London School of Hygiene & Tropical Medicine

Patients admitted to hospital from care homes are much more likely to be dehydrated than those admitted from their own homes, and those dehydrated patients are significantly more likely to die in hospital, according to new research published in the Journal of the Royal Society of Medicine.

The authors say that any care home from which more than a few patients are admitted to hospital with high sodium levels should be investigated by the Care Quality Commission.

Old and infirm people are at increased risk of dehydration, especially if they require assistance with drinking and, left to themselves, may not drink enough to avoid dehydration. Dehydration leads to high sodium levels, which can have severe consequences.

Researchers from Barnet and Chase Farm Hospitals NHS Trust, the University of Oxford and the London School of Hygiene & Tropical Medicine reviewed over 20,000 patients aged 65 years and over admitted to a London hospital trust for the first time between January 2011 and December 2013.

While 1% of patients admitted from their own home were found to have high sodium levels, the figure for patients admitted from care homes was 12%. After adjustment for a number of possible explanatory factors, including age and dementia, the risk of high sodium levels was still over five times higher for those admitted from care homes.

Study co-author Martin McKee, Professor of European Public Health at the London School of Hygiene & Tropical Medicine, said: "This raises serious concerns about the quality of care provided in some care homes. When a care home has more than a few residents admitted to hospital with high sodium levels this may well be indicative of a systematic problem at the care home and the issue should be raised formally".

He noted that NHS hospitals are being required to pick up the pieces from weaknesses in the now largely privately operated social care sector.

Co-author Professor David Stuckler, Honorary Research Fellow at the London School of Hygiene & Tropical Medicine, added:  "Clearly this level of dehydration is a problem. Further research is needed to understand why it is occurring. Are care home residents choosing to drink less than they should? Or, as has been speculated, are care home staff not offering enough water to reduce incontinence and the amount of assistance their residents require?"

The study was led by Dr Anthony Wolff of the Royal Free London NHS Foundation Trust, which acquired Barnet and Chase Farm Hospitals in July 2014.

Publication

• Anthony Wolff, David Stuckler and Martin McKee. Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality. Journal of the Royal Society of Medicine. DOI: 10.1177/0141076814566260