DRIE - Dehydration Recognition In our Elders
Dehydration – what is the problem?
Dehydration, when we don’t drink enough for our needs, is bad for all of us. In older people severe dehydration increases confusion and falls, and makes sudden hospital admission more likely. We don’t have a good method of recognising dehydration early, before it becomes severe. Being able to identify dehydration early would allow measures, such as extra encouragement with drinking, to prevent severe dehydration.
What will the research do?
The research will identify an easy method that can signal when someone
is in need of drinking more. We will do this by interviewing people
living in care homes who are interested in this study.
Care home staff will later receive training in how to recognise the early stages of dehydration.
This research aims to improve health and wellbeing of older people in the community through:
1. Identifying a test or decision tree that can be used in residential care to identify early dehydration, so that prevention and treatment strategies can be rapidly mobilised.
We will recruit 200 older people living in residential care (where
dehydration is common). We will include those able to provide their own
informed consent, and those for whom this is not possible. At baseline
we will assess for water-loss dehydration (through serum osmolality)
and measure promising markers of dehydration (such as dry mouth, tongue
furrows, cognitive status, body temperature, dry under-arm, urine
colour and specific gravity, feeling tired, headachy or thirsty,
missing drinks, body temperature, cognition, pulse, orthostatic
hypotension, fingernail capillary refill and foot vein filling) as well
as collecting health and demographic information. We will use baseline
data to assess diagnostic accuracy of each marker, then consider
markers collectively to develop a decision tree to diagnose or rule out
dehydration, while minimising testing.
This is part of the cohort study.
2. Making the test (decision tree) acceptable to older people and realistic for use in care homes, then checking the final test works well.
This test will be refined through work with advisory groups of older
people living in care homes, who will help us ensure that the final
test is acceptable to older people, and a second group of care home
staff who will make sure the test is fit and realistic for daily use in
care homes. The final tool will be re-tested in a second population of
More info on the advisory groups.
3. Clarifying associations between dehydration and health, functional status and quality of life in frail older adults.
We will collect data on mortality, quality of life and functional
status at 1 and 2 years from our 200 care home residents. This will
allow us to clarify the predictive value of dehydration in longer term
health in older people.
This is part of the cohort study.
4. Protecting against dehydration.
Systematic review of the existing research on effectiveness of external factors in reducing the risk of dehydration in older people living in residential care.
As part of her PhD thesis Diane Bunn will investigate the current evidence for the effectiveness of interventions, or the impact of environmental conditions, on reducing the risk of, or reversing, impending water-loss dehydration for older people living in residential care.
Qualitative research to further our understanding of how best to support older people to drink plenty.
Diane will be following up the systematic review with qualitative research to identify the best ways to support older people living in care homes in drinking plenty. More info on Diane's research.
Who is funding the research?
The research will be funded by the National Institute for Health Research (NIHR). The funding is as part of a Career Development Fellowship to Lee Hooper, the researcher.