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
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
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.