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Low-Intake Dehydration in Older Adults
Low-intake dehydration is a common and often chronic condition in older adults. Adverse health outcomes associated with low-intake dehydration in older adults include poorer cognitive performance, reduced quality of life, worsened course of illness and recovery, and a high number of unplanned hospital admissions and increased mortality. The subjective methods to assess (risk of) dehydration are not reliable, and the evidence about preventive measures are also limited. So is the knowledge about the optimal intake of beverages per day. This narrative review presents the state of the science on the role of low intake hydration in older adults. Despite its simple cause—the inadequate intake of beverages—low-intake dehydration appears to be a very complex problem to address and much more research is needed in the area. Based on the existing evidence, it seems necessary to take setting specific differences and individual problems and needs into account to tackle dehydration in older adults. Further, it is necessary to increase awareness of the prevalence and severity of low-intake dehydration among older adults and in nursing staff in care homes and hospitals as well as among caregivers of older adults living at home.
2. Discussion on Low-Intake Dehydration in Older Adults
|Research Question (RQ)||Recommendation §||Grade of Recommendation *|
|1||How should low-intake dehydration be identified in older persons?
(RQ 1.1, 1.2, 1.3)
|An action threshold of directly measured serum osmolality > 300 mOsm/kg should be used to identify low-intake dehydration in older adults||B|
|Where directly measured osmolality is not available then the osmolarity equation (osmolarity = 1.86 × (Na+ + K+) + 1.15 × glucose + urea + 14 (all measured in mmol/L) with an action threshold of >295 mmol/L) should be used to screen for low-intake dehydration in older persons||B|
|Simple signs and tests commonly used to assess low-intake dehydration such as skin turgor, mouth dryness, weight change, urine color or specific gravity, shall NOT be used to assess hydration status in older adults.||A|
|Bioelectrical impedance shall NOT be used to assess hydration status in older adults as it has not been shown to be usefully diagnostic||A|
|2||What interventions may help to support older persons to drink well and prevent low-intake dehydration?||To prevent dehydration in older persons living in residential care, institutions should implement multicomponent strategies across their institutions for all residents||B|
|These strategies should include high availability of drinks, varied choice of drinks, frequent offering of drinks, staff awareness of the need for adequate fluid intake, staff support for drinking and staff support in taking older adults to the toilet quickly and when they need it.||B|
|Strategies to support adequate fluid intake should be developed including older persons themselves, staff, management, and policymakers||A|
|3||How much should older people drink each day?||Older women should be offered at least 1.6 L of drinks each day, while older men should be offered at least 2.0 L of drinks each day unless there is a clinical condition that requires different approach||B|
|4||What should older people drink each day?||A range of appropriate (i.e., hydrating) drinks should be offered to older people according to their preferences||B|
2.1. How Should Low-Intake Dehydration Be Identified in Older Persons?
A prospective, interventional study that targets parameters of normal hydration (e.g., plasma osmolarities 280–300 mOsm/kg) and determines whether this translates to health and health economics co-benefits.
The causality of the association between plasma osmolarity thresholds and adverse outcomes needs to be tested through interventional studies.
The development of a suitable device for the routine, bedside assessment of plasma osmolality.
2.2. What Interventions May Help to Support Older Persons to Drink Well and Prevent Low-Intake Dehydration?
2.3. How Much Should Older People Drink Each Day?
2.4. What Should Older People Drink Each Day?
This entry is adapted from 10.3390/nu13093142
- Lacey, J.; Corbett, J.; Forni, L.; Hooper, L.; Hughes, F.; Minto, G.; Moss, C.; Price, S.; Whyte, G.; Woodcock, T.; et al. A multidisciplinary consensus on dehydration: Definitions, diagnostic methods and clinical implications. Ann. Med. 2019, 51, 232–251.
- Paulis, S.J.; Everink, I.H.; Halfens, R.J.; Lohrmann, C.; Schols, J.M.G.A. Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review. J. Am. Med. Dir. Assoc. 2018, 19, 646–657.
- Hooper, L.; Bunn, D.K.; Downing, A.; Jimoh, F.O.; Groves, J.; Free, C.; Cowap, V.; Potter, J.F.; Hunter, P.; Shepstone, L. Which Frail Older People Are Dehydrated? The UK DRIE Study. J. Gerontol. Ser. A Boil. Sci. Med. Sci. 2016, 71, 1341–1347.
