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Dehydration risk factors and outcomes in older people in rural areas. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Abstract
Objective: To determine the risk factors for dehydration in elderly people in one of Elbehira Governorate’s villages.
Methods: A descriptive correlational design was utilized in this study. The study was conducted at Elnemaria village, Markaz Abo Elmatamir, Elbehira Governorate, Egypt. Data were collected using 3 tools: a structured interviewing questionnaire, a dehydration knowledge questionnaire, and a dehydration risk appraisal checklist.
Results: The study found that 29.5% of the participants were aged between 65 and 70. Males constituted 51% of the study participants. The majority of the study participants regularly took anti-acids, anti-inflammatory drugs, and diuretics. Among the elderlies comprising the respondents, 40% had a low level of knowledge regarding dehydration. More than half of the study subjects were at moderate risk for dehydration.
Conclusions: The study showed that half of the participants had diabetes and a medium level of information about dehydration. The study also showed in general that the elderly in the village are exposed to a moderate dehydration rate, and there is also a strong relationship between taking different types of medication and the occurrence of dehydration.
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Rauf S, Achmad I, Lestaluhu SA. WATER SUPPLEMENTATION AFFECTS THE FLUID INTAKE AND SERUM LEVELS OF BDNF AMONG THE ELDERLY IN NURSING HOME. Nutrition 2022; 101:111700. [DOI: 10.1016/j.nut.2022.111700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
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Lord LM. Fluid Needs in the Older Adult Receiving Tube Feedings. Nutr Clin Pract 2021; 36:360-368. [PMID: 33666945 DOI: 10.1002/ncp.10634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Fluid imbalance can occur quickly in older adults and in others who cannot express thirst or are in a setting where fluid status is not closely monitored. In tube-fed individuals receiving inadequate calories, severe malnutrition may occur in weeks to months, but improper water intake may lead to critical fluid imbalances in a matter of days. Simplistic equations frequently used to determine fluid needs in adults include milliliters per kilogram of body weight and milliliters per energy (kilocalories) consumed or per energy (kilocalories) need and variations of the Holliday-Segar formula. None of these fluid-requirement equations have been validated through evidenced-based science, and research investigations have revealed that they can grossly overestimate or underestimate fluid needs in the older adult. Clinicians need guidance to better estimate initial fluid needs for the older adult receiving tube feedings and to provide proper close monitoring afterward to avert preventable fluid imbalance-related hospital readmissions, morbidities, and mortalities in this patient population.
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Affiliation(s)
- Linda M Lord
- University of Rochester Medical Center, Rochester, New York, USA
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[Analysis of dehydration in older people in a nursing home in Spain: prevalence and associated factors]. NUTR HOSP 2021; 38:252-259. [PMID: 33593070 DOI: 10.20960/nh.03260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: dehydration in institutionalized elderly people has not been extensively studied. There are not clear data on the Spanish context. Aim: to estimate the prevalence of dehydration and to identify the associated factors in institutionalized older people in a nursing home. Methods: a cross-sectional study was carried out. Dehydration was measured through the colour of urine. For the identification of the associated factors, sociodemographic, clinical, functional, and mental variables were selected. Results: the total sample studied was comprised of 96 individuals with a mean age of 86.6 years (± 7.1), of whom 80.2 % were women. The prevalence of dehydration was 31.3% (95 % CI, 22.0 to 40.6). The factors that were independently associated with dehydration were the presence of sunken eyes (OR = 8.67; p = 0.004), low fluid intake (OR = 3.96; p = 0.041), and both functional (OR = 0.97; p = 0.012) and cognitive (OR = 1.10; p = 0.009) impairment. Conclusions: this study highlights the problem of dehydration in institutionalized older people in Spain. An urine colour table may be used routinely, non-invasively, and cheaply. So, it may well be the best simple method for detecting dehydration in this population. Taking into account that chronic dehydration is most prevalent in elderly people, the identification of associated factors is a key factor for a successful approach.
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Masot O, Miranda J, Santamaría AL, Paraiso Pueyo E, Pascual A, Botigué T. Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review. Nutrients 2020; 12:E3383. [PMID: 33158071 PMCID: PMC7694182 DOI: 10.3390/nu12113383] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 01/17/2023] Open
Abstract
The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.
