Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

Leibovitz, Arthur; Baumoehl, Yehuda; Lubart, Emily; Yaina, A.; Platinovitz, N.; Segal, Refael

doi:10.1159/000099144

Cited by 111 publications

(75 citation statements)

References 32 publications

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“…BUN and Cr results were recorded and a BUN/Cr ratio calculated. A BUN/Cr ratio of >20 was used as the cut-off for dehydration in the current study as is commonly reported in the dysphagia literature [9,4,22,23].…”

Section: Methodsmentioning

confidence: 99%

“…The literature has demonstrated that, especially if reliant on oral intake alone, individuals with dysphagia following stroke often present with inadequate fluid intake [6][7][8] and dehydration [9].Therefore much of the research regarding fluid intake and hydration in the stroke population has involved patients presenting with dysphagia. One study comparing the fluid intake of hospitalized patients post-stroke with and without dysphagia found those without dysphagia permitted thin liquids drank significantly more than those with dysphagia prescribed thickened liquids (mean of 1237ml and 947ml, respectively), although only one patient from the total sample of patients met the minimum standard of fluid intake set at 1500ml [10].…”

Section: Introductionmentioning

confidence: 99%

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A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Murray

Doeltgen

Miller

et al. 2015

Journal of Nutrition in Gerontology and Geriatrics

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Abstract:Adequate hydration is important for all people particularly when hospitalized with illness.Individuals with dysphagia following stroke are considered to be at risk of inadequate fluid intake and, therefore, dehydration but there is little information about the fluid intake or hydration of individuals without dysphagia post-stroke. This cohort study measured the average beverage intake, calculated the urea/creatinine ratio as a measure of hydration, and documented specific health outcomes of 86 people without dysphagia post-stroke who were inpatients in rehabilitation centres. Participants drank on average 1504ml per day (SD 359ml) which typically represented 67% of their estimated daily requirement. Approximately 44% of the participants in the sample were dehydrated based on a Blood Urea Nitrogen/Creatinine ratio >20:1. Sixteen percent of participants were diagnosed with one or more of the health outcomes of dehydration/hypernatremia, urinary tract infection or constipation. A greater level of dependence was associated with poorer beverage intake and higher risk of an adverse health outcome. Those in the older/elderly age range (particularly older women) and those with poor mobility were most at risk of poor hydration. This study highlights that patients in rehabilitation facilities post-stroke, even without dysphagia, may be at risk of sub-optimal fluid intake and hydration.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Murray

Doeltgen

Miller

et al. 2015

Journal of Nutrition in Gerontology and Geriatrics

View full text Add to dashboard Cite

show abstract

“…The specific index used was the blood urea nitrogen/creatinine ratio (BUN/Cr). A conservative cut-off point for the ratio of greater than 20 was used to classify a participant as dehydrated, in keeping with previous studies of fluid intake and dehydration in the dysphagia population [43,44].…”

