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 Assessing Dehydration Requires a Uniform Approach, Study Says

Dehydration—a serious concern for skilled nursing center residents—can result in delirium, falls, constipation, urinary tract infections, and renal impairment. Identifying and assessing dehydration is also a concern, according to a new report in the August issue of JAMDA, the official journal of AMDA—The Society of Post-Acute and Long-Term Care Medicine.

In the study​, titled “Prevalence and Risk Factors of Dehydration Among Nursing Home Residents: A Systematic Review,” the authors reported that a wide variety of methods have been used to assess dehydration and that it is often unclear which type of dehydration—chronic or acute—is being measured.

The authors conducted a systematic review of 19 studies that included information on nursing center residents or residents of other long term care settings. Prevalence rates of dehydration varied between 0.8 percent and 38.5 percent and were measured using different methods.

“A possible explanation for the differences in prevalence rates is that different methods were used to assess dehydration, such as blood tests, urine tests, and various physical symptoms,” says Simone Paulis, RN, a PhD candidate at the Department of Health Services Research, Maastricht University, Maastricht, The Netherlands, and an author of the study. “This makes it difficult to compare prevalence rates. Furthermore, it can be questioned which assessment method is most valid and reliable to detect dehydration.”

In addition, 49 total potential risk factors for dehydration were identified, including diabetes, renal disease, and heart disease. Only 12 of the 49 risk factors were examined in multiple studies, and of those 12, cognitive impairment and fever were significantly associated with dehydration among nursing center residents.

Of the risk factors measured in only one study, those significantly associated with dehydration included renal function, functional impairment, blood urea nitrogen level, the need for feeding assistance, parenteral/intravenous fluids, being malnourished, being in an end-of-life stage, having more than four chronic diseases/acute diagnoses, staff turnover, and requiring skilled care.

The most frequently investigated variable was gender, and three of four studies found a significant relationship between gender and dehydration, showing females more likely to become dehydrated.

These results suggest a “lack of universally agreed-on operationalization” and “a strong need to develop a uniform and reliable method for detecting dehydration in this population,” the authors said. The study suggests more clarity about the risk factors for dehydration in nursing centers is needed to support early, tailor-made care to prevent dehydration in this target group.

The study was conducted by researchers at the Institute of Nursing Science at the Medical University of Graz in Austria and the Department of Health Services Research and Department of Family Medicine in the Care and Public Health Research Institute at the Maastricht University in Th​​e Netherlands.​​

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