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Affiliation(s)
- Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Jèssica Miranda
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
- Nursing Home and Day Center for the Elderly Balàfia II, Health services management (GSS), 25005 Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Elena Paraiso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Alexandra Pascual
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
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Lacey J, Corbett J, Forni L, Hooper L, Hughes F, Minto G, Moss C, Price S, Whyte G, Woodcock T, Mythen M, Montgomery H. A multidisciplinary consensus on dehydration: definitions, diagnostic methods and clinical implications. Ann Med 2019; 51:232-251. [PMID: 31204514 PMCID: PMC7877883 DOI: 10.1080/07853890.2019.1628352] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/28/2019] [Accepted: 05/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background: Dehydration appears prevalent, costly and associated with adverse outcomes. We sought to generate consensus on such key issues and elucidate need for further scientific enquiry. Materials and methods: A modified Delphi process combined expert opinion and evidence appraisal. Twelve relevant experts addressed dehydration's definition, objective markers and impact on physiology and outcome. Results: Fifteen consensus statements and seven research recommendations were generated. Key findings, evidenced in detail, were that there is no universally accepted definition for dehydration; hydration assessment is complex and requires combining physiological and laboratory variables; "dehydration" and "hypovolaemia" are incorrectly used interchangeably; abnormal hydration status includes relative and/or absolute abnormalities in body water and serum/plasma osmolality (pOsm); raised pOsm usually indicates dehydration; direct measurement of pOsm is the gold standard for determining dehydration; pOsm >300 and ≤280 mOsm/kg classifies a person as hyper or hypo-osmolar; outside extremes, signs of adult dehydration are subtle and unreliable; dehydration is common in hospitals and care homes and associated with poorer outcomes. Discussion: Dehydration poses risk to public health. Dehydration is under-recognized and poorly managed in hospital and community-based care. Further research is required to improve assessment and management of dehydration and the authors have made recommendations to focus academic endeavours. Key messages Dehydration assessment is a major clinical challenge due to a complex, varying pathophysiology, non-specific clinical presentations and the lack of international consensus on definition and diagnosis. Plasma osmolality represents a valuable, objective surrogate marker of hypertonic dehydration which is underutilized in clinical practice. Dehydration is prevalent within the healthcare setting and in the community, and appears associated with increased morbidity and mortality.
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Affiliation(s)
- Jonathan Lacey
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Jo Corbett
- Department of Sport & Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Lui Forni
- Intensive Care Unit, Royal Surrey County Hospital, Guildford, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fintan Hughes
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Gary Minto
- Department of Anaesthesia, University Hospitals Plymouth, Plymouth, UK
- Peninsula School of Medicine, Plymouth, UK
| | - Charlotte Moss
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Susanna Price
- Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Greg Whyte
- Research Institute for Sport & Exercise Science, Liverpool John Moores University, UK
| | - Tom Woodcock
- Formerly Consultant University Hospitals Southampton NHS Trust, Southampton, UK
| | - Michael Mythen
- Institute of Sport Exercise & Health, University College London, London, UK
| | - Hugh Montgomery
- Centre for Human Health and Performance, University College London, London, UK
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Gaspar PM, Scherb CA, Rivera-Mariani F. Hydration Status of Assisted Living Memory Care Residents. J Gerontol Nurs 2019; 45:21-29. [PMID: 30917202 DOI: 10.3928/00989134-20190213-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 01/18/2019] [Indexed: 11/20/2022]
Abstract
Water intake and hydration status of assisted living memory care (ALMC) residents were evaluated. Thirty-two residents (eight men; mean age 86.5 years; Global Deterioration Scale [GDS] 3 to 7) from four ALMC units participated. Ingested food and fluid amount, type, and time, and ingestion behaviors were observed from 7:00 a.m. to 7:00 p.m. Related factors were obtained from chart review/participant survey. Mean fluid intake was 1,160.16 mL; mean water intake from food and fluid was 56.55% (SD = 23.4%) of recommended water intake (RWI). Only one participant met 100% RWI. Using osmolality laboratory results (available for 21 participants), five participants were hydrated, whereas eight (38.1%) participants were in impending dehydration and dehydration categories, respectively. Fluid intake, GDS, and level of assistance during meals predicted RWI. Water intake of ALMC residents is inadequate, placing them at risk for dehydration, and justifies development and implementation of care standards for increasing water intake. [Journal of Gerontological Nursing, 45(4), 21-29.].
