1
|
Constantinou C, Jefford J, Zygo M, White J, Dale M, Morris R, Jenkins J. Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation. J Hum Nutr Diet 2024. [PMID: 39038170 DOI: 10.1111/jhn.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). METHODS A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. RESULTS A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. CONCLUSIONS BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.
Collapse
Affiliation(s)
| | - Joanne Jefford
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Marzena Zygo
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judith White
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Megan Dale
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Rhys Morris
- Cardiff and Vale Local University Health Board, Cardiff, UK
| | - Judyth Jenkins
- Cardiff and Vale Local University Health Board, Cardiff, UK
| |
Collapse
|
2
|
Fonseca SCF, Barroso SC, Santos MCT. Enhancing Elderly Nutrition: A Qualitative Evaluation of Menus in a Social Solidarity Institution in the North of Portugal. Nutrients 2024; 16:753. [PMID: 38474881 DOI: 10.3390/nu16050753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
This work addresses the importance of food and nutrition in promoting the health of the elderly population, with a specific focus on the qualitative evaluation of menus provided by a social solidarity institution in Portugal. The aim of this study is to conduct a qualitative evaluation of menus furnished by a social solidarity institution situated in the northern region of Portugal in order to prevent and/or treat malnutrition in the elderly. The methodology involves the evaluation of four weekly menus, totaling 28 complete daily menus for the elderly, using the "Avaliação Qualitativa de Ementas Destinadas a Idosos" (AQEDI) tool. This assessment tool comprises six domains: general items, soup, protein suppliers, carbohydrate suppliers, vegetable suppliers, and dessert, each consisting of various parameters. The findings reveal that all menus were classified as "acceptable," with percentages ranging from 60.73% to 68.84%, and suggest that there exists room for improvement. This study emphasizes the necessity for coordinated efforts within the institution to enhance menu planning, taking into account both nutritional guidelines and sensory aspects of food. Effective coordination within the institution is crucial for maintaining positive aspects and rectifying inadequacies in menu planning.
Collapse
Affiliation(s)
- Sandra Celina Fernandes Fonseca
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), 5001-801 Vila Real, Portugal
| | - Suzanne Carvalho Barroso
- Department of Sports, Exercise and Health Sciences, University of Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Maria Cristina Teixeira Santos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- ProNutri Group-CINTESIS@RISE, Center for Health Technology and Services Research (CINTESIS), Associate Laboratory RISE-Health Research Network, University of Porto, 4200-450 Porto, Portugal
| |
Collapse
|
3
|
Aliyu AI, Nixon A, Hoad CL, Marciani L, Corsetti M, Aithal GP, Cordon SM, Macdonald IA, Alhussain MH, Inoue H, Yamada M, Taylor MA. A comparative, randomised MRI study of the physiological and appetitive responses to gelling (alginate) and non-gelling nasogastric tube feeds in healthy men. Br J Nutr 2023; 130:1316-1328. [PMID: 36746392 PMCID: PMC10511685 DOI: 10.1017/s0007114523000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
Inclusion in nasogastric tube feeds (NGTF) of acid-sensitive, seaweed-derived alginate, expected to form a reversible gel in the stomach, may create a more normal intragastric state and modified gastrointestinal responses. This may ameliorate NGTF-associated risk of diarrhoea, upper gastrointestinal symptoms and appetite suppression. In a randomised, crossover, comparison study, undertaken in twelve healthy males, an alginate-containing feed (F + ALG) or one that was alginate-free (F-ALG) (300 ml) was given over 1 h with a 7-14-d washout period between treatments. Baseline and for 4-h post-feed initiation, MRI measurements were made to establish small bowel water content (SBWC), gastric contents volume (GCV) and appearance, and superior mesenteric artery blood flux. Blood glucose and gut peptides were measured. Subjective appetite and upper gastrointestinal symptoms scores were obtained. Ad libitum pasta consumption 3-h post-feeding was measured. F + ALG exhibited a gastric appearance consistent with gelling surrounded by a freely mobile water halo. Significant main effects of feed were seen for SBWC (P = 0·03) and peptide YY (PYY) (P = 0·004) which were attributed to generally higher values for SBWC with F + ALG (max difference between adjusted means 72 ml at 210 min) and generally lower values for PYY with F + ALG. GCV showed a faster reduction with F + ALG, less between-participant variation and a feed-by-time interaction (P = 0·04). Feed-by-time interactions were also seen with glucagon-like-peptide 1 (GLP-1) (P = 0·02) and glucose-dependent insulinotropic polypeptide (GIP) (P = 0·002), both showing a blunted response with F + ALG. Apparent intragastric gelling with F + ALG and subsequent differences in gastrointestinal and endocrine responses have been demonstrated between an alginate-containing and alginate-free feed.
Collapse
Affiliation(s)
- Abdulsalam I. Aliyu
- Department of Human Physiology, College of Medical Sciences, Gombe State University, Gombe, Nigeria
- The David Greenfield Human Physiology Unit, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Aline Nixon
- The David Greenfield Human Physiology Unit, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Caroline L. Hoad
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Luca Marciani
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Guruprasad P. Aithal
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sally M. Cordon
- The David Greenfield Human Physiology Unit, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Ian A. Macdonald
- The David Greenfield Human Physiology Unit, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
- Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A, Lausanne, Switzerland
| | - Maha H. Alhussain
- Department of Food Science and Nutrition, King Saud University, Riyadh, Saudi Arabia
| | - Hiroaki Inoue
- Global Planning Group, Medical Solutions Vehicle, KANEKA CORPORATION, Osaka, Japan
| | - Masahiko Yamada
- Regenerative Medicine and Cell Therapy Laboratories, KANEKA CORPORATION, Kobe, Japan
| | - Moira A. Taylor
- The David Greenfield Human Physiology Unit, Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre at Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| |
Collapse
|
4
|
Bech CB, Svendsen JA, Knudsen AW, Munk T, Beck AM. The association between malnutrition and dehydration in older adults admitted to a geriatric unit: An observational study. Clin Nutr ESPEN 2023; 57:598-605. [PMID: 37739711 DOI: 10.1016/j.clnesp.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM There is an overlap between the risk factors causing low intake of water and low intake of nutrients, respectively. This study aims to explore the agreement between the assessment of malnutrition and the outcome of low-intake dehydration in a population of older hospitalized patients. METHODS Patients ≥65 years old and hospitalized at the geriatric hospital ward were screened for eligibility within 96 h of admission. Dehydration was assessed with the calculated serum osmolarity ≥295 mmol/L (1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14), and (risk of) malnutrition was assessed with NRS-2002 ≥ 3 points, MNA-SF ≤ 7 points, MNA-LF < 17, MUST ≥ 2 points, and GLIM after screening with NRS-2002 and MNA-LF. Follow-up data regarding exercise rehabilitation, readmissions, and mortality was collected 30 days after discharge. Statistics used were the Chi-squared test, Fishers-exact test, and Wilcoxon signed rank test. RESULTS A total of 114 patients (57% females) were included. Median age 85.5 (IQR 80; 89.25) years. A total of 49 (43%) were dehydrated. Fewer females were dehydrated (F: 42.9% vs. M: 67.7%, p = 0.013). The patients with osmolarity ≥295 mmol/L had a higher median weight (68.3 (IQR 58.5; 78.4) vs. 62 (IQR 51.8; 72.1), p = 0.021) and mid-up-arm circumference (27 (IQR 26; 30) vs. 25.5 (IQR 22.9; 28.3), p = 0.004). No significant difference was found in the prevalence of malnutrition between those with or without dehydration (NRS-2002; 70% vs. 81%, p = 0.174; MNA-SF: 23.1 vs. 23.2%, p = 1.0; MNA-LF: 37.1 vs. 30.2%, p = 0.644; MUST: 24.5 vs. 33.8%, p = 0.308; GLIM after screening with NRS-2002: 84.4 vs. 74.5%, p = 0.405, GLIM after screening with MNA-LF: 74.1 vs. 75.6%, p = 0.438). Kappa values varied around 0 and reflected low agreement. There were no differences in the follow-up data, between those who were normohydrated and those who were dehydrated. CONCLUSION We found low agreement between the assessment of malnutrition and low-intake dehydration in a population of older hospitalized patients. All geriatric patients should therefore be assessed for both conditions.
