Validation analysis of a geriatric dehydration screening tool in community-dwelling and institutionalized elderly people

Susana Rodrigues, Joana Silva, Milton Severo, Cátia Inácio, Patrícia Padrão, Carla Lopes, Joana Carvalho, Isabel do Carmo, Pedro Moreira, Susana Rodrigues, Joana Silva, Milton Severo, Cátia Inácio, Patrícia Padrão, Carla Lopes, Joana Carvalho, Isabel do Carmo, Pedro Moreira

Abstract

Dehydration is common among elderly people. The aim of this study was to perform validation analysis of a geriatric dehydration-screening tool (DST) in the assessment of hydration status in elderly people. This tool was based on the DST proposed by Vivanti et al., which is composed by 11 items (four physical signs of dehydration and seven questions about thirst sensation, pain and mobility), with four questions extra about drinking habits. The resulting questionnaire was evaluated in a convenience sample comprising institutionalized (n=29) and community-dwelling (n=74) elderly people. Urinary parameters were assessed (24-h urine osmolality and volume) and free water reserve (FWR) was calculated. Exploratory factor analysis was used to evaluate the scale's dimensionality and Cronbach's alpha was used to measure the reliability of each subscale. Construct's validity was tested using linear regression to estimate the association between scores in each dimension and urinary parameters. Two factors emerged from factor analysis, which were named "Hydration Score" and "Pain Score", and both subscales showed acceptable reliabilities. The "Hydration Score" was negatively associated with 24-h urine osmolality in community-dwelling; and the "Pain Score" was negatively associated with 24-h urine osmolality, and positively associated with 24-h urine volume and FWR in institutionalized elderly people.

Figures

Figure 1
Figure 1
Flow chart of study sample and exclusion criteria.