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Jimoh OF, Brown TJ, Bunn D, Hooper L. Beverage Intake and Drinking Patterns-Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies. Nutrients 2019; 11:E447. [PMID: 30795521 PMCID: PMC6412353 DOI: 10.3390/nu11020447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 11/16/2022] Open
Abstract
Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication.
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Affiliation(s)
- Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Diane Bunn
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK.
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Botigué T, Masot O, Miranda J, Nuin C, Viladrosa M, Lavedán A, Zwakhalen S. Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents. J Am Med Dir Assoc 2018; 20:317-322. [PMID: 30337227 DOI: 10.1016/j.jamda.2018.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years. MEASURES Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected. RESULTS Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio. CONCLUSIONS/IMPLICATIONS The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.
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Affiliation(s)
- Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain.
| | - Jèssica Miranda
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain; Residència i Centre de dia Lleida-Balàfia, GSS, Lleida, Catalonia, Spain
| | - Carmen Nuin
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Maria Viladrosa
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain; Arnau de Vilanova University Hospital of Lleida, Lleida, Catalonia, Spain
| | - Ana Lavedán
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Sandra Zwakhalen
- Research School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
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Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. J Am Med Dir Assoc 2018; 19:646-657. [DOI: 10.1016/j.jamda.2018.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/10/2018] [Accepted: 05/12/2018] [Indexed: 12/24/2022]
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Masot O, Lavedán A, Nuin C, Escobar-Bravo MA, Miranda J, Botigué T. Risk factors associated with dehydration in older people living in nursing homes: Scoping review. Int J Nurs Stud 2018; 82:90-98. [PMID: 29626702 DOI: 10.1016/j.ijnurstu.2018.03.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Dehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions. OBJECTIVES The scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes. DESIGN The revised scoping methodology framework of Arksey and O'Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment. DATA SOURCES An electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017. REVIEW METHODS Thematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies. RESULTS In all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n = 1), to medium (n = 13) and high (n = 2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter. CONCLUSIONS The most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.
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Affiliation(s)
- Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
| | - Ana Lavedán
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
| | - Carmen Nuin
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
| | | | - Jèssica Miranda
- Residència i Centre de dia Lleida-Balàfia, GSS, Lleida, Spain.
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.
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Elevated Serum Osmolality and Total Water Deficit Indicate Impaired Hydration Status in Residents of Long-Term Care Facilities Regardless of Low or High Body Mass Index. J Acad Nutr Diet 2017; 116:828-836.e2. [PMID: 27126154 DOI: 10.1016/j.jand.2015.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/01/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dehydration is typically associated with underweight and malnutrition in long-term care (LTC) settings. Evidence is lacking regarding the influence of the rising prevalence of overweight and obesity on risk factors, prevalence, and presentation of dehydration. OBJECTIVE The aim of this study was to objectively assess hydration status and the adequacy of total water intake, and determine relationships between hydration status, total water intake, and body mass index (BMI) in LTC residents. DESIGN A cross-sectional analysis of baseline data was performed. PARTICIPANTS AND SETTING Baseline data from 247 subjects recruited from eight community-based LTC facilities participating in two randomized trials comparing nutrient and cost-efficacy of between-meal snacks vs oral nutrition supplements (ONS). MAIN OUTCOMES Hydration status was assessed by serum osmolality concentration and total water intakes were quantified by weighed food, beverage, water, and ONS intake. STATISTICAL ANALYSES Simple and multiple linear regression methods were applied. RESULTS Forty-nine (38.3%) subjects were dehydrated (>300 mOsm/kg) and another 39 (30.5%) had impending dehydration (295 to 300 mOsm/kg). The variance in serum osmolality was significantly accounted for by blood urea nitrogen level, mental status score, and having diabetes (R(2)=0.46; P<0.001). Total water intake averaged 1,147.2±433.1 mL/day. Thus, 96% to 100% of subjects did not meet estimated requirements, with a deficit range of 700 to 1,800 mL/day. The variance in total water intake was significantly accounted for by type of liquid beverages (thin vs thick), type of ONS, total energy intake, total activities of daily living dependence, sex, and BMI (R(2)=0.56; P<0.001). CONCLUSIONS Dehydration and inadequate total water intake is prevalent in LTC residents across all BMI categories. Type of liquid beverages, type of ONS, and type of between-meal snacks are factors that could be targeted for nutrition interventions designed to prevent or reverse dehydration.
