Journal of Human Nutrition and Dietetics
PUBLIC HEALTH NUTRITION AND EPIDEMIOLOGY A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital L. Gaff, J. Jones, I. H. Davidson & E. Bannerman School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, UK
Keywords elderly, fluid consumption, fluid provision, hydration, rehabilitation. Correspondence E. Bannerman, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, East Lothian, UK. Tel.: +44 (0)131 474 0000 Fax: 0131 474 0001 E-mail: [email protected] How to cite this article Gaff L., Jones J., Davidson I. H. & Bannerman E. (2015) A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital. J Hum Nutr Diet. 28, 384–389 doi:10.1111/jhn.12294
Abstract Background: Adequate hydration is key to good clinical care and essential for preventing problems in elderly patients such as constipation, pressure sores and confusion. The present study aimed to evaluate fluid provision and consumption in elderly patients against current standards for Scottish hospitals. Methods: A service evaluation, of fluid provision and consumption over 24 h by elderly orthopaedic rehabilitation patients in a long-stay hospital in Scotland was conducted. Fluids provided and consumed from trolley services, those at meal times and beverages from jugs of water were measured. The average fluid content of a jug, cup and glass on each ward was determined. Each jug of water provided was recorded, as was the acceptance of hot and cold drinks offered. Intake was determined by measuring the leftover water in each jug when these were refreshed and any leftover liquid in patients’ cups deducted from that provided. Observations were made with respect to the presentation and encouragement of fluids. Results: Fifty-eight patients (12 males, 46 female, aged ≥65 years) were monitored, of whom 56 were provided with more than the recommended minimum fluid per day [mean (SEM) = 2379 (82) mL]; however, mean intake was lower than recommended [mean (SEM) = 1302 (60) mL; P = 0.002]. Provision of drinks from a trolley service [mean (SEM) = 956 (44) mL] was less than fluid from jugs [mean (SEM) = 1398 (54) mL; P = 0.002]; however, the consumption of drinks from the trolley was greater [77% consumed, mean (SEM) = 770 (46) mL] than from jugs [41% mean (SEM) = 514 (36) mL; P < 0.001]. Conclusions: Patients consumed significantly more fluid from individual beverages than jugs. Consideration of the method of fluid provision is important with respect to influencing fluid intakes.
Introduction Adequate hydration is recognised as a fundamental aspect of essential clinical care within the UK (1–5), in Europe (6) and internationally (7). Fluid intakes can often be overlooked, with elderly hospital inpatients frequently presenting a high risk of dehydration through inadequate fluid intakes resulting from factors such as reduced thirst mechanisms, increased skin losses, increased urine production and conscious reduced intakes because of a fear of incontinence (8). Adequate fluid intake is essential for 384
helping prevent common problems associated with dehydration, such as constipation (9), pressure sores, confusion and hypotension, which in turn may increase the risk of falls (10). These issues may complicate and prolong illnesses, and also increase the length of stay (11,12). As such, care services within hospitals and social care institutions need to not only identify individuals’ specific needs, but also ensure that services and strategies are in place and are monitored to meet these needs (6,13). To improve food and fluid provision across hospitals in Scotland, NHS Health Improvement Scotland [formerly NHS ª 2015 The British Dietetic Association Ltd.
L. Gaff et al.
Quality Improvement Scotland (QIS)] has published clinical standards for Food, Fluid and Nutritional Care in Hospitals aiming to improve patients’ nutritional health and wellbeing (3). To support health boards with the implementation of these clinical standards, the Scottish Government developed practical guidance on catering and nutrition standards (Food in Hospitals) (14) with specific guidance on fluid provision. Current standards in Scottish hospitals on fluid provision recommend ‘a minimum provision of 1500 mL of fluid per day, constant access to fresh drinking water and the regular provision of assorted beverages at the correct temperature with assistance to drink if required’. ‘Water jugs provided at the side of the bed should be covered and refreshed at least three times a day’ (3,14). Low fluid intakes by older adults in varying institutions are frequently reported in the literature (15–18); however, many of these studies are dated and practices are likely to vary (17,19). It is not known whether the standards and guidance provided by The Scottish Government (14) are being met. Although inspections and self-assessments suggest that most health boards are fully compliant (>90% of standards are being met) (20), whether this means that patients are consuming sufficient amounts is unknown. The present study aimed to evaluate fluid provision and consumption in elderly patients (>65 years) in a long-stay Scottish hospital and to identify whether current strategies meet the appropriate requirements or whether there is a need for any modifications. Materials and methods The present study took place at a post-acute long-stay hospital in Scotland, UK. Patients were recruited from three orthopaedic rehabilitation wards for the elderly (two female and one male wards), covering potentially 63 beds. Participants needed to be aged 65 years and older and have been an inpatient on the ward for more than 24 h. Those on texture modified foods and or thickened fluids, those receiving artificial nutritional support, and those who were ‘nil by mouth’ were excluded from the study. Because this was a service evaluation and no personal identifiable information was accessed or gathered, no consent was required and so cognitive status was unknown. Data were collected over a 24-h period for each patient where all fluid provided and consumed within this period was recorded. Fluids were provided to individuals as covered jugs of drinking water on bedside lockers, and individuals were also offered hot and cold beverages from a trolley service throughout the day. The researcher was on-site to measure provision and consumption throughout the day from all of the trolley services. To measure fluid provision, the average fluid content of a jug, a cup and glass on each ª 2015 The British Dietetic Association Ltd.
