{"id":3174,"date":"2016-06-02T09:56:25","date_gmt":"2016-06-02T08:56:25","guid":{"rendered":"http:\/\/www.thinkkidneys.nhs.uk\/aki\/?p=3174"},"modified":"2016-06-02T10:00:25","modified_gmt":"2016-06-02T09:00:25","slug":"kidney-health-care-home","status":"publish","type":"post","link":"https:\/\/www.thinkkidneys.nhs.uk\/aki\/blog\/kidney-health-care-home\/","title":{"rendered":"Kidney health in your care home"},"content":{"rendered":"

Dr Miles D Witham, Clinical Reader in Ageing and Health, University of Dundee and Consultant Geriatrician, NHS Tayside<\/strong><\/p>\n

It’s handover time in your local care home. \u201cMr Smith isn\u2019t doing so well the last couple of days. He\u2019s not joined the other residents in the dining area, and he\u2019s taken to his bed. I couldn\u2019t even wake him up this morning for his medications.\u201d<\/p>\n

\u201cHas he passed urine? He had trouble with his kidneys last time he was unwell\u201d<\/p>\n

\u201cThere\u2019s very little in his catheter leg bag \u2013 and it hasn\u2019t been changed since I did it yesterday morning. Maybe we should get the doctor out to have a look?\u201d<\/p>\n

\u201cI\u2019ll give them a call straight away\u2026\u201d<\/p>\n

The GP came along later than morning, sent off urgent bloods, and later that day, Mr Smith was admitted to the local hospital for IV fluids and further investigation. He had a high sodium level causing drowsiness and stage 1 AKI; the eventual diagnosis was dehydration and upper respiratory tract infection. Although AKI wasn\u2019t avoided completely in this case, the problem was detected at an early stage due to awareness of AKI and by the care home staff asking the right questions.<\/p>\n

Care home residents are a particularly frail group of people, who are often prone to AKI. Many have dementia, and this in combination with physical impairments, may make it difficult for them to eat and drink at the best of times. Frail older people lose the ability to self-regulate their body systems – once things start to go wrong, they tend to get worse quickly. So it is no surprise that even minor illnesses, such as a cold, or an episode of vomiting and diarrhoea, can lead to a rapid spiral of dehydration, further reduction in drinking, and further dehydration. Acute Kidney injury is the inevitable result \u2013 often in people who already have impaired kidney function or other risk factors for AKI.<\/p>\n

How can we tackle this? We cannot prevent AKI in all care home residents (and indeed for some, it will not be appropriate to even investigate for this), but there are things we can do to help. Being aware of whether residents are passing urine \u2013 or if there is a change in volume. Keeping good records of how much residents are drinking. Making sure that concerns are voiced and acted on early \u2013 in this case, the prompt decision to call the GP probably prevented a much worse episode of AKI. And regular review of medication \u2013 medications that increase the risk of AKI may no longer be required in a care home setting as levels of function and goals of care change.<\/p>\n

That might all sound like yet more work to place on our underpaid and overstretched care home and primary care staff. But the good news is that most of the ingredients are part of what we know we should be doing already: monitoring of fluid and nutrition, frequent, regular engagement with the local GP surgery, medication review by the primary care team. So it isn\u2019t new work, but applying the basics. As with so many other things in medicine, \u2018simple things done well\u2019 is the key to reducing the impact of AKI on our care home residents.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dr Miles D Witham, Clinical Reader in Ageing and Health, University of Dundee and Consultant Geriatrician, NHS Tayside It’s handover time in your local care home. \u201cMr Smith isn\u2019t doing so well the last couple of days. He\u2019s not joined the other residents in the dining area, and he\u2019s taken to his bed. I couldn\u2019t even wake him up this morning for his medications.\u201d \u201cHas he…<\/p>\n","protected":false},"author":114,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"enabled":false},"version":2}},"categories":[1],"tags":[],"class_list":["post-3174","post","type-post","status-publish","format-standard","hentry","category-blog"],"acf":[],"yoast_head":"\nKidney health in your care home - Acute Kidney Injury<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.thinkkidneys.nhs.uk\/aki\/blog\/kidney-health-care-home\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Kidney health in your care home - Acute Kidney Injury\" \/>\n<meta property=\"og:description\" content=\"Dr Miles D Witham, Clinical Reader in Ageing and Health, University of Dundee and Consultant Geriatrician, NHS Tayside It’s handover time in your local care home. \u201cMr Smith isn\u2019t doing so well the last couple of days. 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