Identifying and preventing dehydration in the elderly population living in residential Care Homes
Diane Bunn is undertaking a PhD as part of the DRIE study.
Plan of work:
The plan for this thesis is to:
1. Undertake a systematic review to assess the effectiveness of
interventions and environmental factors which may reduce the risk of,
and/or reverse, dehydration in older people living in residential care.
2. Investigate factors promoting hydration in residential Care Homes.
3. Investigate the diagnostic accuracy of clinical assessment(s) to
identify impending dehydration in older people, as well as determining
their practicality for use in Care Homes.
Diane’s PhD supervisors are Lee Hooper and Fiona Poland.
Part 1: Effectiveness of external factors to reduce the risk of dehydration in older people living in residential care: a Systematic Review
Aim: To investigate the
current evidence for the effectiveness of interventions, or the impact
of environmental conditions, on reducing the risk of, or reverse,
impending water-loss dehydration for older people living in residential
care.
Background: The risk of dehydration is greater
amongst elderly people living in residential care, as it is this
population who are more likely to be physically and mentally frail and
it is recognised that external factors can impact on this risk.
Methods: The literature will be systematically
searched according to the Cochrane Collaboration’s guidelines for
systematic reviews, and the results analysed and collated for
publication.
The protocol for this systematic review is published at: http://www.crd.york.ac.uk/Prospero/display_record.asp?ID=CRD42012003100
Diane presented a poster on this systematic review at the Nutrition Society Summer Meeting in Newcastle on 17th July 2013. This is the poster.
Part 2: Promoting hydration in residential Care Homes
Aim: To identify
factors which promote hydration amongst residents of Care Homes. This
will include an assessment of environmental conditions, interventions,
systems of care and attitudes of staff, residents and their families.
Background: Care Homes are aware of the importance
of preventing dehydration, and so have developed systems of care to
address this issue. However, these seem to vary between homes; they may
or may not be based on research findings, and the degree of
effectiveness may be unknown. An understanding of the different
practices would benefit future research into identifying the most
effective practices.
Method, data collection: Staff and residents of
selected Care Homes will be invited to join focus groups to explore
issues which both promote and inhibit the maintenance of hydration. The
data will be analysed from the transcripts of the recordings notes. The
results will be written up for publication.
Part 3: To determine the diagnostic accuracy and practicality of clinical assessments in order to identify dehydration in older people
Aim: To formally
compare selected practical examinations with the reference standard,
serum osmolality, to identify a more user-friendly test to diagnose
impending dehydration.
Background: A review of the literature has shown
that serum osmolality, obtained from a venous blood sample, is the most
effective test available to identify hydration status. However, blood
tests for serum osmolality are impractical as a routine test for
dehydration in Care Home residents for a number of reasons: it may be
uncomfortable for the resident; few residential Care Home staff are
trained in venepuncture; the blood sample should be tested in a
suitable laboratory and the results are not immediately available.
Therefore, there is a need for another test, or group of tests, which
would address these criteria. Several tests have been described as
possible indicators of impending dehydration, but few have been
formally tested against the reference standard of serum osmolality.
Methods, data collection: Recruitment of 200
participants will take place from residential Care Homes in Norfolk and
London. Participants will be interviewed using standard questionnaires
and undergo a series of assessments, including a blood test to
determine serum osmolality (the reference standard), skin turgor, urine
testing and orthostatic hypotension.
Background information on the participant, and the Care Home in
general, will be provided by the Care Home Staff. To standardise the
assessments, the researchers will undertake comparative assessments.
This will be repeated at a later stage in the study when one or more
possible measures have been identified as having the potential to act
as markers of impending dehydration, within a group of Care Home staff
to ensure reproducibility in a real-life situation.
Methods, data analysis: The sensitivity and
specificity of each test will be calculated against the reference
standard of serum osmolality. Levels of agreement between the examiners
for each assessment will be analysed using the kappa statistic. Results
will be collated and written up for publication.
