Developing a quick and practical screen to improve the identification of poor hydration in geriatric and rehabilitative care

Dehydration has been associated with increased morbidity and mortality. Dehydration risk increases with advancing age, and will progressively become an issue as the aging population increases. Worldwide, those aged 60 years and over are the fastest growing segment of the population. The study aimed to develop a clinically practical means to identify dehydration amongst older people in the clinical care setting. Older people aged 60 years or over admitted to the Geriatric and Rehabilitation Unit (GARU) of two tertiary teaching hospitals were eligible for participation in the study. Ninety potential screening questions and 38 clinical parameters were initially tested on a single sample (n=33) with the most promising 11 parameters selected to undergo further testing in an independent group (n=86). Of the almost 130 variables explored, tongue dryness was most strongly associated with poor hydration status, demonstrating 64% sensitivity and 62% specificity within the study participants. The result was not confounded by age, gender or body mass index. With minimal training, inter-rater repeatability was over 90%. This study identified tongue dryness as a potentially practical tool to identify dehydration risk amongst older people in the clinical care setting. Further studies to validate the potential screen in larger and varied populations of older people are require

Dietetics in the digital age: the impact of an electronic medical record on a tertiary hospital dietetic department

Aim: The present study aimed to assess the impact of a hospital-wide electronic medical record (EMR) on the way dietitians collect routine data for their assessments and its impact on their clinical documentation and service provision. Methods: Data were collected retrospectively from the following sources: interdepartmental chart audit, the EMR itself (nutrition diagnosis), National Health Roundtable database (admissions requiring nutrition events) and the hospital-wide Pressure Injury Prevention Audits (height, weight and malnutrition screening). Results: There were improvements in medical record accessibility (76.4% pre vs 100% post, P

Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients

Obesity, defined as a BMI\ua0≥\ua030\ua0kg/m, has demonstrated protective associations with mortality in some diseases. However, recent evidence demonstrates that poor nutritional status in critically ill obese patients confounds this relationship. The purpose of this paper is to evaluate if poor nutritional status, poor food intake and adverse health-related outcomes have a demonstrated association in non-critically ill obese acute care hospital patients.This is a secondary analysis of the Australasian Nutrition Care Day Survey dataset (N\ua0=\ua03122), a prospective cohort study conducted in hospitals from Australia and New Zealand in 2010. At baseline, hospital dietitians recorded participants' BMI, evaluated nutritional status using Subjective Global Assessment (SGA), and recorded 24-h\ua0food intake (as 0%, 25%, 50%, 75%, and 100% of the offered food). Post-three months, participants' length of stay (LOS), readmissions, and in-hospital mortality data were collected. Bivariate and regression analyses were conducted to investigate if there were an association between BMI, nutritional status, poor food intake, and health-related outcomes.Of the 3122 participants, 2889 (93%) had eligible data. Obesity was prevalent in 26% of the cohort (n\ua0=\ua0750; 75% females; 61\ua0±\ua015 years; 37\ua0±\ua07\ua0kg/m). Fourteen percent (n\ua0=\ua0105) of the obese patients were malnourished. Over a quarter of the malnourished obese patients (N\ua0=\ua030/105, 28%) consumed ≤25% of the offered meals. Most malnourished obese patients (74/105, 70%) received standard diets without additional nutritional support. After controlling for confounders (age, disease type and severity), malnutrition and intake ≤25% of the offered meals independently trebled the odds of in-hospital mortality within 90 days of hospital admission in obese patients.Although malnourished obese experienced significantly adverse health-related outcomes they were least likely to receive additional nutritional support. This study demonstrates that BMI alone cannot be used as a surrogate measure for nutritional status and warrants routine nutritional screening for all hospital patients, and subsequent nutritional assessment and support for malnourished patients

Meal and food preferences of nutritionally at-risk inpatients admitted to two Australian tertiary teaching hospitals