Fluid provision and consumption
ward was determined. Each new jug of water provided was recorded. Acceptance of each hot or cold drink offered was recorded over the course of the day. Intake was determined by measuring the leftover water in each jug when the jugs were refreshed, and by measuring any leftover liquid in patients’ cups and deducting this from the provision. Observations were carried out on each ward with respect to the presentation and encouragement of fluid consumption. Ward staff were informed about the project and provided with a list of patients in the study for each 24-h period. They were asked to record any fluid provided and consumed after the evening drinks service but before breakfast (21.00 h to 07.00 h). Pilot studies were carried out to gain familiarity with fluid provision on the wards, test the feasibility of the study, and choose the best recording methods for data collection. Statistical analyses were performed using SPSS, version 17 (SPSS Inc., Chicago, IL, USA). A one-sample t-test was used to compare mean fluid provision and mean fluid consumption with the recommendation for daily fluid provision (14). Paired t-tests were used to determine differences in fluid provision and consumption as drinks from the trolley service compared to fluid provided in jugs and an independent t-test was used to compare provision and consumption between genders. P < 0.05 was considered statistically significant. South East Scotland, UK NHS research ethics approval was granted for the present study as a service evaluation project. The hospital and wards also provided their consent for the study. Results Fluid provision and consumption was monitored for 58 inpatients (12 males and 46 females). All patients were provided with covered jugs of water at the start of the day. Twenty-seven out of 58 jugs were changed once per day and 31 out of 58 were changed twice per day. None were changed three times. Hot and cold beverages from a trolley were offered between five and six times throughout the day (mid-morning, mid-afternoon, pre-bed and after each meal service). Total mean fluid provision was greater than the recommended minimum [mean (SEM) = 2379 (82) mL] (Table 1), with 56 out of the 58 patients provided with more than the recommended minimum of 1500 mL day 1. Mean fluid intake was, however, significantly lower than the recommended provision [mean (SEM) = 1302 (60) mL; P = 0.002], with 35 out of 58 patients consuming
PUBLIC HEALTH NUTRITION AND EPIDEMIOLOGY A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital L. Gaff, J. Jones, I. H. Davidson & E. Bannerman School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, UK
Keywords elderly, fluid consumption, fluid provision, hydration, rehabilitation. Correspondence E. Bannerman, School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh EH21 6UU, East Lothian, UK. Tel.: +44 (0)131 474 0000 Fax: 0131 474 0001 E-mail: [email protected] How to cite this article Gaff L., Jones J., Davidson I. H. & Bannerman E. (2015) A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital. J Hum Nutr Diet. 28, 384–389 doi:10.1111/jhn.12294
Abstract Background: Adequate hydration is key to good clinical care and essential for preventing problems in elderly patients such as constipation, pressure sores and confusion. The present study aimed to evaluate fluid provision and consumption in elderly patients against current standards for Scottish hospitals. Methods: A service evaluation, of fluid provision and consumption over 24 h by elderly orthopaedic rehabilitation patients in a long-stay hospital in Scotland was conducted. Fluids provided and consumed from trolley services, those at meal times and beverages from jugs of water were measured. The average fluid content of a jug, cup and glass on each ward was determined. Each jug of water provided was recorded, as was the acceptance of hot and cold drinks offered. Intake was determined by measuring the leftover water in each jug when these were refreshed and any leftover liquid in patients’ cups deducted from that provided. Observations were made with respect to the presentation and encouragement of fluids. Results: Fifty-eight patients (12 males, 46 female, aged ≥65 years) were monitored, of whom 56 were provided with more than the recommended minimum fluid per day [mean (SEM) = 2379 (82) mL]; however, mean intake was lower than recommended [mean (SEM) = 1302 (60) mL; P = 0.002]. Provision of drinks from a trolley service [mean (SEM) = 956 (44) mL] was less than fluid from jugs [mean (SEM) = 1398 (54) mL; P = 0.002]; however, the consumption of drinks from the trolley was greater [77% consumed, mean (SEM) = 770 (46) mL] than from jugs [41% mean (SEM) = 514 (36) mL; P < 0.001]. Conclusions: Patients consumed significantly more fluid from individual beverages than jugs. Consideration of the method of fluid provision is important with respect to influencing fluid intakes.
