Bunn, Diane

Hooper, Lee

English

University of East Anglia digital repository

 PROSPERO International prospective register of systematic reviews Effectiveness of external factors to reduce the risk of dehydration in older peopleliving in residential care: a systematic reviewDiane Bunn, Lee Hooper  CitationDiane Bunn, Lee Hooper. Effectiveness of external factors to reduce the risk of dehydration in older people living inresidential care: a systematic review. PROSPERO 2012:CRD42012003100 Available from  http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42012003100  Review question(s)Among elderly people living in residential care, what interventions or environmental factors have been shown toreduce dehydration prevalence as compared to those not exposed?SearchesSearches of electronic databases using keywords, MeSH and other index terms, as well as combinations of theseterms and appropriate synonyms. Searches of trial registers. Searches of reference lists, including those of included papers, relevant reviews, systematic reviews and meta-analyses Databases and registers to be searched; MEDLINE, EMBASE, CINAHL, BNI, PsycInfo, The Kings Fund Libraryand Information Service Database, ProQuest, Open Thesis, CRD (Centre for Reviews and Dissemination), USNational Institutes of Health Register of Clinical Trials, WHO International Registry of Clinical Trials.Link to search strategyhttp://www.crd.york.ac.uk/PROSPEROFILES/3100_STRATEGY_20120914.pdfTypes of study to be includedStudy design: randomised (individual or clustering) controlled trials, non-randomised controlled studies, controlledbefore and after studies, case control studies, cohort studies and cross-sectional studies.Condition or domain being studiedTo investigate the current evidence for the effectiveness of interventions, or the impact of environmental conditions,on reducing the risk of, or reversing, impending water-loss dehydration for older people living in residential care.Participants/ populationParticipants should be >= 65 years of age at the time of entry to the study and living in residential care. "Residential care": a permanent setting where older adults reside in an institution where at least 2 other people reside,all of whom are unrelated to each other. Residents share living facilities and require care, which is provided by staff.The institution is responsible for providing meals and beverages. These will include nursing homes, residential carehomes, long-term geriatric wards in hospitals and other similar institutions. They will not include acute care settings(acute care is a temporary care setting, to provide specialist care in order to treat a condition or conditions, with aview to discharge to a more permanent setting).Intervention(s), exposure(s)Intervention: does the intervention aim to improve hydration status and/or reduce dehydration risk? Includeadministrative, educational, behavioural, social and environmental interventions.                                Page: 1 / 5“Interventions”: a change in practice or an observation which has been linked to a change in hydration status. “Dehydration”: a deficit in the body’s fluid balance, such that it has been clinically detected. Studies should include an assessment of hydration status or an assessment of fluid intake, as the primary outcomemeasures, before and after the intervention.  Observational studies: has a link between the exposure and the outcome measure(s) been assessed?Comparator(s)/ controlComparators will be control groups or non-exposed groups. ContextParticipants should be >=65 years of age, living in residential care and be able to eat and drink orally, and should notbe receiving fluids or nutrition by any other means (parenteral or enteral feeding).Outcome(s)Primary outcomesIntervention studies: An assessment of dehydration which was applied before and after the intervention and/or anassessment of fluid intake which was applied before and after the intervention. Case-control, cross-sectional and cohort studies should include: an assessment of dehydration or fluid intake AND anobservation of at least one of the following: environmental factor or system of care or pattern of behaviour, with anassessment of the relationship between the environmental factor and the outcome.Secondary outcomesSecondary outcomes may be:  (i) an assessment of comorbidity which was applied before and after the intervention. The aspect of comorbidityassessed should have a known link to dehydration, such as stroke, urinary tract infection (UTI), upper respiratory tractinfection (URTI), constipation, falls or death. (ii). A measure of quality of life which was applied before and after the intervention. (iii). In case-control, cross-sectional or cohort studies, if there is an assessment of correlation with quality of life,stroke, UTI, URTI, constipation, falls or death these will be noted.Data extraction, (selection and coding)Study selection. This will be conducted in two phases. Initial screening of titles and abstracts against the inclusioncriteria will identify those studies where full papers will be required for the second part, and will be carried out bytwo reviewers independently, and papers identified by either reviewer collected in full text. An Inclusion form will becompleted by each reviewer for each study, Assessment of inclusion will be made by two reviewers independently,and disagreements resolved by discussion. For those studies with missing or insufficient data, the correspondingauthor will be contacted for clarification. The selection of studies meeting the inclusion criteria will be duplicated bytwo independent reviewers, with differences discussed, and a third reviewer’s opinion sought if required. The level ofagreement between the reviewers will be assessed mathematically using the kappa statistic. The process will bepiloted on a sample of papers. Data extraction will include details of the authors, year and country of publication, funding source, participantinformation, study details and design, outcomes included, analyses, key results and whether any further information isrequired.  