Aim: To determine preferences for meals and snack of long-stay patients and hospitalised patients with increased energy and protein requirements.----- Methods: Using consistent methodology across two tertiary teaching hospitals, a convenience sample of adult public hospital inpatients with increased energy and protein requirements or longer stays (seven days or more) were interviewed regarding meal and snack preferences. Descriptive reporting of sample representativeness, preferred foods and frequency of meals and between meal snacks.----- Results: Of 134 respondents, 55% reported a decreased appetite and 28% rated their appetite as 'poor'. Most felt like eating either nothing (42%) or soup (15%) when unwell. The most desired foods were hot meal items, including eggs (31%), meat dishes (20%) and soup (69%). Of items not routinely available, soft drink (7.6%) and alcohol (6.7%) were most commonly desired during admission. Almost half (49%) reported difficulty opening packaged food and a majority (81%) indicated finger foods were easy to eat.----- Conclusion: Appetites during admission were frequently lower than usual. Responses encourage consideration of eggs, meat dishes and soups for long-stayers or those with high-energy, high-protein needs. Easy to consume but not routinely offered, between meal items, such as soup, juice, cake, soft drink or Milo could be explored further to enhance oral intakes

PENGARUH KEPRIBADIAN (EKSTROVERT VS INTROVERT) TERHADAP WATER FOOTPRINT SISWA SEKOLAH MENENGAH ATAS DI JAKARTA

The increasing of economic growth evoked the prosperity of its citizen which subsequently would lead to the consumption behaviors of such population for goods andservices. Ecological Footprint is a individual or population as well as the services needed to assimilate west in term of land. Social factors, such as personality, is known as a crucial factor that cause the consumption pattern of individuals is vary considerably. This research was aimed to determine the effect of personality on Ecological Footprint of students at senior high school in Jakarta. Measuring of Ecological Footprint is concentrated on water using at home and school. The activities of water using focused on urinating, defecating, face washing, taking a bath, hand washing, and ritual ablution before Moslem prayers. Water Footprint was calculated from 54 students enrolled in SMAN 107 which are selected acording to simple random sampling, Cakung Jakarta Timur This study was conducted from January to February 2016. The finding indicated that there was no significantly difference between extraversion and intraversion based on their total Water Footprint value

Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people (Review)