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Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lindner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MGM, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJD, Stotts NA, Thomas DR, Vivanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 2015; 2015:CD009647. [PMID: 25924806 PMCID: PMC7097739 DOI: 10.1002/14651858.cd009647.pub2] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality. However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised. OBJECTIVES To determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screening tests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated). SEARCH METHODS Structured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTA databases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studies and identified relevant reviews were checked. Authors of included studies were contacted for details of further studies. SELECTION CRITERIA Titles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables. DATA COLLECTION AND ANALYSIS Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off ≥ 295 mOsm/kg, serum osmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuous test may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to create receiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three. These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability. MAIN RESULTS There were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests to be used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. We assessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary target condition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95% CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration. AUTHORS' CONCLUSIONS There is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicate water-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a high proportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy.
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Murray J, Doeltgen S, Miller M, Scholten I. A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke. J Nutr Gerontol Geriatr 2015; 34:292-304. [PMID: 26267442 DOI: 10.1080/21551197.2015.1054573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Adequate hydration is important for all people, particularly when hospitalized with illness. Individuals with dysphagia following stroke are considered to be at risk of inadequate fluid intake and, therefore, dehydration, but there is little information about the fluid intake or hydration of individuals without dysphagia poststroke. This cohort study measured the average beverage intake, calculated the urea/creatinine ratio as a measure of hydration, and documented specific health outcomes of 86 people without dysphagia poststroke who were inpatients in rehabilitation centers. Participants drank on average 1504 ml per day (SD 359 ml), which typically represented 67% of their estimated daily requirement. Approximately 44% of the participants in the sample were dehydrated based on a blood urea nitrogen/creatinine ratio >20:1. Sixteen percent of participants were diagnosed with one or more of the health outcomes of dehydration/hypernatremia, urinary tract infection, or constipation. A greater level of dependence was associated with poorer beverage intake and higher risk of an adverse health outcome. Those in the older/elderly age range (particularly older women) and those with poor mobility were most at risk of poor hydration. This study highlights that patients in rehabilitation facilities poststroke, even without dysphagia, may be at risk of suboptimal fluid intake and hydration.
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Affiliation(s)
- Jo Murray
- a Hampstead Rehabilitation Centre , Adelaide , Australia
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Murray J, Miller M, Doeltgen S, Scholten I. Intake of thickened liquids by hospitalized adults with dysphagia after stroke. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:486-494. [PMID: 24007386 DOI: 10.3109/17549507.2013.830776] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is widespread concern that individuals with dysphagia as a result of stroke do not drink enough fluids when they are prescribed thickened liquids. This paper details a retrospective audit of thickened liquid consumption of 69 individuals with dysphagia following stroke in acute and rehabilitation hospitals in Adelaide, South Australia. Hospitalized individuals with dysphagia following stroke drank a mean of 781 ml (SD = 507 ml) of prescribed thickened liquids per day, significantly less in the acute setting (M = 519 ml, SD = 305 ml) than in the rehabilitation setting (M = 1274 ml, SD = 442 ml) (t(67) = -8.34, p < .001). This daily intake of thickened liquids was lower than recommended standards of fluid intake for hospitalized adults. Fluid intake could be increased with definitive protocols for the provision and monitoring of consumption of thickened liquids, by offering more fluid via food or free water protocols or by routine use of non-oral supplementary routes. Future research into the effectiveness of such recommendations needs to evaluate not only the impact on fluid intake but also on health outcomes.