Risk of bias (quality) assessmentBias: This refers to the validity of the study, both in asking an appropriate research question (external validity) and inaddressing that question (internal validity). An inappropriate research question may affect the generalisability of theresults, whereas the methodological quality of the research in which the risk of systematic deviations occurring has                               Page: 2 / 5not been effectively addressed, may result in either an over- or an under-estimation of the effects of the intervention.Bias may be due to: inappropriate choice of study design, poor selection of participants, poor methodological quality(performance and detection bias), attrition bias, and reporting bias. The Cochrane Collaboration’s tool for assessingrisk of bias in intervention studies and the Newcastle-Ottawa Scale for case-control and cohort studies will be usedand the results presented in a Risk of Bias Table. Quality: Included studies will be assessed for quality (study design) and risk of bias (due to selection, performance,attrition, reporting) as described in Chapter 8 of the Cochrane Handbook. The quality of the study will be assessed forthe appropriateness of the design to address the research question; the risk of bias, choice of intervention, choice ofoutcome measure, choice and use of statistical analyses, quality of reporting and generalisability. The checklistcreated by Downs and Black as an assessment of study quality will be used as a guideline to ensure that theappropriate factors are addressed. Strategy for data synthesisResults will be described, as well as being presented in tabulated format, including a flow diagram demonstrating theresults of the search.  The flow diagram will show: •The number of unique records identified in the searches. •The number of records excluded after preliminary screening. •The number of records retrieved in full text. •The number of records or studies excluded after assessment of the full text, with brief reasons. •The number of studies meeting eligibility criteria for the review. •The number of studies contributing to the main outcome. Those studies included in the review will be grouped according to type of intervention (environmental,administrative, behavioural). The results will be displayed in a summary of characteristics table, which willsummarise the location, setting, methods, participants, interventions and outcome measures. Any other importantcharacteristics will be described, as well as any important differences between the studies. A table describing thereasons for exclusion of the excluded studies will be formatted. The quality and bias of the included studies will be depicted in assessment of quality and risk of bias tablesrespectively.  A narrative synthesis of the results of the review process will identify any common themes as to why an interventionworks, or does not work, for whom and in which setting. A summary of findings table will present the main findingsconcerning the quality of evidence, participants, magnitude of the intervention effects and the data on the mainoutcomes. If the similarities between included studies allow for a meta-analysis, then this will be undertaken in orderto increase the power of the estimates of treatment effect, and assess whether treatment effects are similar in similarsituations, using a RevMan forest plot to display the effect and confidence intervals of each included study. Asummary characteristic will be calculated for each study to describe the observed intervention effect (risk ratios fordichotomous data and difference between means for continuous data). These will then be weighted to allow fordifferences, such as sample size and event rate. The relative risk of dehydration, or mean difference for continuousoutcomes, will be calculated to compare the intervention group with the control group.Analysis of subgroups or subsetsNone planned.Dissemination plansResults will be reported according to PRISMA guidelines, and a paper submitted for publication in an appropriate                               Page: 3 / 5peer-reviewed journal.Contact details for further informationDiane BunnNorwich Medical School University of East Anglia Norwich Norfolk. NR4 7TJd.bunn@uea.ac.ukOrganisational affiliation of the reviewUniversity Of East Angliahttp://www.uea.ac.uk/Review teamMrs Diane Bunn, UEADr Lee Hooper, UEAAnticipated or actual start date16 April 2012Anticipated completion date31 May 2013Funding sources/sponsorsDiane Bunn: Research Assistant and Registered PhD Student at University of East Anglia. PhD training supported byNIHR grant, number: NIHR-CDF-2011-04-025. Lee Hooper, Senior Lecturer in Research Synthesis and Nutrition, UEA. NIHR Career Development Fellow, Grantholder of NIHR grant: NIHR-CDF-2011-04-025Conflicts of interestNone knownLanguageEnglishCountryEnglandSubject index terms statusSubject indexing assigned by CRDSubject index termsAged; Dehydration; Homes for the Aged; Humans; Primary Prevention; Risk FactorsStage of reviewOngoingDate of registration in PROSPERO                               Page: 4 / 515 October 2012Date of publication of this revision15 October 2012Stage of review at time of this submission Started CompletedPreliminary searches No   Yes Piloting of the study selection process   Yes   No Formal screening of search results against eligibility criteria   No   No Data extraction   No   No Risk of bias (quality) assessment   No   No Data analysis   No   No  PROSPEROInternational prospective register of systematic reviewsThe information in this record has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record,any associated files or external websites. Powered by TCPDF (www.tcpdf.org)                               Page: 5 / 5

Effectiveness of external factors to reduce the risk of dehydration in older people living in residential care: a systematic review

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