BackgroundThere is evidence that water-loss dehydration is common in older people and associated with many causes of morbidity and mortality.However, it is unclear what clinical symptoms, signs and tests may be used to identify early dehydration in older people, so that support can be mobilised to improve hydration before health and well-being are compromised.ObjectivesTo determine the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs and tests to be used as screeningtests for detecting water-loss dehydration in older people by systematically reviewing studies that have measured a reference standard and at least one index test in people aged 65 years and over. Water-loss dehydration was defined primarily as including everyone with either impending or current water-loss dehydration (including all those with serum osmolality ≥ 295 mOsm/kg as being dehydrated).Search methodsStructured search strategies were developed for MEDLINE (OvidSP), EMBASE (OvidSP), CINAHL, LILACS, DARE and HTAdatabases (The Cochrane Library), and the International Clinical Trials Registry Platform (ICTRP). Reference lists of included studiesand identified relevant reviews were checked. Authors of included studies were contacted for details of further studies.Selection criteriaTitles and abstracts were scanned and all potentially relevant studies obtained in full text. Inclusion of full text studies was assessed independently in duplicate, and disagreements resolved by a third author. We wrote to authors of all studies that appeared to have collected data on at least one reference standard and at least one index test, and in at least 10 people aged ≥ 65 years, even where no comparative analysis has been published, requesting original dataset so we could create 2 x 2 tables.Data collection and analysis.Diagnostic accuracy of each test was assessed against the best available reference standard for water-loss dehydration (serum or plasma osmolality cut-off≥295mOsm/kg, serumosmolarity or weight change) within each study. For each index test study data were presented in forest plots of sensitivity and specificity. The primary target condition was water-loss dehydration (including either impending or current water-loss dehydration). Secondary target conditions were intended as current (> 300 mOsm/kg) and impending (295 to 300 mOsm/kg) water-loss dehydration, but restricted to current dehydration in the final review.We conducted bivariate random-effects meta-analyses (Stata/IC, StataCorp) for index tests where there were at least four studies and study datasets could be pooled to construct sensitivity and specificity summary estimates. We assigned the same approach for index tests with continuous outcome data for each of three pre-specified cut-off points investigated.Pre-set minimum sensitivity of a useful test was 60%, minimum specificity 75%. As pre-specifying three cut-offs for each continuoustest may have led to missing a cut-off with useful sensitivity and specificity, we conducted post-hoc exploratory analyses to createreceiver operating characteristic (ROC) curves where there appeared some possibility of a useful cut-off missed by the original three.These analyses enabled assessment of which tests may be worth assessing in further research. A further exploratory analysis assessed the value of combining the best two index tests where each had some individual predictive ability.Main resultsThere were few published studies of the diagnostic accuracy of state (one time), minimally invasive clinical symptoms, signs or tests tobe used as screening tests for detecting water-loss dehydration in older people. Therefore, to complete this review we sought, analysed and included raw datasets that included a reference standard and an index test in people aged ≥ 65 years.We included three studies with published diagnostic accuracy data and a further 21 studies provided datasets that we analysed. Weassessed 67 tests (at three cut-offs for each continuous outcome) for diagnostic accuracy of water-loss dehydration (primary targetcondition) and of current dehydration (secondary target condition).Only three tests showed any ability to diagnose water-loss dehydration (including both impending and current water-loss dehydration) as stand-alone tests: expressing fatigue (sensitivity 0.71 (95% CI 0.29 to 0.96), specificity 0.75 (95% CI 0.63 to 0.85), in one study with 71 participants, but two additional studies had lower sensitivity); missing drinks between meals (sensitivity 1.00 (95% CI 0.59 to 1.00), specificity 0.77 (95% CI 0.64 to 0.86), in one study with 71 participants) and BIA resistance at 50 kHz (sensitivities 1.00 (95% CI 0.48 to 1.00) and 0.71 (95% CI 0.44 to 0.90) and specificities of 1.00 (95% CI 0.69 to 1.00) and 0.80 (95% CI 0.28 to 0.99) in 15 and 22 people respectively for two studies, but with sensitivities of 0.54 (95% CI 0.25 to 0.81) and 0.69 (95% CI 0.56 to 0.79) and specificities of 0.50 (95% CI 0.16 to 0.84) and 0.19 (95% CI 0.17 to 0.21) in 21 and 1947 people respectively in two other studies). In post-hoc ROC plots drinks intake, urine osmolality and axillial moisture also showed limited diagnostic accuracy. No test was consistently useful in more than one study.Combining two tests so that an individual both missed some drinks between meals and expressed fatigue was sensitive at 0.71 (95%CI 0.29 to 0.96) and specific at 0.92 (95% CI 0.83 to 0.97).There was sufficient evidence to suggest that several stand-alone tests often used to assess dehydration in older people (including fluid intake, urine specific gravity, urine colour, urine volume, heart rate, dry mouth, feeling thirsty and BIA assessment of intracellular water or extracellular water) are not useful, and should not be relied on individually as ways of assessing presence or absence of dehydration in older people.No tests were found consistently useful in diagnosing current water-loss dehydration.Authors’ conclusionsThere is limited evidence of the diagnostic utility of any individual clinical symptom, sign or test or combination of tests to indicatewater-loss dehydration in older people. Individual tests should not be used in this population to indicate dehydration; they miss a highproportion of people with dehydration, and wrongly label those who are adequately hydrated.Promising tests identified by this review need to be further assessed, as do new methods in development. Combining several tests may improve diagnostic accuracy