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Affiliation(s)
- Jo Murray
- Faculty of Health Sciences, Flinders University , Adelaide , Australia
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Sandoval Garrido FA, Tamiya N, Kashiwagi M, Miyata S, Okochi J, Moriyama Y, Yamaoka Y, Takamuku K. Relationship between structural characteristics and outcome quality indicators at health care facilities for the elderly requiring long-term care in Japan from a nationwide survey. Geriatr Gerontol Int 2013; 14:301-8. [PMID: 23773284 DOI: 10.1111/ggi.12098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 11/30/2022]
Abstract
AIM To clarify the performance situation of selected quality indicators: falls, pressure ulcers and dehydration, at health care facilities for the elderly in Japan, and what structural characteristics are related to them. METHODS The operational population consisted of 1057 institutionalized users (approximately 10 randomly selected per facility) from a survey answered by the care staff. The facilities were divided into two groups according to their prevalence of negative outcomes (falls, pressure ulcers, dehydration): the best 25% (the very good performers) and the remaining 75% (not so good performers). Logistic regression analysis was carried out to examine the relationship between the structure characteristics of the facilities and their performance regarding each quality indicator. RESULTS After controlling for sex, years of operation and average age of the users, our results showed a beneficial significant relationship between falls and the total number of nurses per 100 users with an adjusted odds ratio (AOR) of 0.77 (95% CI 0.59-0.98); In contrast, for pressure ulcers, harmful associations between a higher number of registered nurses (AOR 1.23, 95% CI 1.01-1.05) and the availability of 24-h nurse staffing (AOR 4.95, 95% CI 1.19-24.91) were found; regarding dehydration, we did not find any related staffing characteristics. CONCLUSION Nursing staff might be considered as a potentially related variable in the quality of care in health care facilities for the elderly. The present study is the first to show a relationship between structural characteristics and quality outcomes in health care facilities for the elderly.
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Silver HJ, Wall R, Hollingsworth E, Pruitt A, Shotwell M, Simmons S. Simple kcal/kg formula is comparable to prediction equations for estimating resting energy expenditure in older cognitively impaired long term care residents. J Nutr Health Aging 2013; 17:39-44. [PMID: 23299377 PMCID: PMC4957543 DOI: 10.1007/s12603-012-0387-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Assessment of energy needs is a critical step in developing the nutrition care plan, especially for individuals unable to modulate their own energy intakes. The purpose of this study was to assess precision and accuracy of commonly used prediction equations in comparison to measured resting energy expenditure in a sample of "oldest old" adults residing in long term care (LTC). SUBJECTS AND DESIGN Resting energy expenditure (mREE) was measured by indirect calorimetry in 45 residents aged 86.1 ± 7.3 years, and compared to frequently used prediction equations (pREE): Mifflin St.Jeor, Harris Benedict, World Health Organization and Owen. Precision and accuracy were determined by concordance correlation coefficients and number of individuals within ± 10% of mREE. Bland Altman plots with linear dependence trends were constructed to visualize agreement. To complete analyses, the common 25 kcal/kg formula was assessed and alternative formulas were determined for best fit by regressing adjusted mREE on body weight. RESULTS mREE averaged 976.2 ± 190.3 kcal/day for females and 1260.0 ± 275.9 kcal/d for males. The strength of the relationships between pREE and mREE were only moderate (r = 0.41 - 0.72). In examining linear trends in the Bland Altman plots, significant systematic deviation from mREE was detected for all pREE. Two kcal/kg formulas were generated: 20.6 kcal/kg for females and 22.7 kcal/kg for males, which were not significantly different. CONCLUSION None of the prediction equations adequately estimated energy needs in this sample of the "oldest old." A simple formula using 21-23 kcal/kg may be a more practical and reliable method to determine energy needs in the LTC setting.
