total body water decreases with age, as does the thirst sensation. Thus, the elderly, particularly those who are institutionalized, are more at risk of dehydration. This leaves them more vulnerable to infections, pressure ulcers, and disorientation. Fluid intake of the institutionalized elderly is a common concern, but is often not adequately addressed in practice. Three standards of recommended fluid intake were evaluated in a nursing home population. The standards were based on body weight and calorie intake. The study found that between 1,700 and 2,500 ml of daily fluid intake was the most adequate for all patients. The study also found that patients were not offered enough fluid outside of medication time. Older patients also tend to be more dependent on meals for fluids. Overall dependency was indicated as a risk factor for dehydration.”

Chidester JC; Spangler AA. Fluid intake in the institutionalized elderly. Journal of the American Dietetic Association 1997 97:23-28

“Water is an essential nutrient required for life. To be well hydrated, the average sedentary adult man must consume at least 2,900 mL (12 c) fluid per day, and the average sedentary adult woman at least 2,200 mL (9 c) fluid per day, in the form of non-caffeinated, nonalcoholic beverages, soups, and foods. Solid foods contribute approximately 1,000 mL (4 c) water, with an additional 250 mL (1 c) coming from the water of oxidation. The Nationwide Food Consumption Surveys indicate that a portion of the population may be chronically mildly dehydrated. Several factors may increase the likelihood of chronic, mild dehydration, including a poor thirst mechanism, dissatisfaction with the taste of water, common consumption of the natural diuretics caffeine and alcohol, participation in exercise, and environmental conditions. Dehydration of as little as 2% loss of body weight results in impaired physiological and performance responses. New research indicates that fluid consumption in general and water consumption in particular can have an effect on the risk of urinary stone disease; cancers of the breast, colon, and urinary tract; childhood and adolescent obesity; mitral valve prolapse; salivary gland function; and overall health in the elderly”

Kleiner SM.Water: An essential but overlooked nutrient. Journal of the American Dietetic Association; 99. 200-206. 1999