Review Article
Increasing Fluid Intake and Reducing Dehydration Risk in Older People Living in Long-Term Care: A Systematic Review

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Abstract

Objective

To assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in long-term care facilities.

Design

Systematic review of intervention and observational studies.

Data Sources

Thirteen electronic databases were searched from inception until September 2013 in all languages. References of included papers and reviews were checked.

Eligibility Criteria

Intervention and observational studies investigating modifiable factors to increase fluid intake and/or reduce dehydration risk in older people (≥65 years) living in long-term care facilities who could drink orally.

Review Methods

Two reviewers independently screened, selected, abstracted data, and assessed risk of bias from included studies; narrative synthesis was performed.

Results

A total of 4328 titles and abstracts were identified, 325 full-text articles were obtained and 23 were included in the review. Nineteen intervention and 4 observational studies from 7 countries investigated factors at the resident, institutional, or policy level. Overall, the studies were at high risk of bias due to selection and attrition bias and lack of valid outcome measures of fluid intake and dehydration assessment.

Reported findings from 6 of the 9 intervention studies investigating the effect of multicomponent strategies on fluid intake or dehydration described a positive effect. Components included greater choice and availability of beverages, increased staff awareness, and increased staff assistance with drinking and toileting. Implementation of the US Resident Assessment Instrument reduced dehydration prevalence from 3% to 1%, P = .01. Two smaller studies reported positive effects: one on fluid intake in 9 men with Alzheimer disease using high-contrast red cups, the other involved supplementing 13 mildly dehydrated residents with oral hydration solution over 5 days to reduce dehydration. Modifications to the dining environment, advice to residents, presentation of beverages, and mode of delivery (straw vs beaker; prethickened drinks vs those thickened at the bedside) were inconclusive.

Two large observational studies with good internal validity investigated effects of ownership; in Canada, for-profit ownership was associated with increased hospital admissions for dehydration; no difference was seen in dehydration prevalence between US for-profit and not-for-profit homes, although chain facilities were associated with lower odds of dehydration. This US study did not suggest any effect of staffing levels on dehydration prevalence.

Conclusions

A wide range of interventions and exposures were identified, but the efficacy of many strategies remains unproven due to the high risk of bias present in many studies. Reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management, and care staff, but these require further investigation using more robust study methodologies.

The review protocol was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100).

Keywords

Aged
beverages
dehydration
drinking
geriatrics
long-term care

Cited by (0)

The authors declare no conflicts of interest.

This article summarizes independent research funded by the National Institute for Health Research (NIHR) under its Career Development Fellowship program to LH (NIHR-CDF-2011-04-025). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service (NHS), NIHR, or the Department of Health. The study sponsor is Sue Steel, Contracts Manager, Research and Enterprise Hub, UEA, Norwich, Norfolk, UK NR4 7TJ; [email protected]. The study sponsor is a member of the steering group. She has had no role in the design, data collection, analysis or interpretation of data, writing, or decision to publish. There are no additional data available, but the full set of data tables for the review is found in the submitted online supplementary materials.

Systematic review registration: International Prospective Register of Systematic Reviews, http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42012003100. Protocol registered October 2012.