Can a beverage cart help improve hydration?

doi:10.1067/mgn.2002.126967

Geriatric Nursing

Volume 23, Issue 4, July–August 2002, Pages 208-211

https://doi.org/10.1067/mgn.2002.126967 Get rights and content

Abstract

The purpose of this study was to determine the effectiveness of a hydration program to improve hydration and prevent conditions associated with dehydration (delirium, urinary tract infections, respiratory infections, falls, skin breakdown, and constipation). Data showed a significant increase in fluid in each body compartment, significant decrease in the number of laxatives, increase in the number of bowel movements, decline in the number of falls, and decrease in cost during the hydration period. (Geriatr Nurs 2002;23:208-11)

Section snippets

Setting and subjects

Subjects were recruited from a 250-bed nursing home in a small Midwestern city. We obtained informed consent from either the resident or his or her power-of-attorney designee. Fifty-one older adults participated in the study. Demographic data we collected included diagnoses and medications that were risk factors for dehydration. We developed a care plan for each resident based on functional status and any specific needs, such as sugar-free drinks or thickened liquids.

The mean age of the

Results

Twenty-seven (53%) subjects always consumed the 8 ounces of beverage mid-morning and mid-afternoon. The remaining 24 (47%) did not reach the goal every time.

A computer program compared the subjects' TBW as measured by the BIA to a normal standard for a person of that age, weight, and height. These standards were derived from data obtained through the National Health and Nutrition Examination Survey.¹² TBW includes both ICW and ECW; it includes the fluid within the cells, between the cells, and

Nursing implications

The project has demonstrated that a caregiver who ensures that each resident receives additional fluids can help prevent dehydration. It has shown that two additional glasses per day can raise TBW to a normal level for most older nursing home residents.

Residents had a greater number of bowel movements and consequently required fewer laxatives. The number of falls declined significantly, reflecting a relationship between adequate circulatory volume and fall prevention. Additional benefits

Suggestions for implementing a hydration program

Regardless of the type of hydration program, the first step must be education. All nursing staff and administrators must view fluid provision of equal importance to such tasks as bathing, dressing, and getting residents to the dining room. Nursing assistants need education on the loss of thirst sensation with aging and hydration's role in preventing infection, constipation, and falls. Providing fluids must be viewed as a valuable service important to patients, families, staff, and

Acknowledgements

The authors would like to thank The Retirement Research Foundation for supporting this study.

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Dehydration is recognised as an important problem among care home residents and can be associated with severe consequences. Insufficient provision of fluids to meet resident preferences and lack of assistance to drink have been identified as key factors driving under-hydration of care home residents. Using targeted interventions, this study aimed to optimise hydration care for frail older people in a care home setting.
The study used quality improvement methods to develop and test interventions to extend drinking opportunities and choice in two care homes. Changes were made and evaluated using Plan-Do-Study-Act (PDSA) cycles. Data were captured on the amount of fluids served and consumed, and staff and resident feedback. The long-term impact of the interventions was assessed by measuring daily laxative and antibiotic consumption, weekly incidence of adverse health events, and average fluid intake of a random sample of six residents captured monthly.
The interventions were associated with an increase in the amount and range of fluids consumed, in one home mean fluid intakes exceeded 1500 ml for three consecutive months. Laxative use decreased significantly in both homes. A number of practical and organisational barriers affected the sustainability of interventions.
Interventions to optimise the hydration of care home residents can be effective. Plan-Do-Study-Act cycles provide an effective methodology to implement new interventions into existing practice in care homes. Sustainable change requires strong leadership, organisational support and teamwork.
Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents
2019, Journal of the American Medical Directors Association
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors.
This was a cross-sectional study.
The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years.
Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected.
Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio.
The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.
The International Collaboration of Orthopaedic Nursing (ICON): Best practice nursing care standards for older adults with fragility hip fracture
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What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence
2017, Journal of the American Medical Directors Association
Citation Excerpt :
Recurring narratives from the care home research reviewed under the other theory areas underlined the need for new approaches to care to fit within existing structures of authority and working practices in the care home. Forty-one sources were relevant to this theory area.8,26,29,30,41,43,44,68–83,87,88,90,92,96,99,100,103,104,107–112,115,122,123 Burgio and Engel and colleagues71,72 investigating behavioral treatments for UI and FI (in the 1990s) concluded “the only two mechanisms by which toileting programs are likely to succeed: one is by increasing the number of trained personnel and the other is by redistributing staff time….”72
The prevalence of fecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. Using realist synthesis, 6 potential program theories of what should work were identified. These addressed clinician-led support, assessment, and review; the contribution of teaching and support for care home staff on how to reduce and manage FI; addressing the causes and prevention of constipation; how cognitive and physical capacity of the resident affects outcomes; how the potential for recovery, reduction, and management of FI is understood by those involved; and how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Dementia was a known risk factor for fecal incontinence (FI), but how it affected uptake of different interventions or the dementia specific continence and toileting skills staff require, were not addressed in the literature. There was a lack of dementia-specific evidence on continence aids. Most care home residents with FI will be doubly incontinent; there is, therefore, limited value in focusing solely on FI or single causes, such as constipation. Medical and nursing support for continence care is an important resource, but it is unhelpful to create a distinction between what is continence care and what is personal or intimate care. Prompted toileting is an approach that may be particularly beneficial for some residents. Valuing the intimate and personal care work unqualified and junior staff provide to people living with dementia and reinforcement of good practice in ways that are meaningful to this workforce are important clinician-led activities. Providing dementia-sensitive continence care within the daily work routines of care homes is key to helping to reduce and manage FI for this population.
Increasing fluid intake and reducing dehydration risk in older people living in long-term care: A systematic review
2015, Journal of the American Medical Directors Association
Citation Excerpt :
Of these, 292 were excluded, 10 were related publications of included studies, and 23 studies (19 intervention, 4 observational) were included in this review (Figure 1). Most studies were based in North America (14 United States,10–23 3 Canada24–26)’ 4 in Europe (2 UK,27,28 1 Ireland,29 1 Germany30), and 2 in Asia (Japan,31 Taiwan32. Characteristics of included studies are described briefly in Tables 1 and 2; and in further detail in Web Tables 1 and 2).
To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities.
Systematic review of intervention and observational studies.
Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked.
Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally.
Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed.
A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment.
Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive.
Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence.
A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies.
The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100).
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Feature ArticleCan a beverage cart help improve hydration?

Abstract

Section snippets

Setting and subjects

Results

Nursing implications

Suggestions for implementing a hydration program

Acknowledgements

Geriatr Nurs

Syringe feeding: current clinical practice and recommendations

Geriatr Nurs

Poststroke dysphagia: implications for nurses

Rehab Nurs

Dehydration: stopping a “sentinel event.”

Nursing Homes

Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision

J Am Geriatr Soc

An intervention to increase fluid intake in nursing home residents: prompting and preference compliance

J Am Geriatr Soc

Feature Article
Can a beverage cart help improve hydration?