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Affiliation(s)
- H J Silver
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Kenkmann A, Hooper L. The restaurant within the home: experiences of a restaurant‐style dining provision in residential homes for older people. QUALITY IN AGEING AND OLDER ADULTS 2012. [DOI: 10.1108/14717791211231184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tannenbaum SL, Castellanos VH, George V, Arheart KL. Current Formulas for Water Requirements Produce Different Estimates. JPEN J Parenter Enteral Nutr 2012; 36:299-305. [DOI: 10.1177/0148607111416484] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Stacey L. Tannenbaum
- Department of Dietetics and Nutrition, Florida International University, Miami, Florida
| | | | - Valerie George
- Department of Dietetics and Nutrition, Florida International University, Miami, Florida
| | - Kristopher L. Arheart
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida
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Bannerman E, McDermott K. Dietary and Fluid Intakes of Older Adults in Care Homes Requiring a Texture Modified Diet: The Role of Snacks. J Am Med Dir Assoc 2011; 12:234-9. [DOI: 10.1016/j.jamda.2010.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 06/14/2010] [Indexed: 10/18/2022]
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Presse N, Ferland G. [Risk factors contributing to insufficient water intake in elderly living in nursing homes and long-term care units: a review of the literature]. CAN J DIET PRACT RES 2010; 71:e94-9. [PMID: 21144139 DOI: 10.3148/71.4.2010.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Elderly living in nursing homes and long-term care units are well-known to be vulnerable to dehydration. Insufficient water intake contributes to suboptimal hydration status and leads to decreased quality of life and global health status. Based on published studies, 32 to 96% of nursing home residents had insufficient water intake and more than 50% drank less than 1.5L per day. Risk factors contributing to decreased water intake in nursing home residents can be divided into two categories, depending whether they apply to the individuals per se (individual factors) or their social and institutional environment (environmental factors). Water intake is associated with meals and medication administration frequency. Diminished thirst sensation, intentional fluid restriction, dysphagia and functional dependency are individual factors recognized as most contributing to decreased water intake. Lack of familial support and insufficient staff are also important since they can contribute to decreased patients' assistance. Dietitians can play a fundamental role in preventing suboptimal hydration status by identifying risk factors that are known to compromise individual's water intake and by implementing corrective measures.
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Affiliation(s)
- Nancy Presse
- Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
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Presse N, Ferland G. Facteurs de risque associés à l'apport insuffisant en eau chez les personnes âgées vivant dans les centres d'hébergement: une revue de la littérature. CAN J DIET PRACT RES 2010. [DOI: 10.3148/71.3.2010.e94] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Wu SJ, Wang HH, Yeh SH, Wang YH, Yang YM. Hydration status of nursing home residents in Taiwan: a cross-sectional study. J Adv Nurs 2010; 67:583-90. [DOI: 10.1111/j.1365-2648.2010.05514.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Stotts NA, Hopf HW, Kayser-Jones J, Chertow GM, Cooper BA, Wu HS. Increased fluid intake does not augment capacity to lay down new collagen in nursing home residents at risk for pressure ulcers: A randomized, controlled clinical trial. Wound Repair Regen 2009; 17:780-8. [DOI: 10.1111/j.1524-475x.2009.00539.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vivanti AP, Campbell KL, Suter MS, Hannan-Jones MT, Hulcombe JA. Contribution of thickened drinks, food and enteral and parenteral fluids to fluid intake in hospitalised patients with dysphagia. J Hum Nutr Diet 2009; 22:148-55. [PMID: 19302120 DOI: 10.1111/j.1365-277x.2009.00944.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Studies amongst older people with acute dysphagic stroke requiring thickened fluids have assessed fluid intakes from combinations of beverage, food, enteral and parenteral sources, but not all sources simultaneously. The present study aimed to comprehensively assess total water intake from food, beverages, enteral and parenteral sources amongst dysphagic adult in-patients receiving thickened fluids. METHODS Patients requiring thickened fluid following dysphagia diagnosis were recruited consecutively from a tertiary teaching hospital's medical and neurosurgical wards. Fluid intake from food and beverages was assessed by wastage, direct observation and quantified from enteral and parenteral sources through clinical medical records. RESULTS No patients achieved their calculated fluid requirements unless enteral or parenteral fluids were received. The mean daily fluid intake from food was greater than from beverages whether receiving diet alone (food: 807 +/- 363 mL, food and beverages: 370 +/- 179 mL; P < 0.001) or diet with enteral or parenteral fluid support (food: 455 +/- 408 mL, food and beverages: 263 +/- 232 mL; P < 0.001). Greater daily fluid intakes occurred when receiving enteral and parenteral fluid in addition to oral dietary intake, irrespective of age group, whether assistance was required, diagnosis and whether stage 3 or stage 2 thickened fluids were required (P < 0.05). After enteral and parenteral sources, food provided the most important contribution to daily fluid intakes. CONCLUSIONS The greatest contribution to oral fluid intake was from food, not beverages. Designing menus and food services that promote and encourage the enjoyment of fluid dense foods, in contrast to thickened beverages, may present an important way to improve fluid intakes of those with dysphagia. Supplemental enteral or parenteral fluid may be necessary to achieve minimum calculated fluid requirements.
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Affiliation(s)
- A P Vivanti
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Queensland, Australia.