Collapse
Affiliation(s)
- Camilla Balle Bech
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | | | - Anne Wilkens Knudsen
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Tina Munk
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev Gentofte, Denmark.
| |
Collapse
|
5
|
Urinary Hydration Biomarkers and Water Sources in Older Adults with Neurocognitive Disorder. Nutrients 2023; 15:nu15030548. [PMID: 36771256 PMCID: PMC9921382 DOI: 10.3390/nu15030548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
The risk of dehydration in older adults with neurocognitive disorder (NCD) is controversial. The purpose of this study was to assess hydration status, its determinants, and water intake sources in older adults with NCD. A sample of 30 participants (≥60 years) was included. Sociodemographic, clinical data and one 24-h urine sample were collected. Urinary osmolality, sodium, potassium, volume, and creatinine were quantified. Inadequate hydration status corresponded to urine osmolality > 500 mOsm/Kg, or a negative Free Water Reserve (FWR). Two 24-h food recalls were used to assess dietary intake and water sources. The adequacy of total water intake (TWI) was estimated according to EFSA. The contribution of food and beverages to TWI was calculated, and their associations with the urinary osmolality median were tested. Of the total number of participants, 30% were classified as having inadequate hydration status, with no differences between sexes. Regarding TWI, 68.4% of women and 77.8% of men did not reach the reference values. Water (23%), followed by soup (17%), contributed the most to TWI, while vegetables (2%) and alcoholic/other beverages (3%) contributed the least. According to the median urinary osmolality, there was no significant difference in sociodemographic/clinical characteristics. It is critical not to overlook hydration in this vulnerable population.
Collapse
|
6
|
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics. Clin Nutr 2022; 41:958-989. [DOI: 10.1016/j.clnu.2022.01.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/15/2022]
|
7
|
Calderwood LE, Wikswo ME, Mattison CP, Kambhampati AK, Balachandran N, Vinjé J, Barclay L, Hall AJ, Parashar U, Mirza SA. Norovirus Outbreaks in Long-term Care Facilities in the United States, 2009-2018: A Decade of Surveillance. Clin Infect Dis 2022; 74:113-119. [PMID: 34523674 PMCID: PMC8978331 DOI: 10.1093/cid/ciab808] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In the United States, norovirus is the leading cause of healthcare-associated gastroenteritis outbreaks. To inform prevention efforts, we describe the epidemiology of norovirus outbreaks in long-term care facilities (LTCFs). METHODS The Centers for Disease Control and Prevention (CDC) collect epidemiologic and laboratory data on norovirus outbreaks from US health departments through the National Outbreak Reporting System (NORS) and CaliciNet. Reports from both systems were merged, and norovirus outbreaks in nursing homes, assisted living, and other LTCFs occurring in 2009-2018 were analyzed. Data from the Centers for Medicare and Medicaid Services and the National Center for Health Statistics were used to estimate state LTCF counts. RESULTS During 2009-2018, 50 states, Washington D.C., and Puerto Rico reported 13 092 norovirus outbreaks and 416 284 outbreak-associated cases in LTCFs. Participation in NORS and CaliciNet increased from 2009 to 2014 and median reporting of LTCF norovirus outbreaks stabilized at 4.1 outbreaks per 100 LTCFs (interquartile range [IQR]: 1.0-7.1) annually since 2014. Most outbreaks were spread via person-to-person transmission (90.4%), and 75% occurred during December-March. Genogroup was reported for 7292 outbreaks with 862 (11.8%) positive for GI and 6370 (87.3%) for GII. Among 4425 GII outbreaks with typing data, 3618 (81.8%) were GII.4. LTCF residents had higher attack rates than staff (median 29.0% vs 10.9%; P < .001). For every 1000 cases, there were 21.6 hospitalizations and 2.3 deaths. CONCLUSIONS LTCFs have a high burden of norovirus outbreaks. Most LTCF norovirus outbreaks occurred during winter months and were spread person-to-person. Outbreak surveillance can inform development of interventions for this vulnerable population, such as vaccines targeting GII.4 norovirus strains.
Collapse
Affiliation(s)
- Laura E. Calderwood
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Mary E. Wikswo
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Claire P. Mattison
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Anita K. Kambhampati
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Neha Balachandran
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA;,Cherokee Nation Assurance, Arlington, Virginia, USA
| | - Jan Vinjé
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Barclay
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aron J. Hall
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A. Mirza
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Falcetta MRR, Rocha GBM, Daudt LR, Bublitz AK, Menegolla MP, Borges RDP, Bauer AC. Benefits of water intake on kidney function in older adults: protocol for a randomized controlled trial. GERIATRICS, GERONTOLOGY AND AGING 2022. [DOI: 10.53886/gga.e0220004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: The goal of this study is to evaluate the benefits of an increase in water intake guided by a mathematical formula (per kg of body weight) on kidney function in older adults. Methods: Older adults (≥ 65 years old) cared for at the Internal Medicine Unit of a tertiary hospital will be randomized to receive or not guidance on water intake (30 mL/kg per day) after initial assessment of kidney function. After 14 days, participants will be reevaluated through clinical and laboratory examinations. Patients with uncompensated disease will be excluded. The main outcomes will be glomerular filtration rate and laboratory measures such as serum and urinary osmolality, sodium, urea, 24-h urine volume and serum creatinine, uric acid, and copeptin. The Mini Nutritional Assessment (MNA) questionnaire will be applied to participants at each visit. Categorical variables will be described as numbers of cases (%) and compared using the χ2 test whereas continuous variables will be analyzed with Student’s t-test in relation to baseline measures. The Generalized Estimating Equations (GEE) method will be performed to assess differences over time and between groups. This study was approved by the Institution’s Research Ethics Committee (grant number 16-0153) and is in accordance with the Declaration of Helsinki. Expected Results:By increasing water intake (ml/Kg) we expect to provide an improvement in kidney function in older population assessed by serum creatinine and cystatin-c applied to eGFR formulas. Relevance:Many conditions, both organic and behavioral, can contribute to chronic dehydration states in older adults. To mention, decreased ability to concentrate urine, reduced kidney mass, blood flow, and glomerular filtration rate (GFR) along with changes in sensitivity to hormones such as renin, vasopressin and natriuretic peptide can generate water imbalance, leading to dehydration. For being simple and inexpensive, this strategy may be broadly used and bring several health benefits to older adults.