Introduction Adequate hydration is recognised as a fundamental aspect of essential clinical care within the UK (1–5), in Europe (6) and internationally (7). Fluid intakes can often be overlooked, with elderly hospital inpatients frequently presenting a high risk of dehydration through inadequate fluid intakes resulting from factors such as reduced thirst mechanisms, increased skin losses, increased urine production and conscious reduced intakes because of a fear of incontinence (8). Adequate fluid intake is essential for 384
helping prevent common problems associated with dehydration, such as constipation (9), pressure sores, confusion and hypotension, which in turn may increase the risk of falls (10). These issues may complicate and prolong illnesses, and also increase the length of stay (11,12). As such, care services within hospitals and social care institutions need to not only identify individuals’ specific needs, but also ensure that services and strategies are in place and are monitored to meet these needs (6,13). To improve food and fluid provision across hospitals in Scotland, NHS Health Improvement Scotland [formerly NHS ª 2015 The British Dietetic Association Ltd.
L. Gaff et al.
Quality Improvement Scotland (QIS)] has published clinical standards for Food, Fluid and Nutritional Care in Hospitals aiming to improve patients’ nutritional health and wellbeing (3). To support health boards with the implementation of these clinical standards, the Scottish Government developed practical guidance on catering and nutrition standards (Food in Hospitals) (14) with specific guidance on fluid provision. Current standards in Scottish hospitals on fluid provision recommend ‘a minimum provision of 1500 mL of fluid per day, constant access to fresh drinking water and the regular provision of assorted beverages at the correct temperature with assistance to drink if required’. ‘Water jugs provided at the side of the bed should be covered and refreshed at least three times a day’ (3,14). Low fluid intakes by older adults in varying institutions are frequently reported in the literature (15–18); however, many of these studies are dated and practices are likely to vary (17,19). It is not known whether the standards and guidance provided by The Scottish Government (14) are being met. Although inspections and self-assessments suggest that most health boards are fully compliant (>90% of standards are being met) (20), whether this means that patients are consuming sufficient amounts is unknown. The present study aimed to evaluate fluid provision and consumption in elderly patients (>65 years) in a long-stay Scottish hospital and to identify whether current strategies meet the appropriate requirements or whether there is a need for any modifications. Materials and methods The present study took place at a post-acute long-stay hospital in Scotland, UK. Patients were recruited from three orthopaedic rehabilitation wards for the elderly (two female and one male wards), covering potentially 63 beds. Participants needed to be aged 65 years and older and have been an inpatient on the ward for more than 24 h. Those on texture modified foods and or thickened fluids, those receiving artificial nutritional support, and those who were ‘nil by mouth’ were excluded from the study. Because this was a service evaluation and no personal identifiable information was accessed or gathered, no consent was required and so cognitive status was unknown. Data were collected over a 24-h period for each patient where all fluid provided and consumed within this period was recorded. Fluids were provided to individuals as covered jugs of drinking water on bedside lockers, and individuals were also offered hot and cold beverages from a trolley service throughout the day. The researcher was on-site to measure provision and consumption throughout the day from all of the trolley services. To measure fluid provision, the average fluid content of a jug, a cup and glass on each ª 2015 The British Dietetic Association Ltd.
Fluid provision and consumption
ward was determined. Each new jug of water provided was recorded. Acceptance of each hot or cold drink offered was recorded over the course of the day. Intake was determined by measuring the leftover water in each jug when the jugs were refreshed, and by measuring any leftover liquid in patients’ cups and deducting this from the provision. Observations were carried out on each ward with respect to the presentation and encouragement of fluid consumption. Ward staff were informed about the project and provided with a list of patients in the study for each 24-h period. They were asked to record any fluid provided and consumed after the evening drinks service but before breakfast (21.00 h to 07.00 h). Pilot studies were carried out to gain familiarity with fluid provision on the wards, test the feasibility of the study, and choose the best recording methods for data collection. Statistical analyses were performed using SPSS, version 17 (SPSS Inc., Chicago, IL, USA). A one-sample t-test was used to compare mean fluid provision and mean fluid consumption with the recommendation for daily fluid provision (14). Paired t-tests were used to determine differences in fluid provision and consumption as drinks from the trolley service compared to fluid provided in jugs and an independent t-test was used to compare provision and consumption between genders. P < 0.05 was considered statistically significant. South East Scotland, UK NHS research ethics approval was granted for the present study as a service evaluation project. The hospital and wards also provided their consent for the study. Results Fluid provision and consumption was monitored for 58 inpatients (12 males and 46 females). All patients were provided with covered jugs of water at the start of the day. Twenty-seven out of 58 jugs were changed once per day and 31 out of 58 were changed twice per day. None were changed three times. Hot and cold beverages from a trolley were offered between five and six times throughout the day (mid-morning, mid-afternoon, pre-bed and after each meal service). Total mean fluid provision was greater than the recommended minimum [mean (SEM) = 2379 (82) mL] (Table 1), with 56 out of the 58 patients provided with more than the recommended minimum of 1500 mL day 1. Mean fluid intake was, however, significantly lower than the recommended provision [mean (SEM) = 1302 (60) mL; P = 0.002], with 35 out of 58 patients consuming
