Study Suggests Need for Uniform Method to Assess Dehydration in Older Adults
Dehydration is a serious concern for nursing home residents and can result in delirium, falls, constipation, urinary tract infections, and renal impairment. An article in the August issue of JAMDA identifies some of the challenges and issues associated with identifying, assessing, and managing dehydration in nursing homes.
In “Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review,” the authors determined that a “wide variety of methods” can be used to assess dehydration and that it is often unclear which type of dehydration—chronic or acute—is being measured. “This makes it difficult to compare prevalence rates,” they said.
The authors also noted that only two risk factors—fever and cognitive impairment—were more than once significantly associated with dehydration in 19 studies they reviewed. To put this in context, they identified 49 potential risk factors for dehydration, including diabetes, renal disease, and heart disease.
The authors observed that the most frequently investigated variable was gender, and 3 of 4 studies found a significant relationship between gender and dehydration (females are more likely to become dehydrated). They also noted that only 12 risk factors were examined in multiple studies, and the rest were only investigated in one study. Of the risk factors measured in only one study, those significantly associated with dehydration included renal function, functional impairment, blood urea nitrogen (BUN) level, the need for feeding assistance, parenteral/intravenous fluids, being malnourished, being in an end-of-life stage, having more than four chronic diseases/acute diagnoses, staff turnover, and requiring skilled care.
These results, said the authors, suggest a “lack of universally agreed-on operationalization” and “a strong need to develop a uniform and reliable method for detecting dehydration in this population.”
This study was conducted by researchers at the Institute of Nursing Science at the Medical University of Graz in Austria; Department of Health Services Research and Department of Family Medicine in the Care and Public Health Research Institute at the Maastricht University in The Netherlands.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.