Collapse
|
9
|
Bruno C, Collier A, Holyday M, Lambert K. Interventions to Improve Hydration in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13103640. [PMID: 34684642 PMCID: PMC8537864 DOI: 10.3390/nu13103640] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/13/2021] [Indexed: 01/23/2023] Open
Abstract
Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I2 = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.
Collapse
Affiliation(s)
- Chevonne Bruno
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Annaleise Collier
- Nutrition and Dietetics Department, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (A.C.); (M.H.)
| | - Margaret Holyday
- Nutrition and Dietetics Department, Prince of Wales Hospital, Randwick, NSW 2031, Australia; (A.C.); (M.H.)
| | - Kelly Lambert
- School of Medicine, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia
- Correspondence:
| |
Collapse
|
10
|
Dehydration in older people: A systematic review of the effects of dehydration on health outcomes, healthcare costs and cognitive performance. Arch Gerontol Geriatr 2021; 95:104380. [PMID: 33636649 DOI: 10.1016/j.archger.2021.104380] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/27/2021] [Accepted: 02/13/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To systematically examine the effect of dehydration on health outcomes, identify associated financial costs and consider impacts on cognitive performance in older adults. DESIGN A systematic review of English-language articles via OVID using MEDLINE, PsychINFO, EMBASE, and others, to March 2018. Included studies examined the relationship between hydration status and health, care costs or cognitive outcome. SETTING Cross sectional and cohort data from studies reporting on dehydration in older adults. PARTICIPANTS Adults aged 60 years and older. MEASUREMENTS Independent quality ratings were assessed for all extracted articles. RESULTS Of 1684 articles screened, 18 papers (N = 33,707) met inclusion criteria. Participants were recruited from hospital settings, medical long-term care centres and the community dwelling population. Data were synthesised using a narrative summary. Mortality rates were higher in dehydrated patients. Furthermore, health outcomes, including frailty, bradyarrhythmia, transient ischemic attacks, oral health and surgery recovery are linked to and worsened by dehydration. Length of hospital stay, either as a principal or secondary diagnosis, is greater in those with dehydration, compared to those who are euhydrated. Finally, neurocognitive functioning may be impacted by dehydration. There are issues with study design, inconsistency in hydration status measurement and different measures used for outcome assessment. CONCLUSION Dehydration in older people is associated with increased mortality, poorer course of illness and increased costs for health services. In addition, there is some, but sparse evidence that dehydration in older people is linked to poorer cognitive performance. Intervention studies should test strategies for reducing dehydration in older adults.
Collapse
|
11
|
Damiani AP, Strapazzon G, de Oliveira Sardinha TT, Rohr P, Gajski G, de Pinho RA, de Andrade VM. Melatonin supplementation over different time periods until ageing modulates genotoxic parameters in mice. Mutagenesis 2020; 35:465-478. [PMID: 32720686 DOI: 10.1093/mutage/geaa017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022] Open
Abstract
The ageing process is a multifactorial phenomenon, associated with decreased physiological and cellular functions and an increased propensity for various degenerative diseases. Studies on melatonin (N-acetyl-5-methoxytryptamine), a potent antioxidant, are gaining attention since melatonin production declines with advancing age. Hence, the aim of this study was to evaluate the effects of chronic melatonin consumption on genotoxic and mutagenic parameters of old Swiss mice. Herein, 3-month-old Swiss albino male mice (n = 240) were divided into eight groups and subdivided into two experiments: first (three groups): natural ageing experiment; second (five groups): animals that started water or melatonin supplementation at different ages (3, 6, 12 and 18 months) until 21 months. After 21 months, the animals from the second experiment were euthanized to perform the comet assay, micronucleus test and western blot analysis. The results demonstrated that melatonin prolonged the life span of the animals. Relative to genomic instability, melatonin was effective in reducing DNA damage caused by ageing, presenting antigenotoxic and antimutagenic activities, independently of initiation age. The group receiving melatonin for 18 months had high levels of APE1 and OGG1 repair enzymes. Conclusively, melatonin presents an efficient antioxidant mechanism aiding modulating genetic and physiological alterations due to ageing.
Collapse
Affiliation(s)
- Adriani Paganini Damiani
- Translational Biomedicine Laboratory, Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Giulia Strapazzon
- Translational Biomedicine Laboratory, Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Thanielly Thais de Oliveira Sardinha
- Translational Biomedicine Laboratory, Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Paula Rohr
- Translational Biomedicine Laboratory, Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| | - Goran Gajski
- Mutagenesis Unit, Institute for Medical Research and Occupational Health, Zagreb, Croatia, Croatia
| | - Ricardo Aurino de Pinho
- Laboratory of Exercise Biochemistry in Health, Graduate Program in Health Sciences, School of Medicine, Pontifícia Universidade Católica do Paraná, R. Imac. Conceição - Curitiba - PR, Brazil
| | - Vanessa Moraes de Andrade
- Translational Biomedicine Laboratory, Graduate Programme of Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, SC, Brazil
| |
Collapse
|
12
|
|
13
|
Cognitive performance in relation to hydration status and water intake among older adults, NHANES 2011–2014. Eur J Nutr 2019; 59:3133-3148. [DOI: 10.1007/s00394-019-02152-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022]
|
14
|
Cook G, Hodgson P, Thompson J, Bainbridge L, Johnson A, Storey P. Hydration Interventions for older people living in residential and nursing care homes: overview of the literature. Br Med Bull 2019; 131:71-79. [PMID: 31556943 DOI: 10.1093/bmb/ldz027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/05/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.
Collapse
Affiliation(s)
- Glenda Cook
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Philip Hodgson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Juliana Thompson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Lesley Bainbridge
- Nursing, Patient Safety and Quality, Newcastle Gateshead Clinical Commissioning Group, Riverside House, Goldcrest Way, Newburn , Newcastle upon Tyne, UK
| | - Amy Johnson
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Paul Storey
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| |
Collapse
|
15
|
Costa A, Carrión S, Puig-Pey M, Juárez F, Clavé P. Triple Adaptation of the Mediterranean Diet: Design of A Meal Plan for Older People with Oropharyngeal Dysphagia Based on Home Cooking. Nutrients 2019; 11:E425. [PMID: 30781630 PMCID: PMC6412386 DOI: 10.3390/nu11020425] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/08/2019] [Accepted: 02/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) and malnutrition are highly prevalent in older patients that are discharged from general hospitals (47% and 30%, respectively). AIMS To develop a nutritional plan for these patients involving a triple adaptation of their traditional diet: (a) rheological adaptation (texture and viscosity) for safe deglutition, (b) nutritional adaptation (water, calories, and proteins), and (c) organoleptic adaptation to improve compliance. METHODS Two fluid viscosities (250 and 800 mPa·s) were selected according to previous studies on optimal viscosities in older patients. The British Dietetic Association food texture classification based on common clinical practice selected two food textures (thick purée and fork-mashable. Two levels of calorie protein enrichment were selected according to previous studies using the Mini Nutritional Assessment (MNA®). RESULTS The daily caloric-protein and hydric needs were established at 1750 kcal, 70 g protein, and 1750 mL water in patients with MNA® ≥ 17; and, 2037 kcal, 90 g protein, and 2000 mL water/day in malnourished patients. Sixteen weekly menus (296 recipes) were developed while using two textures, two levels of viscosity, two nutritional phenotypes (normal/at-risk vs. malnourished), and two seasons of the year (spring/summer-autumn/winter) based on Mediterranean cuisine. CONCLUSION This concept paper demonstrates that traditional Mediterranean cooking can be adapted to meet the rheological, nutritional, and hydration needs of older patients with OD. The recipes that we have developed meet the needs of patients with varying degrees of OD and malnutrition are reproducible in patient's homes and they could have a major impact on the clinical outcomes of these patients.