Section: Introductionmentioning

confidence: 99%

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

et al. 2016

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The benefit of water protocols for individuals with thin-liquid aspiration remains controversial, with mixed findings from a small number of randomized controlled trials (RCTs). This study aimed to contribute to the evidence of the effectiveness of water protocols with a particular emphasis on health outcomes, especiallyhydration. An RCT was conducted with patients with known thin-liquid aspiration post-stroke randomized to receiving thickened liquids only or a water protocol. For the 14 participants in rehabilitation facilities whose data proceeded to analysis, there was no difference in the total amount of beverages consumed between the water protocol group (mean=1103ml per day, SD=215ml) and the thickened liquids only group (mean=1103ml, SD=247ml). Participants in the water protocol group drank on average 299ml (SD 274) of water but offset this by drinking less of the thickened liquids. Their hydration improved over time compared with participants in the thickened liquids only group, but differences between groups were not significant. Twenty-one percent of the total sample was diagnosed with dehydration and no participants in either group were diagnosed with pneumonia. There were significantly more diagnoses of urinary tract infection in the thickened liquids only group compared to the water protocol group (χ 2 =5.091, p=0.024), but no differences between groups with regard to diagnoses of dehydration (χ 2 = 0.884, p=0.347) or constipation (χ 2 =0.117, p=0.733). The findings reinforce evidence about the relative safety of water protocols for patients in rehabilitation post-stroke and provide impetus for future research into the potential benefits for hydration status and minimizing adverse health outcomes.Drinking, deglutition, deglutition disorders, stroke, water, water-electrolyte imbalance [6]. The premise is that thickening a liquid makes it more cohesive and dense, reducing its flow rate. This enables many patients to better control the bolus intra-orally, thereby reducing aspiration risk before and during swallowing [7,8].There has been growing concern, however, about the blanket prescription of thickened liquids for a number of [14,18,19]. By far the greatest concern about thickened liquid prescription is that individuals with dysphagia do not consume enough fluids. Researchers have demonstrated that the bioavailability of water from a quantity of thickened liquids is equivalent to that from the same quantity of thin liquid [20][21][22] confirming that thickened liquids themselves are not the cause of dehydration. Furthermore, it is recognised that, in addition to beverages, food contributes to approximately 20% of overall fluid intake with an even greater percentage if individuals are on pureed food [23,24]. Notably, food was found to be the greatest contributor to oral fluid intake in a cohort of patients with dysphagia in acute settings [25]. However, total fluid intake has consistently been found to be inadequate for individuals with dysphagia on modified diet and liquids, especially if reliant o...

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“…Of the seven participants, only one participant was well hydrated following a 24-hour consumption of thickened liquids, four participants had mild dehydration, and two participants had significant dehydration. According to Leibovitz and colleagues [31], individuals with dysphagia are at an elevated risk for dehydration. Given the participants in this study were healthy individuals and displayed signs of dehydration after only 24 hours, it is suggested that individuals with dysphagia on a thickened liquid diet for more than 24 hours are at a significant risk for dehydration.…”

Section: Discussionmentioning

confidence: 99%

“…Given the participants in this study were healthy individuals and displayed signs of dehydration after only 24 hours, it is suggested that individuals with dysphagia on a thickened liquid diet for more than 24 hours are at a significant risk for dehydration. Dehydration can lead to many negative health conditions including deterioration of cognitive status, changes in drug effects, poor wound healing, pressure sores, urinary tract infections, altered cardiac function, lethargy, weakness, constipation, and acute renal failure [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Vocal Loading Task on Vocal Function Before and After 24 Hours of Thickened Liquid Use

Gorham-Rowan¹,

Berndt²,

Carter³

et al. 2016

J Speech Pathol Ther

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Objective: To determine the effect of a vocal loading task on vocal function before and after 24 hours of thickened liquid use.Methods: Seven healthy adults, ages 19 to 52 years of age, were recruited as participants. Baseline data regarding daily food/liquid intake and urine specific gravity levels (USG) as a marker of hydration were obtained. Participants then completed a vocal loading task, which consisted of 3 × 10 repetitions of a sustained vowel task at 65 dB to 75 dB SPL. Voice recordings and subjective ratings of vocal fatigue and muscle soreness were obtained prior to and following the vocal loading task for both the pre-thickened liquid and post-thickened liquid experimental session. The voice samples were analyzed for changes in fundamental frequency, loudness, and perturbation measures.Results: There was a significant main effect of vocal loading on vocal loudness as well as subjective ratings of vocal fatigue and muscle soreness; all parameters were higher post-vocal loading. There was also a significant main effect of thickened liquid use on jitter, as jitter levels were substantially lower post-thickened liquids. Conclusion:The objective and subjective changes reported by the participants' post-vocal loading are consistent with prior reports concerning normal adaptive responses to greater vocal demands and increased muscular effort. A brief period of thickened liquids does not appear to affect vocal function.

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Dehydration among Long-Term Care Elderly Patients with Oropharyngeal Dysphagia

Cited by 111 publications

References 32 publications

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

Does a Water Protocol Improve the Hydration and Health Status of Individuals with Thin Liquid Aspiration Following Stroke? A Randomized Controlled Trial

The Effect of a Vocal Loading Task on Vocal Function Before and After 24 Hours of Thickened Liquid Use

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