- Volkert, D.; Beck, A.M.; Cederholm, T.; Cruz-Jentoft, A.J.; Goisser, S.; Hooper, L.; Kiesswetter, E.; Maggio, M.; Raynaud-Simon, A.; Sieber, C.C.; et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin. Nutr. 2019, 38, 10–47.
- Streicher, M.; Wirth, R.; Schindler, K.; Sieber, C.C.; Hiesmayr, M.; Volkert, D. Dysphagia in Nursing Homes—Results from the NutritionDay Project. J. Am. Med. Dir. Assoc. 2018, 19, 141–147.e2.
- Painter, V.; Le Couteur, D.; Waite, L.M. Texture-modified food and fluids in dementia and residential aged care facilities. Clin. Interv. Aging 2017, 12, 1193–1203.
- Mentes, J. Oral Hydration in Older Adults: Greater. Awareness is needed in preventing, recognizing, and treating dehydrationm. AJN. Am. J. Nurs. 2006, 106, 40–49.
- Hooper, L.; Abdelhamid, A.; Attreed, N.J.; Campbell, W.W.; Channell, A.M.; Chassagne, P.; Culp, K.R.; Fletcher, S.J.; Fortes, M.B.; Fuller, N.; et al. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst. Rev. 2015, 2015, CD009647.
- Edmonds, C.J.; Foglia, E.; Booth, P.; Fu, C.H.; Gardner, M. Dehydration in older people: A systematic review of the effects of dehydration on health outcomes, healthcare costs and cognitive performance. Arch. Gerontol. Geriatr. 2021, 95, 104380.
- Paulis, S.J.C.; Everink, I.H.J.; Halfens, R.J.G.; Lohrmann, C.; Wirnsberger, R.R.; Gordon, A.L.; Schols, J.M.G.A. Diagnosing dehydration in the nursing home: International consensus based on a modified Delphi study. Eur. Geriatr. Med. 2020, 11, 393–402.
- Bunn, D.K.; Hooper, L. Signs and Symptoms of Low-Intake Dehydration Do Not Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study. J. Am. Med. Dir. Assoc. 2019, 20, 963–970.
- Oates, L.L.; Price, C.I. Clinical assessments and care interventions to promote oral hydration amongst older patients: A narrative systematic review. BMC Nurs. 2017, 16, 4.
- Abdelhamid, A.; Bunn, D.K.; Copley, M.; Cowap, V.; Dickinson, A.; Gray, L.; Howe, A.; Killett, A.; Lee, H.; Li, F.; et al. Effectiveness of interventions to directly support food and drink intake in people with dementia: Systematic review and meta-analysis. BMC Geriatr. 2016, 16, 26.
- Botigué, T.; Masot, O.; Miranda, J.; Nuin, C.; Viladrosa, M.; Lavedán, A.; Zwakhalen, S. Prevalence and Risk Factors Associated with Low Fluid Intake in Institutionalized Older Residents. J. Am. Med. Dir. Assoc. 2019, 20, 317–322.
- Wotton, K.; Crannitch, K.; Munt, R. Prevalence, risk factors and strategies to prevent dehydration in older adults. Contemp. Nurse 2008, 31, 44–56.
- Bunn, D.; Hooper, L.; Welch, A. Dehydration and Malnutrition in Residential Care: Recommendations for Strategies for Improving Practice Derived from a Scoping Review of Existing Policies and Guidelines. Geriatrics 2018, 3, 77.
- Boockvar, K.S.; Judon, K.M.; Eimicke, J.P.; Teresi, J.A.; Inouye, S.K. Hospital Elder Life Program in Long-Term Care (HELP-LTC): A Cluster Randomized Controlled Trial. J. Am. Geriatr. Soc. 2020, 68, 2329–2335.
- Marra, M.V.; Simmons, S.F.; Shotwell, M.S.; Hudson, A.L.; Hollingsworth, E.K.; Long, E.; Kuertz, B.; Silver, H.J.; Kuertz, B. Elevated Serum Osmolality and Total Water Deficit Indicate Impaired Hydration Status in Residents of Long-Term Care Facilities Regardless of Low or High Body Mass Index. J. Acad. Nutr. Diet. 2016, 116, 828–836.e2.