Collapse
Affiliation(s)
- Alicia Costa
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
- Department of Dietetics and Nutrition, Hospital de Mataró, 08304 Barcelona, Spain.
| | - Silvia Carrión
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
| | - Marc Puig-Pey
- Fundació Alicia, San Fruitós del Bages, 08272 Barcelona, Spain.
| | - Fabiola Juárez
- Fundació Alicia, San Fruitós del Bages, 08272 Barcelona, Spain.
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08304 Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 08304 Barcelona, Spain.
- Fundació de Recerca en Gastroenterologia, 08304 Barcelona, Spain.
| |
Collapse
|
16
|
Meehan AJ, Maher AB, Brent L, Copanitsanou P, Cross J, Kimber C, MacDonald V, Marques A, Peng L, Queirós C, Roigk P, Sheehan KJ, Skúladóttir SS, Hommel A. The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture. Int J Orthop Trauma Nurs 2019; 32:3-26. [DOI: 10.1016/j.ijotn.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
17
|
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]
|
18
|
ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
Collapse
|
19
|
Fava JP, Starr KM, Ratz D, Clemente JL. Dosing challenges with direct oral anticoagulants in the elderly: a retrospective analysis. Ther Adv Drug Saf 2018; 9:405-414. [PMID: 30364869 DOI: 10.1177/2042098618774498] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background Direct oral anticoagulants (DOACs) provide patients with attractive options for anticoagulation in atrial fibrillation (AF). However, dosing these agents in the elderly can be challenging due to factors such as drug interactions, reduced renal function, and less frequent monitoring. This study addressed this challenge by reviewing the dosing of three commonly used DOACs (i.e. apixaban, dabigatran, and rivaroxaban) in elderly patients managed at a pharmacist-run anticoagulation clinic. Methods This was a single-center, retrospective cohort study. A total of 98 cases of DOAC therapy in patients with AF aged 75 years or older receiving care at a large urban healthcare center were identified via chart review. Dosing of each DOAC was assessed at therapy initiation and throughout treatment whenever a serum creatinine was reported, using the Cockcroft-Gault equation to estimate creatinine clearance (CrCl). Dose excursions (defined as instances where patients were exposed to non-Food and Drug Administration (FDA)-approved doses) were documented in each case. Rationales for dose excursions were determined by study investigators via review of progress notes and categorized using clinical judgement. Results Upon therapy initiation apixaban was dosed in accordance with FDA recommendations in 92.9% of patient cases, dabigatran in 91.2% of cases, and rivaroxaban in 86.1% of cases (p = 0.70). FDA-recommended dosing was maintained throughout treatment at the highest rates with dabigatran (88.2% versus 78.6% with apixaban and 58.3% with rivaroxaban; p = 0.01, p = 0.005 for dabigatran versus rivaroxaban). The most common rationales for dose excursion were fluctuation in estimated CrCl near the dosing cutoff, and recommendations from nonpharmacist providers co-managing the patient. Conclusions Prescribing and maintaining FDA-recommended doses of DOAC agents in the elderly is more challenging than initially perceived. Fluctuations in renal function, comorbidities, and concomitant antiplatelet use may necessitate more individualized dosing strategies with these agents.
Collapse
Affiliation(s)
- Joseph P Fava
- Clinical Assistant Professor, Department of Pharmacy Practice, Wayne State University Eugene Applebaum College of Pharmacy and Health Sciences, 259 Mack Ave, Suite 2128, Detroit, MI 48201, USA
| | - Katelyn M Starr
- Department of Pharmacy, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - David Ratz
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Jennifer L Clemente
- Department of Pharmacy, John D. Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| |
Collapse
|
20
|
Lauriola M, Mangiacotti A, D'Onofrio G, Cascavilla L, Paris F, Paroni G, Seripa D, Greco A, Sancarlo D. Neurocognitive Disorders and Dehydration in Older Patients: Clinical Experience Supports the Hydromolecular Hypothesis of Dementia. Nutrients 2018; 10:nu10050562. [PMID: 29751506 PMCID: PMC5986442 DOI: 10.3390/nu10050562] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/11/2018] [Accepted: 04/27/2018] [Indexed: 02/06/2023] Open
Abstract
Abnormalities of water homeostasis can be early expressions of neuronal dysfunction, brain atrophy, chronic cerebrovasculopathy and neurodegenerative disease. The aim of this study was to analyze the serum osmolality of subjects with cognitive impairment. One thousand and ninety-one consecutive patients attending the Alzheimer’s Evaluation Unit were evaluated with the Mini-Mental State Examination (MMSE), 21-Item Hamilton Depression Rating Scale (HDRS-21), Activities of Daily Living (ADL), Instrumental-ADL (IADL), Mini Nutritional Assessment (MNA), Exton-Smith Scale (ESS), and Cumulative Illness Rating Scale (CIRS). For each patient, the equation for serum osmolality developed by Khajuria and Krahn was applied. Five hundred and seventy-one patients had cognitive decline and/or depression mood (CD-DM) and 520 did not have CD-DM (control group). Patients with CD-DM were less likely to be male (p < 0.001), and were more likely to be older (p < 0.001), have a significant clear cognitive impairment (MMSE: p < 0.001), show the presence of a depressive mood (HDRS-21: p < 0.001) and have major impairments in ADL (p < 0.001), IADL (p < 0.001), MNA (p < 0.001), and ESS (p < 0.001), compared to the control group. CD-DM patients had a higher electrolyte concentration (Na+: p < 0.001; K+: p < 0.001; Cl−: p < 0.001), risk of dehydration (osmolality p < 0.001), and kidney damage (eGFR: p = 0.021), than the control group. Alzheimer’s disease (AD) patients showed a major risk for current dehydration (p ≤ 0.001), and dehydration was associated with the risk of developing a type of dementia, like AD or vascular dementia (VaD) (OR = 2.016, p < 0.001). In the multivariate analysis, the presence of dehydration state was associated with ADL (p < 0.001) and IADL (p < 0.001), but independently associated with age (r2 = 0.0046, p = 0.77), ESS (r2 = 0.0052, p = 0.54) and MNA (r2 = 0.0004, p = 0.48). Moreover, younger patients with dementia were significantly more dehydrated than patients without dementia (65–75 years, p = 0.001; 76–85 years, p = 0.001; ≥86 years, p = 0.293). The hydromolecular hypothesis intends to explain the relationship between dehydration and cognitive impairment in older patients as the result of protein misfolding and aggregation, in the presence of a low interstitial fluid volume, which is a defect of the microcirculation. Defective proteins were shown to impair the amount of information in brain biomolecular mechanisms, with consequent neuronal and synaptic damage.
