Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review

Objectives: To provide an overview of the prevalence rates and risk factors of dehydration among nursing home residents. Design: Systematic literature review. Setting: Nursing homes. Participants: Nursing home residents or institutionalized long-term care residents. Measurements: A systematic literature review was executed on March 15, 2018, using the databases PubMed, CINAHL, and EMBASE to retrieve all articles focused on the prevalence rates and risk factors for acute and chronic dehydration. Studies were included if the target population involved nursing home residents or institutionalized long-term care residents. Results: Nineteen studies were included in this systematic review. Prevalence rates of dehydration varied between 0.8% and 38.5% and were measured using different methods. Furthermore, 49 potential risk factors for dehydration were identified. Of the 12 potential risk factors that were investigated in more than 1 study, cognitive impairment and fever were significantly associated with dehydration among nursing home residents. Conclusions/implications: Dehydration is a relevant and frequently occurring problem among nursing home residents. This systematic review shows that a wide variety of methods are used to assess dehydration and that it is often unclear which type of dehydration (chronic or acute) is measured. This makes it difficult to compare prevalence rates among studies. Moreover, only 2 of 49 potential risk factors (fever and cognitive impairment) were more than once significantly associated with dehydration in the respective studies. Most of the other risk factors were assessed by only 1 study or showed inconsistent results. Therefore, more research into dehydration among nursing home residents is needed. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine

Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study

Key summary pointsAim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home. Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (>= 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account

Diagnosing dehydration in the nursing home:international consensus based on a modified Delphi study

Key summary pointsAim To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents. Findings International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests). Message This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home. Purpose Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. Methods Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (>= 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. Results After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. Conclusion This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account