Hydration practices in residential and nursing care homes for older people

Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study

AIM

Examining the perspectives of formal and informal caregivers and residents on roles, mutual expectations and needs for improvement in the care for residents with (a risk of) dehydration.

DESIGN

Qualitative study.

METHODS

Semi-structured interviews with 16 care professionals, three residents and three informal caregivers were conducted between October and November 2021. A thematic analysis was performed on the interviews.

RESULTS

Three topic summaries contributed to a comprehensive view on the care for residents with (a risk of) dehydration: role content, mutual expectations and needs for improvement. Many overlapping activities were found among care professionals, informal caregivers and allied care staff. While nursing staff and informal caregivers are essential in observing changes in the health status of residents, and medical staff in diagnosing and treating dehydration, the role of residents remains limited. Conflicting expectations emerged regarding, for example, the level of involvement of the resident and communication. Barriers to multidisciplinary collaboration were highlighted, including little structural involvement of allied care staff, limited insight into each other's expertise and poor communication between formal and informal caregivers. Seven areas for improvement emerged: awareness, resident profile, knowledge and expertise, treatment, monitoring and tools, working conditions and multidisciplinary working.

CONCLUSION

In general, many formal and informal caregivers are involved in the care of residents with (a risk of) dehydration. They depend on each other's observations, information and expertise which requires an interprofessional approach with specific attention to adequate prevention. For this, educational interventions focused on hydration care should be a core element in professional development programs of nursing homes and vocational training of future care professionals.

IMPACT

The care for residents with (a risk of) dehydration has multiple points for improvement. To be able to adequately address dehydration, it is essential for formal and informal caregivers and residents to address these barriers in clinical practice.

REPORTING METHOD

In writing this manuscript, the EQUATOR guidelines (reporting method SRQR) have been adhered to.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Evaluation of the sensory properties of thickened and protein-enhanced ice cream using check-all-that-apply and temporal check-all-that-apply

Ice cream formulations with varying amounts of added whey protein were created for those living with dysphagia in long-term care facilities (LTCs) to improve protein and fluid intake. The samples of thickened ice cream included a control (0% whey protein [WP]) and formulations with 6% (6WP), 8% (8WP), 10% (10WP), 12% (12WP) and 14% (14WP) added whey protein by volume. The consistency of the samples was assessed using the International Dysphagia Diet Standardization Initiative (IDDSI) Spoon Tilt Test, a sensory trial (n = 102) using hedonic scales and check-all-that-apply (CATA) and another sensory trial (n = 96) using temporal check-all-that-apply (TCATA). The whey protein increased the acceptability of the thickened ice cream except for the 12WP and 14WP formulations. The formulations with higher amounts of whey protein were associated with bitterness, custard/eggy flavor, and mouthcoating. The TCATA identified that the addition of whey protein led to slippery, gritty, and grainy attributes being perceived in the thickened ice cream. The study identified that 10% whey protein by volume can be added to thickened ice cream without impacting its' acceptability and the 6WP, 8WP, and 10WP formulations were liked significantly more than the control (without whey protein).

The Effect of EMG Features on the Classification of Swallowing Events and the Estimation of Fluid Intake Volume

Nowadays, society is experiencing an increase in the number of adults aged 65 and over, and it is projected that the older adult population will triple in the coming decades. As older adults are prone to becoming dehydrated, which can significantly impact healthcare costs and staff, it is necessary to advance healthcare technologies to cater to such needs. However, there has not been an extensive research effort to implement a device that can autonomously track fluid intake. In particular, the ability of surface electromyographic sensors (sEMG) to monitor fluid intake has not been investigated in depth. Our previous study demonstrated a reasonable classification and estimation ability of sEMG using four features. This study aimed to examine if classification and estimation could be potentiated by combining an optimal subset of features from a library of forty-six time and frequency-domain features extracted from the data recorded using eleven subjects. Results demonstrated a classification accuracy of 95.94 ± 2.76% and an f-score of 94.93 ± 3.51% in differentiating between liquid swallows from non-liquid swallowing events using five features only, and a volume estimation RMSE of 2.80 ± 1.22 mL per sip and an average estimation error of 15.43 ± 8.64% using two features only. These results are encouraging and prove that sEMG could be a potential candidate for monitoring fluid intake.

Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond

OBJECTIVES

Poor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake.

DESIGN

Qualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed.

SETTING

Residential care.

PARTICIPANTS

27 invited researcher and provider experts.

RESULTS

Challenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals).

CONCLUSIONS

COVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Optimisation of Heart Failure Management in Nursing Homes Using Point-of-Care Ultrasonography: Harmonious Trial Rationale and Design

Introduction

Heart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents.

Methods

Nursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause.

Expected results

The expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population.

Conclusion

This study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.