Collapse
Affiliation(s)
- Michele Lauriola
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Antonio Mangiacotti
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Grazia D'Onofrio
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Leandro Cascavilla
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Francesco Paris
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Giulia Paroni
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Davide Seripa
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Antonio Greco
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| | - Daniele Sancarlo
- Complex Structure of Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Viale Cappuccini 1, 71013 Foggia, Italy.
| |
Collapse
|
21
|
Picetti D, Foster S, Pangle AK, Schrader A, George M, Wei JY, Azhar G. Hydration health literacy in the elderly. NUTRITION AND HEALTHY AGING 2017; 4:227-237. [PMID: 29276792 PMCID: PMC5734130 DOI: 10.3233/nha-170026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly. METHODS We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge. RESULTS About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death. CONCLUSIONS Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.
Collapse
Affiliation(s)
- Dominic Picetti
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stephen Foster
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amanda K. Pangle
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amy Schrader
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Masil George
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanne Y. Wei
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gohar Azhar
- Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
22
|
Damiani AP, Garcez ML, Letieli de Abreu L, Tavares TH, Rodrigues Boeck C, Moraes de Andrade V. A reduction in DNA damage in neural tissue and peripheral blood of old mice treated with caffeine. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2017; 80:621-629. [PMID: 28524728 DOI: 10.1080/15287394.2017.1286901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Studies on caffeine consumption have shown a negative correlation with development of some diseases with subsequent beneficial manifestations. Our aim was to assess the effects of caffeine on peripheral blood and neural tissue DNA in young adult and aged mice. Male Swiss mice (age 2-3 or 16-18 months, respectively) were treated with a caffeine solution (0.3 g/l) for 4 weeks, while controls received water. After the treatments, blood and hippocampal cells (for a comet assay) and femurs (for a micronucleus [MN] test) were collected. The comet assay of peripheral blood and hippocampal cells demonstrated no significant differences between caffeine-treated and control young adult mice in terms of DNA damage index (DI) and frequency. In contrast, when comparing young adult with aged animals, significant differences were observed in DNA damage in blood and hippocampal cells. The differences between aged animals (with or without caffeine) consisted of a significant decrease in DNA DI in the group that received caffeine. In the MN test, an increase in frequency of micronucleated polychromatic (PCE) erythrocytes was noted in aged animals that received water compared to young adult mice. In addition, comparing treated with control aged murine groups, a decrease in frequency of MN was found in PCE erythrocytes of caffeine-treated mice. Chronic caffeine consumption was neither genotoxic nor mutagenic at the dose tested; however, it appears that caffeine actually protected mice from genotoxicity and mutagenicity, consequences attributed to aging.
Collapse
Affiliation(s)
- Adriani Paganini Damiani
- a Laboratório de Biologia Celular e Molecular, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde , Universidade do Extremo Sul Catarinense - UNESC , Criciúma , SC , Brazil
| | - Michelle Lima Garcez
- a Laboratório de Biologia Celular e Molecular, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde , Universidade do Extremo Sul Catarinense - UNESC , Criciúma , SC , Brazil
| | - Larissa Letieli de Abreu
- a Laboratório de Biologia Celular e Molecular, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde , Universidade do Extremo Sul Catarinense - UNESC , Criciúma , SC , Brazil
| | - Taís Helena Tavares
- a Laboratório de Biologia Celular e Molecular, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde , Universidade do Extremo Sul Catarinense - UNESC , Criciúma , SC , Brazil
| | - Carina Rodrigues Boeck
- b Programa de Pós-graduação em Nanociências , Centro Universitário Franciscano - UNIFRA , Santa Maria , RS , Brazil
| | - Vanessa Moraes de Andrade
- a Laboratório de Biologia Celular e Molecular, Programa de Pós-Graduação em Ciências da Saúde, Unidade Acadêmica de Ciências da Saúde , Universidade do Extremo Sul Catarinense - UNESC , Criciúma , SC , Brazil
| |
Collapse
|
23
|
Bak A, Tsiami A, Greene C. Methods of Assessment of Hydration Status and their Usefulness in Detecting Dehydration in the Elderly. CURRENT RESEARCH IN NUTRITION AND FOOD SCIENCE 2017. [DOI: 10.12944/crnfsj.5.2.01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Assessment of hydration status is complex and difficult to achieve. Few assessment methods have been validated to accurately measure the fluid compartments in the body, but they have little application in practice. Different techniques have been developed to determine hydration status for the use in clinical settings, but their diagnostic accuracy remains questionable. Since many experts argue that there is no 'gold-standard' technique and one can never be achieved, this paper describes both, the benefits and limitations of the available methods and their usability in assessing hydration status of the elderly.
Collapse
Affiliation(s)
- Aggie Bak
- Richard Wells Centre, College of Nursing, Midwifery and Healthcare, University of West London, London
| | - Amalia Tsiami
- London Geller College of Hospitality and Tourism University of West London, London
| | - Carolynn Greene
- Richard Wells Centre, College of Nursing, Midwifery and Healthcare, University of West London, London
| |
Collapse
|
24
|
Oates LL, Price CI. Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review. BMC Nurs 2017; 16:4. [PMID: 28104998 PMCID: PMC5240391 DOI: 10.1186/s12912-016-0195-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients in hospital may be unable to maintain hydration by drinking, leading to intravenous fluid replacement, complications and a longer length of stay. We undertook a systematic review to describe clinical assessment tools which identify patients at risk of insufficient oral fluid intake and the impact of simple interventions to promote drinking, in hospital and care home settings. METHOD MEDLINE, CINAHL, and EMBASE databases and two internet search engines (Google and Google Scholar) were examined. Articles were included when the main focus was use of a hydration/dehydration risk assessment in an adult population with/without a care intervention to promote oral hydration in hospitals or care homes. Reviews which used findings to develop new assessments were also included. Single case reports, laboratory results only, single technology assessments or non-oral fluid replacement in patients who were already dehydrated were excluded. Interventions where nutritional intake was the primary focus with a hydration component were also excluded. Identified articles were screened for relevance and quality before a narrative synthesis. No statistical analysis was planned. RESULTS From 3973 citations, 23 articles were included. Rather than prevention of poor oral intake, most focused upon identification of patients already in negative fluid balance using information from the history, patient inspection and urinalysis. Nine formal hydration assessments were identified, five of which had an accompanying intervention/ care protocol, and there were no RCT or large observational studies. Interventions to provide extra opportunities to drink such as prompts, preference elicitation and routine beverage carts appeared to support hydration maintenance, further research is required. Despite a lack of knowledge of fluid requirements and dehydration risk factors amongst staff, there was no strong evidence that increasing awareness alone would be beneficial for patients. CONCLUSION Despite descriptions of features associated with dehydration, there is insufficient evidence to recommend a specific clinical assessment which could identify older persons at risk of poor oral fluid intake; however there is evidence to support simple care interventions which promote drinking particularly for individuals with cognitive impairment. TRIAL REGISTRATION PROSPERO 2014:CRD42014015178.
