Sudeep Gill, MD and
Paula A. Rochon, MD MPH FRCPC
Baycrest Centre for Geriatric Care.
One of the goals of long-term care is to provide the patient with an appropriate level of care without unnecessarily disrupting his or her comfort and living situation. Older long-term care residents often suffer from acute intercurrent illnesses for which fluid replacement is an important component of treatment. If intravenous (IV) fluid replacement is not possible in these frail seniors, either because of regulations or due to staffing issues in the long-term care facility, it is often necessary to transfer them to an acute-care hospital setting.
In the institutionalized older patient, hypodermoclysis, which is the subcutaneous infusion of fluids, is an attractive alternative to the use of intravenous therapy for fluid replacement. It is a method that has been used since near the turn of the century. Although it has been employed with success for years at the Baycrest Centre for Geriatric Care, and a few other institutions, it remains under-recognized and underutilized as a valuable method for the management of mild to moderate dehydration in the long-term care setting.