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Mealtime Partners, Inc.:  Providing a Bridge to Greater Independence

 

The High Cost of Dehydration

Medical treatment for rehydration is estimated to have exceeded $1 billion in the U.S. in 1999 for elderly patients, alone¹. In 2004, the estimated cost for hospital admissions due to dehydration in the United States was almost 5.5 billion dollars.² This is an enormous medical expense that could be significantly reduced with preventative treatment.

Because medical costs are skyrocketing there is a movement towards providing preventative medical treatment to reduce overall medical cost in the United States. Many health conditions, if treated appropriately on a regular basis, can be managed without hospitalization or the need for emergency treatment, but if neglected can become life threatening. Some examples of these are diabetes, high blood pressure, and some heart conditions. However, something as simple as adequate hydration is often overlooked as a significant health issue that is essential for ongoing good health. When hydration is neglected and someone becomes dehydrated, many negative health issues can occur.

Dehydration is an ongoing problem for many people, especially those with disabilities. It is responsible for health problems such as urinary tract infections, kidney problems, skin tissue deterioration, and headaches. All of these conditions require medical treatment that, in some cases, can be protracted, require hospitalization, and thus be very expensive.

In most cases, dehydration is preventable! However, it takes a vigilant caregiver to offer a drink on a regular schedule to keep someone adequately hydrated. This is a difficult task when someone is undertaking many care-giving responsibilities. Often, what happens is the person is offered a drink infrequently. The response is to drink as much liquid as possible while it is available. This introduces an element of risk to the health of the person. When drinking a large quantity of liquid at a time, the person drinking takes a sizeable volume of liquid into their mouth at one time, and swallows repeatedly to clear all of the liquid from their mouth. This is called piecemeal deglutination. Piecemeal deglutination is a long name for something that we all do at times while eating or drinking but are most probably not aware that we are doing it. The danger of choking or aspiration increases for those at risk when piecemeal deglutination occurs.

To understand what piecemeal deglutination is in a practical sense, imagine you have just been outside on a very hot day without having water available to you. You go inside and grab a drink and take a great big mouthful of water. You then swallow the mouthful of water in several successive swallows until your mouth is empty. Because you took such a large gulp, instead of all of the liquid in your mouth being swallowed at one time, the automatic reflexes controlling the muscles of your mouth and swallowing, break the liquid down into several segments that are manageable to swallow and are swallowed one after the other. Each swallow, within the sequence of swallows, increases the risk of choking or aspiration. Because of the increase in risk, this is a poor method of avoiding dehydration. The desired way to consume liquids or solids it to only take a small portion into your mouth, form it into a bolus, and swallow it. It is important to only take a portion that can be consumed and swallowed without it being broken into smaller pieces.

For most people a drinking system can be made available to them even if they are unable to hold or lift a cup. However, regardless of this easy solution to avoiding dehydration, Medicare, Medicaid and private health care insurance providers consider all drinking systems as “aids for daily living” and do not cover their cost. However, they do cover the cost of an emergency room visit and/or hospital stay that was brought about by dehydration. According to the Agency for Healthcare Research and Quality (AHRQ)³, about one in  ten of the nearly 40 million hospitalizations in 2008 were potentially avoidable. Dehydration was among the conditions for which hospitalization was avoidable with the appropriate outpatient care.

Additionally, according to the National Pressure Ulcer Long-Term Care Study (NPULS)⁴, dehydration was associated with a 42% increase in risk of developing pressure ulcers in nursing home residents. The estimated annual cost for treating pressure, or decubitus, ulcers in the United States is $1.3 billion.

Would it not be wiser for Medicare, Medicaid and private insurance providers to fund drinking systems for those clients who are unable to drink independently? It certainly appears to be one inexpensive approach for reducing overall medical expenses in the United States.

1. Pershad J. A systematic data review of the cost of rehydration therapy. Applied Health Economics and Health Policy. 2010; 8(3): 203-14.

2. Kim, S. Preventable Hospitalizations of Dehydration: Implications of Inadequate Primary Health Care in the United States. Annals of Epidemiology. 2007; 17(9): 736.

3. Stranges, E., Stocks, C  Potentially Preventable Hospitalizations for Acute and Chronic Conditions 2008. 2010; Agency for Healthcare Research and Quality: STATISTICAL BRIEF #99.

4. Horn, S. D., Bender, S. A., Bergstrom, N., Cook, A. S., Ferguson, M. L., Rimmasch, H. L., Sharkey, S. S., Smout, R. J., Taleer,, G. A.,  Voss, A. C.   Description of the National Pressure Ulcer Long-Term Care Study. Journal of the American Geriatric Society. 2002 Nov;(11):1816-25.

 

This page last updated 12-11-2018