Collapse
Affiliation(s)
- Lloyd L Oates
- Northumbria Healthcare NHS Foundation Trust, Stroke Research, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ UK
| | - Christopher I Price
- Northumbria Healthcare NHS Foundation Trust, Stroke Research, Wansbeck General Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ UK ; Newcastle University Institute for Ageing, Newcastle University Stroke Research Group, 3-4 Claremont Terrace, Newcastle upon Tyne, NE1 7RU UK
| |
Collapse
|
25
|
Guo Y, Hainley S, Palmer JL, Bruera E. Azotemia in Cancer Patients During Inpatient Rehabilitation. Am J Hosp Palliat Care 2016; 24:264-9. [PMID: 17601836 DOI: 10.1177/1049909107302298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper presents a study of the relationship between prerenal azotemia and rehabilitation outcomes of cancer patients. A retrospective chart review of 70 patients who underwent inpatient rehabilitation in a tertiary cancer center was undertaken. Eight patients with creatinine values >1.5 were excluded. The remaining 62 patients were divided into 2 groups according to the blood urea nitrogen/creatinine (BUN/Cr) ratio: 27 (44%) in the prerenal azotemia group (BUN/Cr ≥ 20) and 35 (56%) in the non-azotemic group (BUN/Cr < 20). Age, gender, <10 g/dL of hemoglobin, co-morbidity (diabetes mellitus and/or hypertension), discharge destiny and median rehabilitation length of stay were not significantly different in these 2 groups. Prerenal azotemia was present in a significant number of cancer patients, but it did not impact the length of rehabilitation stay or discharge destiny.
Collapse
Affiliation(s)
- Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, 1515 Holcombeboulevard, Houston, TX 77030, USA.
| | | | | | | |
Collapse
|
26
|
Abstract
It is known that the primary cause of dehydration in elderly care is caused by a person not regularly drinking enough. Dehydration is a much-publicised national concern, associated with poor outcomes of care and acute hospital admissions. However, in November last year, NHS England stated that the scale of dehydration is not known; in comparison, it confirmed at least three million people are at risk of malnutrition. The stark comparison in information occurs because there is no nationally recognised screening tool to identify who is at risk of dehydration. An innovative nursing role, focused on finding solutions to reduce the risk of dehydration in the care of older and vulnerable persons, has led to the development of a simple dehydration screening tool called 'ROC to drink' (ROC stands for 'reliance on a carer'), which focuses on the level of support needed to drink. An innovative tea cup has been designed to help raise standards for monitoring drinks and raise awareness about intake.
Collapse
|
27
|
A Randomized Controlled Trial of an Individualized Preoperative Education Intervention for Symptom Management After Total Knee Arthroplasty. Orthop Nurs 2016; 35:20-9. [DOI: 10.1097/nor.0000000000000210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
28
|
Okuyama M, Nishida M. [The physical signs of impending dehydration among elderly people in nursing homes: The association with axillary skin temperature, humidity, intraoral moisture content, and salivary components]. Nihon Ronen Igakkai Zasshi 2016; 53:379-386. [PMID: 27885225 DOI: 10.3143/geriatrics.53.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The aim of the present study was to examine the association between impending dehydration among elderly people in nursing homes and physical signs, including the axillary skin temperature, humidity, intraoral moisture content, and salivary components. METHODS The study included 78 elderly individuals who required long-term care in a nursing home (11 men and 67 women; average age, 86.6±7.3 years). The elderly subjects were classified in two groups according to their serum osmolality levels: those with levels between the upper limit reference value (292 mOsm/kg H2O) and the diagnostic reference value of dehydration (300 mOsm/kg H2O) were classified into the boundary zone group and those with levels of <292 mOsm/kg H2O were classified into the normal range group. The following parameters were measured: basic attributes (age, gender and level of care required), body mass index, diet, daily fluid intake per kilogram of body weight, physiological indicators (blood pressure, pulse rate, body temperature, axillary skin temperature, humidity, total body water, body water rate, internal liquid rate, external solution rate, blood components, intraoral water amount, and salivary components), and the indoor environment (room temperature and humidity). We then performed a statistical analysis to compare the boundary zone group with the normal range group. After adjusting for age and the daily fluid intake per kilogram of body weight (<25 ml/≥25 ml), we performed a logistic regression analysis (the boundary zone group was used as an independent variable) for variables that had significance levels of <0.05 (except for blood components). RESULTS The univariate analysis revealed significant differences in the following parameters: the serum sodium, chloride, and creatinine levels; the blood sugar level; the urea nitrogen/creatinine ratio; the axillary skin temperature; and room humidity. Only the axillary skin temperature showed a significant association in the final model of the logistic regression analysis (odds ratio, 3.664; 95% confidence interval, 1.101-12.197; p = 0.034). CONCLUSION As the axillary skin temperature increased by 1°C, there was a 3.67-fold risk of being classified into the boundary zone group instead of the normal range group. Thus, the axillary skin temperature was associated with impending dehydration.
Collapse
Affiliation(s)
- Mayumi Okuyama
- Department of Nursing, Faculty of Nursing, Sanyo Gakuen University
| | | |
Collapse
|
29
|
Konings FJCM, Mathijssen JJP, Schellingerhout JM, Kroesbergen IHT, Goede de J, Goor de IAM. Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial. Int J Prev Med 2015; 6:103. [PMID: 26644904 PMCID: PMC4671176 DOI: 10.4103/2008-7802.167617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/27/2015] [Indexed: 11/12/2022] Open
Abstract
Background: Dehydration of elderly people living independently is a very important public health issue. This study compares two interventions to prevent dehydration in elderly people at risk: an educational intervention and an educational intervention in combination with a drink reminder device. Methods: This is an experimental two-armed parallel study. A Public Health Service develops the interventions and will be partnering with a general practice and a university to evaluate the effects. Two groups – all people aged 80 years and older, and people of 65 years and older who have cardiovascular disease – receive a letter from the general practice in which they are asked whether they want to participate in the study and if so to return the form. People who want to participate and whose daily fluid intake is insufficient are randomized to receive either the educational intervention or the educational intervention in combination with a drink reminder device. The participants are asked to fill in a questionnaire before the intervention, 6 weeks after the start of the intervention and 6 months after the start (or after the end) of the intervention. Changes between the two groups in fluid intake, knowledge, awareness of the risks of dehydration, and quality-of-life will be tested by Linear Mixed Model analyses. Conclusions: This study will improve the knowledge of the effectiveness of interventions designed to prevent dehydration in elderly people.
Collapse
Affiliation(s)
- Francis J C M Konings
- Department Policy and Research, Regional Public Health Service of West-Brabant, 5003 DA Tilburg, The Netherlands
| | - Jolanda J P Mathijssen
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, 5000 LE Tilburg, The Netherlands
| | | | - Ike H T Kroesbergen
- Department Policy and Research, Regional Public Health Service of West-Brabant, 5003 DA Tilburg, The Netherlands
| | - Joyce Goede de
- Department Policy and Research, Regional Public Health Service of West-Brabant, 5003 DA Tilburg, The Netherlands
| | - Ien A M Goor de
- Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, 5000 LE Tilburg, The Netherlands
| |
Collapse
|
30
|
Johnstone P, Alexander R, Hickey N. Prevention of dehydration in hospital inpatients. ACTA ACUST UNITED AC 2015; 24:568-70, 572-3. [DOI: 10.12968/bjon.2015.24.11.568] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ratan Alexander
- Consultant Anaesthetist and Clinical Tutor, Worcester Royal Hospital, Worcester
| | - Nick Hickey
- Consultant Vascular Surgeon and Clinical Supervisor, Worcester Royal Hospital, Worcester
| |
Collapse
|
31
|
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.
