Validation analysis of a geriatric dehydration screening tool in community-dwelling and institutionalized elderly people

Urinary Hydration Biomarkers and Water Sources in Older Adults with Neurocognitive Disorder

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.

Effect of an Audible Alarm on the Fluid Consumption of Older Adults Living in a Nursing Home: A Randomized Controlled Trial

The aim of the current study was to investigate the effect of an audible alarm on fluid consumption among older adults living in a nursing home. This single-blind, randomized controlled, prospective experimental study was performed between July 27, 2017, and February 1, 2018. This study comprised 100 participants (intervention group, n = 50; control group, n = 50). The amount of fluid consumed by older adults in the intervention group in relation to the audible alarm increased significantly compared to the control group, and the deficiency of fluid consumption decreased. It was determined that the wristwatch with audible alarm was effective when used as a reminder to increase fluid consumption among older adults with fluid deficiency. [Journal of Gerontological Nursing, 48(9), 39-46.].

Perceived quality of collaboration in dehydration care among Dutch nursing home professionals: A cross-sectional study

Aim

To explore the perceived quality of collaboration in dehydration care among nursing and medical staff in Dutch nursing homes.

Design

A cross‐sectional study.

Methods

An online questionnaire was administered to nursing and medical staff in February 2020 to assess the quality of collaboration in dehydration care and its influencing factors. Descriptive statistics, chi‐square tests and multinomial logistic regression analysis were used to describe the results and examine differences between groups.

Results

In total, 695 questionnaires were completed by multiple levels of (specialized) nursing staff and nursing home physicians. The quality of collaboration was assessed as good (23.2%), sufficient (59.4%) and insufficient (17.4%). Predicting factors related to perceiving the quality of collaboration as good were working experience, dehydration training during education and the presence of a dehydration protocol/guideline in the nursing home. Enabling factors related to collaboration in dehydration care were ‘availability of sufficient aids to detect dehydration’, ‘continuity in the care relationship’ and ‘sufficient background data of the resident in the care record’. Factors that hinder collaboration were ‘insufficient knowledge about dehydration among nursing and medical staff’, ‘the absence of a team meeting in which the topic dehydration is discussed’ and ‘insufficient staffing level among nursing and medical staff’.

Conclusion

Collaboration in dehydration care was generally assessed as sufficient. Participants with >10 years of working experience, who received dehydration training during their education and had a dehydration protocol/guideline available in the nursing home, perceived the quality of collaboration more often as good. Experienced barriers and enablers for collaboration in dehydration care varied between professional groups. Therefore, it is important to gain more insight into (informal) caregivers’ perceptions on what is expected from each other about dehydration care.

Impact

Care professionals experience several limiting factors in collaborating in dehydration care. Addressing these factors could optimize dehydration care in Dutch nursing homes.

Effect of a Hydration Management Program on Older Adults' Fluid Consumption and Dehydration Parameters: A Quasi-Experimental Study

The purpose of the current study was to assess effects of a hydration management program on the fluid consumption and dehydration parameters (i.e., dehydration risk scores, urine specific gravity, and urine color) of older adults. The study was conducted as a pre-/post-test quasi-experimental study with a control group (intervention group: n = 42, control group: n = 37). The hydration management program applied to the intervention group was completed in 1 week. After the intervention, the knowledge and awareness of the intervention group regarding fluid consumption increased (p = 0.001). The dehydration risk score of the intervention group was significantly lower than that of the control group (p = 0.0001). There was a significant change in average 3-day water intake (p = 0.0001), urine specific gravity value (p = 0.01), and urine color scale score (p = 0.0001) in the intervention group between pre- and post-test. The hydration management program provided a significant improvement in daily water intake and dehydration risk score and increased knowledge and awareness among older adults concerning the importance of fluid intake. [Journal of Gerontological Nursing, 47(9), 40-48.].

Fluid Intake Monitoring Systems for the Elderly: A Review of the Literature

Fluid intake monitoring is an essential component in preventing dehydration and overhydration, especially for the senior population. Numerous critical health problems are associated with poor or excessive drinking such as swelling of the brain and heart failure. Real-time systems for monitoring fluid intake will not only measure the exact amount consumed by the users, but could also motivate people to maintain a healthy lifestyle by providing feedback to encourage them to hydrate regularly throughout the day. This paper reviews the most recent solutions to automatic fluid intake monitoring both commercially and in the literature. The available technologies are divided into four categories: wearables, surfaces with embedded sensors, vision- and environmental-based solutions, and smart containers. A detailed performance evaluation was carried out considering detection accuracy, usability and availability. It was observed that the most promising results came from studies that used data fusion from multiple technologies, compared to using an individual technology. The areas that need further research and the challenges for each category are discussed in detail.

The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review

Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.

An Innovative Approach to Adequate Oral Hydration in an Inpatient Geriatric Psychiatry Unit

Suboptimal hydration status and dehydration are problems that often exacerbate comorbid conditions in geriatric patients. At a Veterans Administration Hospital, it was observed that suboptimal hydration status in Veterans hospitalized in the geriatric psychiatry unit was a contributing factor in the worsening of their psychiatric and medical conditions. A quality improvement project was chartered to improve hydration in this group of patients. Using a three-pronged intervention approach (i.e., providing flavored water, providing larger cups, and increasing the prompting by nurses for patients to drink more), the project was successful. The goal was to increase average daily fluid intake by 125 mL; the result was an increase of 700 mL. This project has been sustained and the interventions have also benefitted non-geriatric psychiatry in-patients. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 15-20.].

Use of Oral Hydration Protocols for Dysphagic Patients Following Stroke

PURPOSE

The aim of the study was to describe the use of oral hydration protocols for dysphagic patients following stroke.

DESIGN AND METHODS

We reviewed inpatient records for patients able to take food and liquids orally within 30 days of an ischemic stroke. Orders were hierarchically defined with three levels of liquid consistency modification (LCM) and six levels of augmented hydration orders (AHOs). Change from admission to discharge in hydration and functional independence measure (FIM) scores across LCM and AHO groups was assessed.

FINDINGS

Length of stay, admission FIM, discharge FIM, and change in FIM scores were all significantly related to LCM and AHO group assignment. Need for supplemental intravenous hydration was low (6.9%) over the 2-year study period and was significantly related to both LCM and AHO group assignment.

CONCLUSION AND CLINICAL RELEVANCE

The association of LCM and AHO interventions with functional outcomes and need for intravenous fluids helps to validate their clinical utility.