We are publishing this alert in response to a recent coronial inquest in South Australia where an older person living in residential aged care died from acute renal failure caused by severe dehydration. The coroner found the death to be preventable, occurring due to lack of a systemic mechanism to monitor fluid intake or recognition of the potential seriousness of dehydration in aged care residents.
Key points
- Aged care providers must be alert to the dehydration risks for the older people they care for.
- who is at risk of dehydration
- when to escalate their concerns about an older person’s hydration status.
- Providers must make sure they implement strategies to prevent dehydration and maintain these on an ongoing basis.
- A comprehensive assessment must be undertaken on entry. Ongoing assessment of the older person must also occur whenever there is a change in condition, a dehydration risk is identified, or symptoms present.
- Providers should exercise caution when assessing older people for the signs and symptoms of dehydration. They can be unreliable and appear too late. Assessment should consider the person’s recent fluid intake and fluid losses.
Providers must support their staff to be able to recognise:
If dehydration is suspected, encourage fluid intake and refer promptly to the older person’s GP or other medical practitioner for medical assessment, diagnosis, and a treatment plan. The medical assessment should include a discussion regarding the benefit of blood testing for more accurate hydration assessment and monitoring.
What providers need to know
To reduce the risk of harm to older people, aged care providers:
- must understand and be alert to dehydration risks for older people
- must understand the importance of effectively monitoring and managing people’s fluid intake and loss
- need to identify and quickly escalate hydration concerns, in line with the older person’s preferences
should talk to older people and their supporters about the importance of maintaining adequate fluid intake.
Risk factors for dehydration
Risk factors for dehydration in older people living in residential care homes include:
- ageing-related physiological changes such as reduced thirst, reduced body fluid reserves, and reduced ability of the kidneys to conserve fluids
- certain medical conditions – such as the use of diuretic medication (medicines that make the kidneys flush extra salt and water out of the body as urine)
- barriers to adequate fluid intake - such as access to fluids, reduced functional or cognitive capacity, acute illness, increased fluid losses, and polypharmacy (taking multiple medications regularly)
- environmental factors such as increased temperatures or exposure to sun
- cognitive changes where the older person may not recognise thirst.
Proactive identification, monitoring and management
This coronial case highlights the fact that the clinical signs of dehydration are neither reliable nor adequately sensitive to detect dehydration early enough in older people.
We expect providers to proactively identify risk, monitor and manage fluid intake, in line with the older person’s preferences and goals of care.
For each older person in their care, providers should:
- discuss and agree on the strategies they will use to monitor and manage fluid intake
- document the strategies in the person’s care plan
- regularly review and maintain the care plan and strategies.
Providers must have policies and processes in place to identify older people at higher risk of dehydration on admission to their services and reassess whenever there is a change in clinical status or dehydration is suspected.
Providers must also have policies and processes in place to effectively monitor and manage fluid intake across their services.
When in keeping with the older person’s preferences and goals of care, there should be processes to prevent dehydration and escalate concerns when dehydration is suspected. This includes assessment and monitoring to identify older people at higher risk of dehydration, because of changes in behaviour, cognition, function, food and fluid intake, fluid outputs and overall clinical circumstance.
What workers need to know
Aged care workers providing direct care need to:
- know the individual fluid needs of the older people they care for, including when changes in needs occur, and any medical requirements for daily fluid restriction or additional fluid intake. In the absence of a specific medical instruction or individual fluid intake preference, most older people would be recommended to aim to drink at least 1500mls of fluid each day
- make sure fluids are always made available and are always within easy reach across the day. This includes providing support as required by older people to receive and consume fluids, and consulting with relevant health professionals such as occupational therapists to provide assistive equipment when needed
- make sure all food and fluids offered meet an older person’s individualised requirements and preferences for texture modified foods, thickened fluids, and fluid restriction. The food and fluids offered should be in line with the older person’s right to make informed decisions and exercise choice about where, when and what they eat and drink
- monitor those at an increased risk of dehydration and make an early referral for a medical assessment when increased fluid losses may impact fluid reserves - such as during episodes of acute illness, increased urination, vomiting and diarrhoea, or hot weather
- know the typical volume of fluid held in standard glassware, mugs and bowls, and high fluid content foods to assist accurate recording. This can help you accurately record how much fluid people have had
- develop and regularly review the care plan for an older person that outlines their fluid needs and includes any individualised strategies recommended to prevent and monitor for dehydration.
Responding to dehydration
Late signs of dehydration can include confusion, dizziness, fatigue, falls, low urine output and other signs of deterioration.
Dehydration is a serious clinical concern. If dehydration is strongly suspected or diagnosed in an older person, providers should act immediately to make sure:
- a comprehensive assessment is undertaken in line with the older person’s wishes, including consultation with medical practitioners and other relevant health professionals to:
- support the diagnosis
- identify contributing factors (what has caused it)
- discuss treatment options and make plans for early review
- the older person is encouraged to increase their fluid intake, in line with the older person’s:
- food and fluid preferences
- care needs
- individual requirements such as texture-modified foods and thickened fluids
- they monitor, document and review the older person’s ongoing fluid intake and output to make sure their fluid status improves
- they evaluate the systems and processes within their services to identify, monitor and manage dehydration and make improvements as needed.
Providers should also review factors that contribute to dehydration risk and harm and improve their systems and processes where harm or repeated concerns are identified. This includes:
- using open disclosure - an open and honest discussion with an older person when something’s gone wrong that’s caused, or could have caused, harm to the older person
- immediately investigating and understanding any contributing systemic factors across all aspects of care
- educating and supporting staff to understand and recognise:
- the risks, signs and symptoms of dehydration
- when and how to escalate their concerns for further assessment and intervention
- having effective clinical governance that makes sure policies and processes are aligned with the latest evidence-based practice to support sustained effective prevention and management of dehydration.
Please share this alert with relevant managers and staff at your services.
Dr. Mandy Callary
Chief Clinical Advisor
More information
- Dehydration standardised care process | Victorian Department of Health
- Keep your fluids up! | Aged Care Quality and Safety Commission
- Why meals matter | Aged Care Quality and Safety Commission
- Summer clinical alert 2025-26 – Preventing heat stress in older people | Aged Care Quality and Safety Commission