References

    1. Maughan R.J. Hydration, morbidity, and mortality in vulnerable populations. Nutr. Rev. 2012;70:S152–S155. doi: 10.1111/j.1753-4887.2012.00531.x.
    1. Manz F. Hydration and disease. J. Amer. Coll. Nutr. 2007;26:S535–S541. doi: 10.1080/07315724.2007.10719655.
    1. Vivanti A., Harvey K., Ash S., Battistutta D. Clinical assessment of dehydration in older people admitted to hospital: What are the strongest indicators? Arch. Gerontol. Geriatr. 2008;47:340–355. doi: 10.1016/j.archger.2007.08.016.
    1. Bunn D., Jimoh F., Wilsher S.H., Hooper L. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: A systematic review. J. Amer. Med. Dir. Assn. 2015;16:101–113. doi: 10.1016/j.jamda.2014.10.016.
    1. Vivanti A., Harvey K., Ash S. Developing a quick and practical screen to improve the identification of poor hydration in geriatric and rehabilitative care. Arch. Gerontol. Geriatr. 2010;50:156–164. doi: 10.1016/j.archger.2009.03.003.
    1. Baron S., Courbebaisse M., Lepicard E.M., Friedlander G. Assessment of hydration status in a large population. Brit. J. Nutr. 2015;113:147–158. doi: 10.1017/S0007114514003213.
    1. Shirreffs S.M. Markers of hydration status. Eur. J. Clin. Nutr. 2003;57:S6–S9. doi: 10.1038/sj.ejcn.1601895.
    1. Goldberg L.R., Heiss C.J., Parsons S.D., Foley A.S., Mefferd A.S., Hollinger D., Parham D.F., Patterson J. Hydration in older adults: The contribution of bioelectrical impedance analysis. Int. J. Speech lang. Pathol. 2014;16:273–281. doi: 10.3109/17549507.2014.882989.
    1. Manz F., Wentz A. 24-h hydration status: parameters, epidemiology and recommendations. Eur. J. Clin. Nutr. 2003;57:S10–S18. doi: 10.1038/sj.ejcn.1601896.
    1. Lancaster K.J., Smiciklas-Wright H., Heller D.A., Ahern F.M., Jensen G. Dehydration in Black and White older adults using diuretics. Ann. Epidemiol. 2003;13:525–529. doi: 10.1016/S1047-2797(03)00004-8.
    1. Wotton K., Crannitch K., Munt R. Prevalence, risk factors and strategies to prevent dehydration in older adults. Contemp. Nurse. 2008;31:44–56. doi: 10.5172/conu.673.31.1.44.
    1. Morgado J., Rocha C.S., Maruta C., Guerreiro M., Martins I.P. New normative values of Mini-mental state examination. Sinapse. 2009;9:10–16.
    1. Folstein M.F., Folstein S.E., McHugh P.R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Liu L., Ikeda K., Yamori Y. Inverse relationship between urinary markers of animal protein intake and blood pressure in Chinese: Results from the WHO cardiovascular diseases and alimentary comparison (CARDIAC) study. Int. J. Epidemiol. 2002;31:227–233. doi: 10.1093/ije/31.1.227.
    1. Vivanti A. Ph.D. Dissertation/Thesis. Queensland University of Technology; Queensland, Australia: 2007. Screening and Identification of Dehydration in Older People Admitted to a Geriatric and Rehabilitation Unit.
    1. Sanchez-Garcia S., Garcia-Pena C., Duque-Lopez M.X., Juarez-Cedillo T., Cortes-Nunez A.R., Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health. 2007;7 doi: 10.1186/1471-2458-7-2.
    1. Obesity: Preventing and Managing the Global Epidemic. Report of a WHO Consultation. Volume 894. World Health Organization; Geneva, Switzerland: 2000. pp. 1–253.
    1. Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Volume 854. Health Organization; Geneva, Switzerland: 1995. pp. 1–452.
    1. Shirreffs S.M., Maughan R.J. Restoration of fluid balance after exercise-induced dehydration: Effects of alcohol consumption. J. Appl. Physiol. 1997;83:1152–1158.
    1. Hobson R.M., Maughan R.J. Hydration status and the diuretic action of a small dose of alcohol. Alcohol Alcohol. 2010;45:366–373. doi: 10.1093/alcalc/agq029.
    1. Rombo M.M., Silveira D., Martins I., Cruz A. Modelos Fotográficos para Inquéritos Alimentares. Centro de Estudos de Nutrição do Instituto Nacional de Saúde Dr. Ricardo Jorge; Lisbon, Portugal: 1996. (In Portuguese)
    1. INSA: Tabela da Composição dos Alimentos. Instituto Nacional de Saúde Dr. Ricardo Jorge; Lisbon, Portugal: 2006. (In Portuguese)
    1. Armstrong L.E. Assessing hydration status: the elusive gold standard. J. Amer. Coll. Nutr. 2007;26:S575–S584. doi: 10.1080/07315724.2007.10719661.
    1. Manz F., Wentz A. Hydration status in the United States and Germany. Nutr. Rev. 2005;63:S55–S62. doi: 10.1111/j.1753-4887.2005.tb00154.x.
    1. Manz F., Johner S.A., Wentz A., Boeing H., Remer T. Water balance throughout the adult life span in a German population. Brit. J. Nutr. 2012;107:1673–1681. doi: 10.1017/S0007114511004776.
    1. Stevens J. In: Applied Multivariate Statistics for the Social Sciences. 2nd ed. Hillsdale N.J., editor. Lawrence Erlbaum Associates; London, UK: 1992.
    1. Basic Item Analysis for Multiple-Choice Tests; ERIC Clearinghouse on Assessment and Evaluation. [(accessed on 27 February 2015)]. Available online: .
