Maintaining Oral Hydration in Older People; A Systematic Review

Abstract

Objectives The objective of this review is to present the best available evidence related to: • the factors that increase the risk of poor hydration in older people, • how best to assess older people for risk of inadequate fluid intake, presence and/or risk of dehydration, and • how best to maintain adequate oral fluid intake or hydration, or reverse dehydration, in older people. Criteria for Considering Studies for this Review Types of Participants This review considered all studies that included adults aged over 60 years in an acute care, residential care or community setting. Types of Intervention Interventions of interest were those related to the maintenance of oral hydration in older people, including interventions that ensured optimal fluid intake in older people. This review focussed on oral fluid replacement interventions only. Only oral rehydration management protocols were considered because techniques such as subcutaneous, intravenous and feeding tube fluid replacement are less common in community or nursing home settings. In addition to the management of older adults with inadequate fluid intake, this review also included studies that: 1) identified risk factors for poor fluid intake and dehydration, and 2) evaluated assessment tools to assist in determining fluid intake and fluid status in older people. Studies addressing the ethics of hydration in the terminally ill were excluded as beyond the scope of the review. Types of Outcome Measures The primary outcomes of interest were the measurement of oral fluid intake and those related to the identification of dehydration, the maintenance of oral hydration or the reversal of dehydration. Types of Studies This review considered any randomised control trial that evaluated management strategies to ensure adequate oral fluid intake and maintenance of hydration, or reversal of dehydration, in older people. For the identification of risk factors for dehydration in older people, cohort and case control studies were also included. Studies that evaluated assessment tools for the identification of dehydration in older adults were also considered for inclusion in this review. Results This review has been separated into three categories: risk factors, assessment, and management of dehydration/reduced fluid intake. Risk Factors Few studies have been performed to determine the risk factors for dehydration and/or reduced fluid intake. Age was determined to be a risk factor for dehydration in nursing home residents, but not in older adult emergency admissions. Age as a risk factor for reduced fluid intake yielded contradictory results. Bedridden patients were found to be at higher risk of dehydration, however semi-dependent older adults were found to be at most risk of reduced fluid intake in one study with no correlation in another. It was unclear from present studies if gender was a risk factor for either dehydration or reduced fluid intake. Incontinence was not found to be a risk factor for dehydration in one study but was for decreased fluid intake in another. Mental status was inversely correlated to risk of dehydration but contradictory results were obtained for reduced fluid intake. Reduced speaking ability and evidence of drooling identified patients as being more dependent however this reduced their risk of decreased fluid intake. A single study identified the presence of multiple diseases/medications as risk factors for dehydration. The number of ingestion sessions provided to nursing home residents was also positively correlated with fluid intake. Finally, one study concluded that being an institutionalised older adult led to an increased risk of a significantly lower fluid intake compared to older adults in the community. TRUNCATED AT 600 WORDS