Hydration Habits and Daily Fluid Intake of Institutionalized Older Adults

PURPOSE: This descriptive study examined the Person-Environment-Occupation fit of the everyday beverage experience of institutionalized older adults to identify potential hydration habits and routines that act as supports or disruptors of intermediaries of falling such as fluid consumption. Dehydration is potentially reversible but has adverse consequences and can be irreversible leading to death. Institutionalized older adults experience 1.5 falls per year, are likely to be dehydrated, and are likely to have cognitive impairment. Chronic dehydration is associated with poor balance and falling. Institutionalized older adults may self-limit fluid intake to avoid incontinence, have poor mobility and limited access to fluids, and have cognitive impairment whereby the person forgets to drink or fails to initiate drinking fluids. Occupational therapists are experts in addressing the PEO fit of daily habits and routines to promote health and well-being across the lifespan which can include the body’s hydration status. The primary research question was: What are the characteristics of the beverage habit patterns for institutionalized residents aged 65 years and older?

DESIGN: The exploratory descriptive observational study examined the daily beverage habits and routines of a purposive sample of 57 North Central Indiana adults aged 65 years or older who consumed food and fluid orally and who resided in three long-term care facilities (i.e., assisted living, general long-term, and dementia care units) owned and managed by the same company.

METHOD: Researcher accuracy and reliability for estimating fluid consumption was established using Simmons and Reuben’s photographic study protocol (2000). Cohen’s Kappa was set at .90 and achieved prior to all data collection. Observed fluid consumption was recorded from early in the morning until bedtime in an observation log modeled upon Simmons, Babineau, Garcia & Schnelle’s 2002 data recording form. MoCA, FES, and PHQ-9 scores, fall history, medical conditions, and medications were also identified. Data were analyzed through descriptive analyses, Spearman Rank correlation, Kruskall-Wallis, and Mann-Whitney U analyses to identify beverage habit and routine characteristics, including relationships and temporal differences of beverage habits and routines with overall fluid intake.

RESULTS: Participants consumed 1257 ml of daily beverages mostly during meals with breakfast being the largest meal. Consumption of beverage fluids was inadequate per expert recommendations. Supports associated with high beverage intake included having beverage choice, variety, and preference with best fluid intake occurring when preferred beverages were consumed during all three non-meal periods rather than only at meal-times or during one non-meal episode. Sixty-one percent of consumed fluids were preferred but less than two daily beverage types were preferred indicating that institutionalized older adults experience an occupational deprivation for drinking preferred varieties of daily beverages.

CONCLUSION: Key beverage habit and routine factors (e.g., beverage choice, variety, and preference) are identified that enable a good PEO fit and act as supports of daily fluid intake for institutionalized older adults. These factors can be included in hydration programs and education programs to support and promote daily fluid consumption for individual clients or for groups of people. Occupational therapists are experts at addressing the PEO fit of beverage habits and incorporating meaningful beverage occupations as crucial components of daily care for promoting fluid intake and hydration status for institutionalized older adults and subsequently to possibly prevent falling.

References

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Simmons, S. F., & Reuben, D. (2000). Nutritional intake monitoring for nursing home residents: a comparison of staff documentation, direct observation, and photography methods. Journal of the American Geriatrics Society, 48(2), 209-213. https://doi.org/10.1111/j.1532-5415.2000.tb03914.x

Simmons, S. F., Babineau, S., Garcia, E., & Schnelle, J. F. (2002). Quality assessment in nursing homes by systematic direct observation feeding assistance. The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences, 57(10), M665-M671. PMID: 12242322, ISSN: 1079-5006.

Hooper, L., Bunn, D. K., Downing, A., Jimoh, F. O., Groves, J., Free, C., ... & Shepstone, L. (2016). Which frail older people are dehydrated? The UK DRIE study. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 71(10), 1341-1347. doi: 10.1093/gerona/glv205