    1. Phillips P.A., Rolls B.J., Ledingham J.G., Forsling M.L., Morton J.J., Crowe M.J., Wollner L. Reduced thirst after water deprivation in healthy elderly men. N. Engl. J. Med. 1984;311:753–759. doi: 10.1056/NEJM198409203111202.
    1. Gross C.R., Lindquist R.D., Woolley A.C., Granieri R., Allard K., Webster B. Clinical indicators of dehydration severity in elderly patients. J. Emerg. Med. 1992;10:267–274. doi: 10.1016/0736-4679(92)90331-M.
    1. Kenney W.L., Chiu P. Influence of age on thirst and fluid intake. Med. Sci. Sport. Exerc. 2001;33:1524–1532. doi: 10.1097/00005768-200109000-00016.
    1. Rosler A., Lehmann F., Krause T., Wirth R., von Renteln-Kruse W. Nutritional and hydration status in elderly subjects: Clinical rating vs. bioimpedance analysis. Arch. Gerontol. Geriatr. 2010;50:81–85. doi: 10.1016/j.archger.2009.06.007.
    1. Popkin B.M., D’Anci K.E., Rosenberg I.H. Water, hydration, and health. Nutr. Rev. 2010;68:439–458. doi: 10.1111/j.1753-4887.2010.00304.x.
    1. Millard-Stafford M., Wendland D.M., O’Dea N.K., Norman T.L. Thirst and hydration status in everyday life. Nutr. Rev. 2012;70:S147–S151. doi: 10.1111/j.1753-4887.2012.00527.x.
    1. Gaspar P.M. Comparison of four standards for determining adequate water intake of nursing home residents. Res. Theory Nurs. Pract. 2011;25:11–22. doi: 10.1891/0889-7182.25.1.11.
    1. Lavizzo-Mourey R., Johnson J., Stolley P. Risk factors for dehydration among elderly nursing home residents. J. Amer. Geriatr. Soc. 1988;36:213–218.
    1. Leiper J.B., Seonaid Primrose C., Primrose W.R., Phillimore J., Maughan R.J. A comparison of water turnover in older people in community and institutional settings. J. Nutr. Health Aging. 2005;9:189–193.
    1. Kayser-Jones J., Schell E.S., Porter C., Barbaccia J.C., Shaw H. Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J. Amer. Geriatr. Soc. 1999;47:1187–1194.
    1. Spangler A.A., Chidester J.C. Age, dependency and other factors influencing fluid intake by long term care residents. J. Nutr. Elder. 1999;18:21–35. doi: 10.1300/J052v18n02_02.
    1. Gaspar P.M. Water intake of nursing home residents. J. Gerontol. Nurs. 1999;25:23–29. doi: 10.3928/0098-9134-19990401-06.
    1. Mentes J.C., Culp K. Reducing hydration-linked events in nursing home residents. Clin. Nurs. Res. 2003;12:210–225. doi: 10.1177/1054773803252996.
    1. Mentes J. Oral hydration in older adults: Greater awareness is needed in preventing, recognizing, and treating dehydration. Amer. J. Nurs. 2006;106:40–49. doi: 10.1097/00000446-200606000-00023.
    1. Luppa M., Luck T., Weyerer S., Konig H.H., Brahler E., Riedel-Heller S.G. Prediction of institutionalization in the elderly: A systematic review. Age Ageing. 2010;39:31–38. doi: 10.1093/ageing/afp202.
    1. Luppa M., Riedel-Heller S.G., Luck T., Wiese B., van den Bussche H., Haller F., Sauder M., Mosch E., Pentzek M., Wollny A., et al. Age-related predictors of institutionalization: Results of the German study on ageing, cognition and dementia in primary care patients (AgeCoDe) Soc. Psychiat. Psychiatr. Epidemiol. 2012;47:263–270. doi: 10.1007/s00127-010-0333-9.
    1. Wu S.J., Wang H.H., Yeh S.H., Wang Y.H., Yang Y.M. Hydration status of nursing home residents in Taiwan: A cross-sectional study. J. Adv. Nurs. 2011;67:583–590. doi: 10.1111/j.1365-2648.2010.05514.x.
    1. Chidester J.C., Spangler A.A. Fluid intake in the institutionalized elderly. J. Amer. Diet. Assn. 1997;97:23–28. doi: 10.1016/S0002-8223(97)00011-4.
    1. Presse N., Ferland G. Risk factors contributing to insufficient water intake in elderly living in nursing homes and long-term care units: a review of the literature. Can. J. Diet. Pract. Res. 2010;71:94–99. doi: 10.3148/71.3.2010.e94.
    1. Mentes J.C. A typology of oral hydration problems exhibited by frail nursing home residents. J. Gerontol. Nurs. 2006;32:13–19. doi: 10.3928/0098-9134-20060101-09.
    1. Shimizu M., Kinoshita K., Hattori K., Ota Y., Kanai T., Kobayashi H., Tokuda Y. Physical signs of dehydration in the elderly. Intern. Med. 2012;51:1207–1210. doi: 10.2169/internalmedicine.51.7056.
    1. Kinoshita K., Hattori K., Ota Y., Kanai T., Shimizu M., Kobayashi H., Tokuda Y. The measurement of axillary moisture for the assessment of dehydration among older patients: A pilot study. Exp. Gerontol. 2013;48:255–258. doi: 10.1016/j.exger.2012.10.002.
    1. Weinberg A.D., Minaker K.L. Dehydration. Evaluation and management in older adults. Council on Scientific Affairs, American Medical Association. JAMA. 1995;274:1552–1556. doi: 10.1001/jama.1995.03530190066035.
    1. Bennett J.A., Thomas V., Riegel B. Unrecognized chronic dehydration in older adults: Examining prevalence rate and risk factors. J. Gerontol. Nurs. 2004;30:22–28. doi: 10.3928/0098-9134-20041101-09.

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