Collapse
|
32
|
Gaff L, Jones J, Davidson IH, Bannerman E. A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital. J Hum Nutr Diet 2015; 28:384-9. [DOI: 10.1111/jhn.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L. Gaff
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - J. Jones
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - I. H. Davidson
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - E. Bannerman
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| |
Collapse
|
33
|
Goldberg LR, Heiss CJ, Parsons SD, Foley AS, Mefferd AS, Hollinger D, Parham DF, Patterson J. Hydration in older adults: the contribution of bioelectrical impedance analysis. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 16:273-281. [PMID: 24521507 DOI: 10.3109/17549507.2014.882989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sensory and gastrointestinal changes that occur with ageing affect older adults' food and liquid intake. Any decreased liquid intake increases the risk for dehydration. This increased dehydration risk is compounded in older adults with dysphagia. The availability of a non-invasive and easily administered way to document hydration levels in older adults is critical, particularly for adults in residential care. This pilot study investigated the contribution of bioelectrical impedance analysis to measure hydration in 19 older women in residential care: 13 who viewed themselves as healthy and six with dysphagia. Mann-Whitney U analyses documented no significant between-group differences for Total Body Water (TBW), Fat Free Mass (FFM), Fat Mass (FM), and percentage Body Fat (%BF). However, when compared to previously published data for age-matched women, the TBW and FFM values of the two participant groups were notably less, and FM and %BF values were notably greater than expected. If results are confirmed through continued investigation, such findings may suggest that long-term care facilities are unique environments in which all older residents can be considered at-risk for dehydration and support the use of BIA as a non-invasive tool to assess and monitor their hydration status.
Collapse
|
34
|
Water-loss dehydration and aging. Mech Ageing Dev 2013; 136-137:50-8. [PMID: 24333321 DOI: 10.1016/j.mad.2013.11.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 11/12/2013] [Accepted: 11/27/2013] [Indexed: 11/21/2022]
Abstract
This review defines water-loss and salt-loss dehydration. For older people serum osmolality appears the most appropriate gold standard for diagnosis of water-loss dehydration, but clear signs of early dehydration have not been developed. In older adults, lower muscle mass, reduced kidney function, physical and cognitive disabilities, blunted thirst, and polypharmacy all increase dehydration risk. Cross-sectional studies suggest a water-loss dehydration prevalence of 20-30% in this population. Water-loss dehydration is associated with higher mortality, morbidity and disability in older people, but evidence is still needed that this relationship is causal. There are a variety of ways we may be able to help older people reduce their risk of dehydration by recognising that they are not drinking enough, and being helped to drink more. Strategies to increase fluid intake in residential care homes include identifying and overcoming individual and institutional barriers to drinking, such as being worried about not reaching the toilet in time, physical inability to make or to reach drinks, and reduced social drinking and drinking pleasure. Research needs are discussed, some of which will be addressed by the FP7-funded NU-AGE (New dietary strategies addressing the specific needs of elderly population for a healthy ageing in Europe) trial.
Collapse
|
35
|
Beattie E, O'Reilly M, Strange E, Franklin S, Isenring E. How much do residential aged care staff members know about the nutritional needs of residents? Int J Older People Nurs 2013; 9:54-64. [DOI: 10.1111/opn.12016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/21/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Elizabeth Beattie
- Dementia Collaborative Research Centre: Carers & Consumers; Queensland University of Technology; Brisbane Australia
- Dementia Training Studies Centre; Queensland University of Technology; Brisbane Australia
- School of Nursing; Queensland University of Technology; Brisbane Australia
| | - Maria O'Reilly
- School of Nursing; Queensland University of Technology; Brisbane Australia
| | - Elise Strange
- Dietetics Department; School of Human Movement Studies; The University of Queensland; Brisbane Australia
| | - Sara Franklin
- Dementia Collaborative Research Centre: Carers & Consumers; Queensland University of Technology; Brisbane Australia
| | - Elisabeth Isenring
- Princess Alexandra Hospital; School of Human Movement Studies; The University of Queensland; Brisbane Australia
- Master of Dietetic Studies Program; School of Human Movement Studies; The University of Queensland; Brisbane Australia
| |
Collapse
|
36
|
Affiliation(s)
- Janet C Mentes
- University of California, Los Angeles, UCLA School of Nursing, Los Angeles, CA 90095, USA.
| | | |
Collapse
|
37
|
Millard-Stafford M, Wendland DM, O'Dea NK, Norman TL. Thirst and hydration status in everyday life. Nutr Rev 2013; 70 Suppl 2:S147-51. [PMID: 23121351 DOI: 10.1111/j.1753-4887.2012.00527.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Water is an essential nutrient for all persons; thus, maintaining a chronic state of optimal hydration is recognized to provide health benefits. Fluid balance is maintained via thirst, a feedback-controlled variable, regulated acutely by central and peripheral mechanisms. However, voluntary drinking is also a behavior influenced by numerous social and psychological cues. Therefore, whether "thirst-guided" drinking maintains optimal hydration status is a multifactorial issue. Thirst perception is typically assessed by subjective ratings using either categorical or visual analog scales; however, which instrument yields greater sensitivity to change in hydration status has not been examined. Ratings of thirst perception do not always yield predictable patterns of voluntary drinking following dehydration; therefore, perceived thirst and ad libitum drinking are not equivalent measures of human thirst. The recommendation "drink to thirst" is frequently given to healthy individuals during daily life. However, factors and conditions (e.g., age, disease) that influence thirst should be recognized and probed further.
Collapse
Affiliation(s)
- Mindy Millard-Stafford
- School of Applied Physiology, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | | | | | | |
Collapse
|
38
|
|
39
|
|
40
|
Thirst deficits in aged rats are reversed by dietary omega-3 fatty acid supplementation. Neurobiol Aging 2012; 33:2422-30. [DOI: 10.1016/j.neurobiolaging.2011.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/11/2011] [Accepted: 12/01/2011] [Indexed: 02/05/2023]
|
41
|
Godfrey H, Cloete J, Dymond E, Long A. An exploration of the hydration care of older people: a qualitative study. Int J Nurs Stud 2012; 49:1200-11. [PMID: 22575619 DOI: 10.1016/j.ijnurstu.2012.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 04/10/2012] [Accepted: 04/20/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older adults are more susceptible to water imbalance and ensuring they drink sufficiently is a complex and challenging issue for nurses. The factors that promote adequate hydration and the barriers which prevent older people from drinking are not well understood. OBJECTIVE This study aimed to understand the complexity of issues associated with the hydration and hydration care of older people. DESIGN A qualitative study using multiple methods. SETTINGS Two healthcare sites providing care for older people in the South West of England: a hospital ward in a major hospital and a care home providing personal and nursing care. PARTICIPANTS Twenty-one older people aged 68-96 years, were recruited to the study from the hospital ward and care home. The inclusion criteria for older people to participate were men or women aged 65 years and over and the exclusion criteria were being unable to provide informed consent, or being too ill or distressed to take part in the study. The staff participants of nurses and health care assistants totalled 21. The inclusion criterion for staff was any nurse or health care assistant providing hydration care. Seven friends or relatives participated by making anonymous comments via a suggestion box available to all friends and relatives. METHODS Data were collected via interviews with older people, focus group discussions involving staff, suggestion box comments made by friends and relatives and twelve hours observation of hydration practice. The data were analysed using thematic analysis. RESULTS Health professionals successfully employed several strategies to promote drinking including verbal prompting, offering choice, placing drinks in older people's hands and assisting with drinking. Older people revealed their experience of drinking was diminished by a variety of factors including a limited aesthetic experience and a focus on fluid consumption rather than on drinking as a pleasurable and social experience. CONCLUSION The rich and varied dimensions usually associated with drinking were lacking and the role of drinking beverages to promote social interaction was underplayed in both settings. Hydration practice which supports the individual needs of older people is complex and goes beyond simply ensuring the consumption of adequate fluids.
