Hydration and Acute Confusion in Long-Term Care Residents

Abstract

Although it is generally appropriate for a healthy adult to consume 2000 to 2500 ml per day, the literature does not address evaluating any standard. The objective here was to develop a weight-based hydration management intervention and evaluate the impact of this on the incidence of acute confusion (AC) using an N = 98. The intervention consisted of a fluid intake goal based on 100 ml per kg for the first 10 kg, 50 ml/kg for the next 10 kg, and 15 ml for the remaining body weight. The treatment group received instruction and assistance on the fluid goal and the control group received routine care. Measurements included serum electrolytes, bioimpedance analysis, urinalysis, Mini-Mental State Exam, and the NEECHAM. There was no difference in the incidence of AC between treatment and controls, but those individuals with > or = 90% compliance demonstrated higher ECF volumes and also lower urine leukocyte counts.

Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long‐Term Care Delivered by Certified Nursing Assistants

“…8 We selected intervention components that had evidence to support their use in ameliorating delirium risk factors that were highly prevalent in nursing home residents, including cognitive impairment, 3 immobility, 7,9 dehydration, 7,9,10 malnutrition, 11 and sleep problems. 7 We chose to employ a CNA to deliver HELP-LTC because CNAs have the skills and knowledge to deliver HELP components and they can be drawn from a large available nursing home workforce pool.…”

Nutritional status and delirium in long-term care elderly individuals

“…Bioelectrical impedance analysis (BIA) can be used to estimate body composition, although it has been neglected as a technique in this setting (Culp, Mentes, & Wakefield, 2003). Simply described, BIA is a technique whereby a very small electrical signal carried by water and fluids is passed through the body; impedance is greatest in fat tissue, which contains only 10-20% water (Di Iorio, Scalfi, Terracciano, & Bellizzi, 2004).…”

Hydration Status of Geriatric Patients in a Psychiatric Hospital

“…They further suggest tea times or happy hours, where a social time is provided for a gathering of patients to imbibe of approved fluids. Establishing a hydration protocol (Culp, Mentes, & Wakefield, 2003; Mentes & Iowa-Veteran's Affairs Research Consortium) is a strategy to foster adequate oral fluid intake for elderly persons. Many of the suggested interventions can be adapted for inpatient use so that intravenous fluids are not needed except for extreme dehydration (Weinberg et al, 1995).…”

“…Between 34-50% of hospitalized older adults experience poor health outcomes, including dehydration and malnutrition (Palmisano-Mills, 2007). Low hydration may lead to iatrogenic complications, such as decreased functional status, falls, pressure ulcers, decreased cognition (Brown & Marland, 2002;Culp, Mentes, & Wakefield, 2003;Inouye, 2000), increased medications, and social difficulties such as isolation and depression (Palmisano-Mills). Geriatric patients diagnosed with depression or other psychiatric illnesses pose special challenges as dehydration can lengthen hospital stays, delay necessary treatments (i.e., physical therapy, electroconvulsive therapy), precipitate long-term institutionalization (Bennett, Thomas, & Riegel, 2004;Brown & Marland), and increase hospital costs and mortality rates (Palmisano-Mills).…”

“…Further compounding the problem is a lack of agreement about what constitutes adequate intake of fluids for the elderly (Bennett, Thomas, & Riegal, 2004;Culp, Mentes, & Wakefield, 2003;Holben, Hassell, Williams, & Helle, 1999) and that "no absolute definition of dehydration exists" (Weinberg, Minaker, & the Council on Scientific Affairs, American Medical Association, 1995, p. 1553. Most studies of dehydration were completed in long-term care or community facilities and not with acute care inpatients.…”