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There is an increasing number of older adults living in residential care, either retirement, assisted living, or long-term care (LTC) homes (Gibbard, 2018). Many of these residents are frail and require support with instrumental and basic activities of daily living, as well as health care, with a high proportion of residents in LTC specifically living with cognitive impairment or dementia (Harrison et al., 2019; Keller et al., 2017). Many residents also experience incontinence and challenges with self-feeding and drinking, including chewing and swallowing difficulties (i.e., dysphagia) (Harrison et al., 2019; Keller et al., 2017).
Adequate hydration is fundamental to health. Dehydration, the acute or chronic deprivation of water (Collins & Claros, 2011), has significant detrimental outcomes, including falls, impaired cognition, and delirium (Gaspar & Mentes, 2020; Grabowski et al., 2007). Consequently, dehydration is a common underlying factor in avoidable resident hospital transfers (Gaspar & Mentes, 2020), resulting in unnecessary and significant costs to the health care system, including extended lengths of hospital stay (Grabowski et al., 2007; Pash et al., 2014). Dehydration is also associated with orthostatic hypotension and hyperglycemia, as well as a wide variety of effects on other physiological systems (El-Sharkawy et al., 2015). Thus, the costs associated with chronic dehydration are unknown, but are likely to be substantial.
Dehydration (serum osmolality >300 mOsm/kg) is estimated to occur in up to one in five LTC residents (Jimoh et al., 2019), with low fluid intake as the primary cause. Recent estimates of average fluid intake (∼1,100/mL per day; Namasivayam-MacDonald et al., 2018) are well below recommendations for health (Volkert et al., 2019). Suboptimal fluid intake can lead to chronic dehydration, which can occur in up to 50% of residents (Bunn & Hooper, 2019; Jimoh et al., 2019). In an attempt to prevent dehydration, epidemiological research has focused on identifying resident characteristics associated with an increased risk of dehydration. These characteristics include being female, older, having other comorbidities (e.g., renal disease, diabetes, pressure ulcers, stroke, mental health problems), cognitive and physical difficulties, malnutrition, dementia-related behavioral expressions, self-feeding difficulties, dysphagia/texture modified diets, delirium, having an infection, being...