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Forsyth DM, Lapid MI, Ellenbecker SM, Smith LK, O'Neil ML, Low DJ, Clobes JE, Drier JA, Seifers MJ. Hydration status of geriatric patients in a psychiatric hospital. Issues Ment Health Nurs 2008; 29:853-62. [PMID: 18649211 DOI: 10.1080/01612840802182904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dehydration negatively impacts geriatric hospitalization outcomes. The purpose of this study was to investigate the hydration status of psychogeriatric inpatients and explore possible factors for dehydration. A descriptive, retrospective chart review of patients discharged from a psychogeriatric unit was completed. Clinical and biochemical information was collected at three time points (admission, mid-point, and discharge). Results were consistent with clinical observations that less hydrated patients seem to do worse clinically. It is important to closely monitor hydration status in psychogeriatric inpatients to reduce morbidity. Further studies are needed to develop strategies to prevent dehydration and its complications in this population.
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Reed PS, Zimmerman S, Sloane PD, Williams CS, Boustani M. Characteristics Associated With Low Food and Fluid Intake in Long-Term Care Residents With Dementia. THE GERONTOLOGIST 2005; 45 Spec No 1:74-80. [PMID: 16230753 DOI: 10.1093/geront/45.suppl_1.74] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article describes the prevalence, assessment, and treatment of, as well as characteristics associated with, the food and fluid intake of 407 residents with dementia in 45 assisted living facilities and nursing homes. Overall, 54% of observed residents had low food intake, and 51% had low fluid intake. Staff monitoring of residents, having meals in a public dining area, and the presence of noninstitutional features were each associated with higher food and fluid intake.
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Affiliation(s)
- Peter S Reed
- Alzheimer's Association, National Office, Chicago, IL 60601, USA.
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Feinsod FM, Levenson SA, Rapp K, Rapp MP, Beechinor E, Liebmann L. Dehydration in Frail, Older Residents in Long-Term Care Facilities. J Am Med Dir Assoc 2004. [DOI: 10.1016/s1525-8610(04)70090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The Link Between Tissue Oxygen and Hydration in Nursing Home Residents With Pressure Ulcers. J Wound Ostomy Continence Nurs 2003. [DOI: 10.1097/00152192-200307000-00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Feinsod FM, Levenson SA, Rapp K, Rapp MP, Beechinor E, Liebmann L. Dehydration in Frail, Older Residents in Long-Term Care Facilities. J Am Med Dir Assoc 2002. [DOI: 10.1016/s1525-8610(04)70529-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Feinsod FM, Levenson SA, Rapp K, Rapp MP, Beechinor E, Liebmann L. Dehydration in frail, older residents in long-term care facilities. J Am Med Dir Assoc 2002; 5:S35-41. [PMID: 14984609 DOI: 10.1097/01.jam.0000036697.72589.a8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Fred M Feinsod
- Division of Geriatric Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA
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Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 2002. [PMID: 11841046 DOI: 10.1177/0148607102026001011] [Citation(s) in RCA: 365] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
BACKGROUND AND AIMS To investigate the fluid intakes of patients with dysphagic acute stroke and to evaluate the effect of disability, the ward speciality and the type of fluid given on oral intake. METHODS Patients were prospectively recruited and randomly assigned to receive powder-thickened fluids or ready prepared pre-thickened fluids. Parenteral, enteral and oral fluid intakes, urine output, clinical sequelae and the frequency of requests for biochemical measures of hydration were recorded for a maximum of fourteen days. RESULTS 24 patients with dysphagic acute stroke requiring thickened fluids were recruited from a large teaching hospital. Mean thickened fluid intake was 455 ml/d (SEM+/-70) resulting in the use of an extra 742 ml/d (+/-132) of supplementary fluids. This did not result in an adequate total intake due to insufficient volumes being given for too short a period. Patients not on specialist stroke units who received pre-thickened fluids drank almost 100% more than those on powder-thickened fluids (P=0.04). CONCLUSIONS Fluid intakes in this patient group are insufficient to achieve requirements. Hospital staff must ensure adequate fluid intakes in patients at risk of dehydration, which should include both an adequate prescription and provision of supplementary fluids. Pre-thickened drinks improve oral fluid intake in patients with dysphagic acute stroke on non-specialist wards.
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Affiliation(s)
- K Whelan
- Department of Nutrition and Dietetics, Kings College London, UK
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