- Mentes, J.C.; Tripp-Reimer, T. Barriers and Facilitators in Nursing Home Intervention Research. West. J. Nurs. Res. 2002, 24, 918–936.
- Bhanu, C.; Avgerinou, C.; Kharicha, K.; Bauernfreund, Y.; Croker, H.; Liljas, A.; Rea, J.; Kirby-Barr, M.; Hopkins, J.; Walters, K. ‘I’ve never drunk very much water and I still don’t, and I see no reason to do so’: A qualitative study of the views of community-dwelling older people and carers on hydration in later life. Age Ageing 2019, 49, 111–118.
- Jimoh, O.F.; Brown, T.J.; Bunn, D.; Hooper, L. Beverage Intake and Drinking Patterns—Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies. Nutrients 2019, 11, 447.
- Wilson, J.; Bak, A.; Tingle, A.; Greene, C.; Tsiami, A.; Canning, D.; Myron, R.; Loveday, H. Improving hydration of care home residents by increasing choice and opportunity to drink: A quality improvement study. Clin. Nutr. 2019, 38, 1820–1827.
- Lazenby-Paterson, T. Thickened liquids: Do they still have a place in the dysphagia toolkit? Curr. Opin. Otolaryngol. Head Neck Surg. 2020, 28, 145–154.
- Bak, A.; Wilson, J.; Tsiami, A.; Loveday, H. Drinking vessel preferences in older nursing home residents: Optimal design and potential for increasing fluid intake. Br. J. Nurs. 2018, 27, 1298–1304.
- Lea, E.J.; Goldberg, L.R.; Price, A.D.; Tierney, L.T.; McInerney, F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J. Clin. Nurs. 2017, 26, 5169–5178.
- Nell, D.; Neville, S.; Bellew, R.; O’Leary, C.; Beck, K.L. Factors affecting optimal nutrition and hydration for people living in specialised dementia care units: A qualitative study of staff caregivers’ perceptions. Australas. J. Ageing 2016, 35, E1–E6.
- Törmä, J.; Pingel, R.; Cederholm, T.; Saletti, A.; Winblad, U. Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy. Int. J. Older People Nurs. 2021, 16, e12367.
- Bunn, D.; Jimoh, F.; Wilsher, S.H.; Hooper, L. Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review. J. Am. Med. Dir. Assoc. 2015, 16, 101–113.
- Steven, A.; Wilson, G.; Young-Murphy, L.; Bevc, S.; Wong, A.; Danilovich, M. The Implementation of an Innovative Hydration Monitoring App in Care Home Settings: A Qualitative Study. JMIR mHealth uHealth 2019, 7, e9892.
- Korsgaard, D.; Bjøner, T.; Nilsson, N.C. Where would you like to eat? A formative evaluation of mixed-reality solitary meals in virtual environments for older adults with mobility impairments who live alone. Food Res. Int. 2019, 117, 30–39.
- Eichhorn, C.; Plecher, D.A.; Lurz, M.; Leipold, N.; Böhm, M.; Krcmar, H.; Ott, A.; Volkert, D.; Hiyama, A.; Klinker, G. The Innovative Reminder in Senior-Focused Technology (THIRST)—Evaluation of Serious Games and Gadgets for Alzheimer Patients. In Proceedings of the 5th International Conference, ITAP 2019, Held as Part of the 21st HCI International Conference, HCII 2019, Orlando, FL, USA, 26–31 July 2019. Proceedings, Part II.
- Thomas, D.R.; Cote, T.R.; Lawhorne, L.; Levenson, S.A.; Rubenstein, L.; Smith, D.A.; Stefanacci, R.G.; Tangalos, E.G.; Morley, J.E. Dehydration Council. Understanding Clinical Dehydration and Its Treatment. J. Am. Med. Dir. Assoc. 2008, 9, 292–301.
- Polhuis, K.C.M.M.; Wijnen, A.H.C.; Sierksma, A.; Calame, W.; Tieland, M. The Diuretic Action of Weak and Strong Alcoholic Beverages in Elderly Men: A Randomized Diet-Controlled Crossover Trial. Nutrients 2017, 9, 660.