Abstract
Background Water-loss dehydration, associated with poor health outcomes, is prevalent in older people living in care homes. Identifying effective prevention strategies will improve quality of life. Methods We systematically reviewed intervention and observational studies to identify effective interventions and modifiable factors aiming to improve fluid intake or hydration status in older (>65 years) care home residents. Thirteen electronic databases were searched until September 2013, reference lists of reviews and included studies checked. Using pre-determined criteria, two reviewers independently selected studies for inclusion, abstracted data and assessed validity (http://www.crd.york.ac.uk/Prospero/display_record.asp?ID=CRD42012003100). Results Searches identified 4328 titles/abstracts; 325 full-text papers obtained, nineteen intervention and four observational studies included. Lack of accurate assessment of fluid intake and/or dehydration, paucity of randomisation and allocation concealment meant many strategies were unproven. Observational studies investigating ownership demonstrated increased hospital admissions for dehydration from for-profit Canadian homes. In the US, dehydration prevalence was unaltered between for-profit and not-for-profit homes, but an intervention study reported reduced dehydration prevalence following implementation of the Resident Assessment Instrument. Use of red-tableware, compared to white, and multi-component German, Japanese and US interventions (including increased choice, availability, between-meals drinks rounds, staff education, drinking and toileting assistance) were associated with increased fluid intake. Small studies suggested no effect for less institutionalised settings, fewer dining-room residents, permanent seating positions, noise, sitting/standing feeding assistants, use of straws or type of thickening agent (Canada, Ireland, UK, US). Conclusions Some interventions improving fluid intake in care-home residents are promising, but high quality well-powered RCTs are needed to confirm their efficacy.
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