Dehydration in older adults is common and is 37% among community living older adults. No prevalence in US nursing homes is published.

To describe the prevalence of dehydration, defined as BUN/creatinine ratio ≥20:1, among residents of a single veterans administration (VA) nursing home over three years.

To describe concurrent trends in selected quality metrics during the implementation of a multi component hydration quality improvement program.

We identified dehydration based on blood urea nitrogen and creatinine (BUN/Creat) ratio as ≥20:1 because of convenience and availability.

We implemented several approaches to improve dehydration in our VA facility: Providing favorite drink at: bedside, table or wherever resident is.

Encourage to drink on entry to room and before leaving,

Flavored water,

Door magnet,

Huddle meetings with staff:

Education of aging changes that put older adults at risk of dehydration

Rationale for need of 2 quarts or more a day

Soliciting from frontline staff for their tips on how to increase fluid intake.

Asked for barriers to implementation,

Discussing with staff and showing study progress over time.

Of 20-48 residents (varied because of pandemic) between 2021-2023:

Dehydration improved from 75% to 36.6% over 3 years.

We found associations with:

Improved behaviors in our residents and fewer hospitalizations.

Fall rates declined every year, from 6.4 in 2021 to 3.9 in 2023.

UTI decreased, and our catheter associated UTIs moved our facility to the 1 ^st quintile, receiving a #1 in the nation ranking among all VA nursing homes.

Challenges: Resident turnover, co-morbidities, poor insight, and staff turnover requires us to keep education ongoing.

Multiple approaches and ongoing education over time cut our dehydration rate in half over 3 years. We noted fewer UTIs, falls, behaviors and hospitalizations. This material is the result of work supported with resources and the use of facilities at the Cincinnati VA Medical Center.