Collapse
Affiliation(s)
- Helen Godfrey
- Faculty of Health and Life Sciences, University of the West of England, Bristol BS16 1DD, United Kingdom.
| | | | | | | |
Collapse
|
42
|
Hooper L, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Lindner G, Mack GW, Mentes JC, Needham RA, Olde Rikkert MGM, Ranson SC, Ritz P, Rowat AM, Smith AC, Stookey JJD, Thomas DR, Wakefield BJ, Ward S, Potter JF, Hunter PR. Clinical and physical signs for identification of impending and current water-loss dehydration in older people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
43
|
Gleibs IH, Haslam C, Haslam SA, Jones JM. Water clubs in residential care: Is it the water or the club that enhances health and well-being? Psychol Health 2011; 26:1361-77. [DOI: 10.1080/08870446.2010.529140] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
44
|
Prevalence of geriatric conditions: A hospital-wide survey of 455 geriatric inpatients in a tertiary medical center. Arch Gerontol Geriatr 2011; 53:46-50. [DOI: 10.1016/j.archger.2010.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/31/2010] [Accepted: 06/01/2010] [Indexed: 12/12/2022]
|
45
|
|
46
|
Beloosesky Y, Hershkovitz A, Solovey B, Salai M, Weiss A. Hip fracture post-operation dysnatremia and Na+-courses in different cognitive and functional patient groups. Arch Gerontol Geriatr 2010; 53:179-82. [PMID: 21067828 DOI: 10.1016/j.archger.2010.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 10/10/2010] [Accepted: 10/12/2010] [Indexed: 10/18/2022]
Abstract
The aim of the study was to investigate Na(+)-course of hip fracture patients in relation to demographic and clinical parameters. Data on 155 older hip fracture patients were analyzed retrospectively. Clinical parameters and serum Na(+) on admission (Na1), during 24h pre-op. (Na2), during 24h post-op. (Na3), and pre-discharge (Na4) were recorded. Hyponatremia and hypernatremia rates pre- and post-operation were 26.5%, 2.6%, 24.5% and 5.8%. Higher Na3 (138.76 ± 4.4 mEq/l) vs. Na1 (137.69 ± 4.5 mEq/l) (p = 0.004) and correlation between age and Na3 (p = 0.021) was found. Mean serum Na(+) of impaired mental status (IMS) vs. normal patients and of partially/independent vs. dependent patients were higher (p < 0.05). More complications occurred in IMS patients tending to higher Na3 in patients with complications. No differences in Na(+)-courses were found according to sex or co-morbidities. Dysnatremia is highly prevalent in older hip fracture patients. A distinct post-operative increase in serum Na(+) was found, higher in the cognitively and functionally impaired patients. It seems that the Na(+) increase characterizes more IMS patients who suffer more complications, but does not necessarily indicate complications. We recommend surveillance of serum Na(+), particularly in cognitively and functionally impaired older patients in whom the risk of hypernatremia and complications is higher.
Collapse
Affiliation(s)
- Yichayaou Beloosesky
- Department of Geriatrics, Rabin Medical Center, Beilinson Hospital, Sackler School of Medicine, Tel Aviv University, 39 Jabotinski St, Petah Tikva 49100, Israel.
| | | | | | | | | |
Collapse
|
47
|
Mentes JC, Wang J. Measuring risk for dehydration in nursing home residents: evaluation of the dehydration risk appraisal checklist. Res Gerontol Nurs 2010; 4:148-56. [PMID: 20509595 DOI: 10.3928/19404921-20100504-02] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 12/09/2009] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to evaluate the ability of the Dehydration Risk Appraisal Checklist (DRAC) to measure dehydration risk in nursing home (NH) residents. The DRAC includes items concerning health conditions, medications, fluid intake behaviors, and laboratory abnormalities that have been identified in the literature as risk factors for dehydration. Principal component factor analysis, known group comparisons, and multiple logistic regression were used to evaluate the criterion-related validity and reliability of the DRAC. After reducing the number of items on the DRAC on the basis of a correlation matrix, a single-factor solution with moderate internal consistency was supported. Further validity analysis demonstrated that NH residents with higher urine-specific gravity scored higher than those who had lower specific gravity. The psychometric properties of the DRAC indicate that it has potential in determining dehydration risk in NH residents. Future refinement of the instrument is also discussed.
Collapse
Affiliation(s)
- Janet C Mentes
- School of Nursing, University of California Los Angeles, Los Angeles, California 90095-6919, USA
| | | |
Collapse
|
48
|
2010 Forum and House of Delegates Agenda and Proposed Position Statements. AORN J 2010. [DOI: 10.1016/j.aorn.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Clinical Update on Nursing Home Medicine: 2009. J Am Med Dir Assoc 2009; 10:530-53. [DOI: 10.1016/j.jamda.2009.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 08/04/2009] [Indexed: 12/25/2022]
|
50
|
Wakefield BJ, Mentes J, Holman JE, Culp K. Risk factors and outcomes associated with hospital admission for dehydration. Rehabil Nurs 2009; 33:233-41. [PMID: 19024237 DOI: 10.1002/j.2048-7940.2008.tb00234.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The hospital admission rate for dehydration is one of the Agency for Healthcare Research and Quality Prevention's Quality Indicators, which are considered screening tools for potential quality issues. Thus, admission for dehydration may reflect the quality of care provided in community settings. Using a case-control design, this study estimated the incidence, risk factors, and outcomes of dehydration in adults admitted to the hospital. The overall prevalence rate for three International Classification of Diseases codes for dehydration at admission was 0.55%. Cases and controls differed significantly on a number of clinical variables at admission, including weight, body mass index, pulse, blood pressure, use of bulk-forming laxatives, serum sodium and chloride, and presence of generalized weakness or hemiplegia, edema, diarrhea, vomiting, and having nothing by mouth before admission. Mortality rates at 30 and 180 days after discharge were not significantly different between the two groups. Dehydration in community-dwelling adults may delay rehabilitation or result in hospital admission. Prevention, monitoring, and management are critical to preventing dehydration-associated problems.
Collapse
|