This section should be considered in conjunction with Section 4.26 Swallowing. [2023]
Dehydration and malnutrition are common in hospital inpatients with stroke and associated with poor outcomes (Foley et al, 2008; Rowat et al, 2012). Malnutrition is associated with increased mortality and complications, as well as poorer functional and clinical outcomes (Davalos et al, 1996; Yoo et al, 2008). Up to one quarter of patients become more malnourished in the first weeks following stroke, and the risk of malnutrition increases with increasing hospital stay (Davalos et al, 1996; Yoo et al, 2008). [2016]
Poor nutritional intake, weight loss, and feeding and swallowing problems can persist for many months (Finestone et al, 2002; Perry, 2004; Jonsson et al, 2008). Multiple factors may contribute to a high risk of dehydration and malnutrition after stroke including physical, social and psychological issues. These include swallowing problems (Section 4.26 Swallowing), reduced ability to self-feed, cognitive impairment (Section 4.28 Psychological effects of stroke – general), anxiety or depression (Section 4.39 Anxiety, depression and psychological distress), fatigue (Section 4.25 Fatigue), and unfamiliar foods. [2016]
The assessment of dehydration is complex, and when used in isolation many common assessment methods are inaccurate (Hooper et al, 2015). Structured screening tools for malnutrition (e.g. the Malnutrition Universal Screening Tool [MUST]) have been validated in stroke (Gomes et al, 2016). [2016]
All measures considered should be in line with the Restraint Reduction Network training standards (Ridley & Leitch, 2021) and the relevant mental capacity legislation. [2023]