Hydration management: A long-term care nursing intervention to prevent acute confusion and other hydration-linked events

Abstract

Residents of long-term care have ongoing problems with adequate oral hydration. The results of chronic underhydration are acute confusion, urinary and respiratory infections, and constipation to name a few. The purpose of this study was to test whether a hydration management guideline designed to meet individual nursing home resident's hydration needs, prevents or minimizes episodes of acute confusion and urinary tract infections in this population. This was expanded to include prevention of all hydration-linked events, which were defined as any infection or episode of acute confusion preceded by a urine specific gravity >=1.020 and decreased fluid intake. This was done because only three episodes of acute confusion were documented over the course of the eight-week study. Forty-nine subjects were recruited from four long-term care settings in Eastern Iowa. Each site was randomly assigned to a treatment or control condition. The treatment group subjects received a 2-month individualized hydration management plan that included a daily fluid goal, which was calculated based on the resident's weight. Control subjects received their usual care. Both groups received an extensive baseline assessment and had weekly urine specimens evaluated for color, specific gravity, and leukocyte esterase. Weekly fluid records were also recorded on the subjects. The incidence of HLE in the treatment group was 3 events per 63 days of follow-up and for the control group was 6 events per 60 days of follow-up (RR = .48, 95% CI .18-1.26). Kaplan-Meier survival estimates with a log rank test were used to compare differences in the survival curves. Although there were no significant differences in the time to occurrence of a HLE between the treatment and control groups, (log rank test = .74, p = .39) the members of the treatment group had fewer episodes of HLE. Individual risk factors for dehydration were also delimited based on demographic characteristics of participants. It was concluded that the hydration management intervention needed to be delivered over a longer period of time to realize full benefit