Hydration: LTC Intervention to Prevent Acute Confusion

Principal Investigator: Kennith Culp, PhD, RN

This is in progress testing the effectiveness of a hydration management guideline (HMG) to prevent acute confusion (AC) in residents of long term care (LTC). While AC / delirium is a complex health care problem for the elderly, with dire consequences if left untreated, few intervention studies have been conducted to prevent AC in any setting. In fact, much of the research conducted to date has sought to describe the phenomenon in acutely il, hospitalized elders, but no nursing interventions have ever been tested in LTC. Few have focused on a single etiologically based intervention, such as dehydration. While there are additional etiologies which lead to AC, dehydration negatively influences many of these other causes, such as urinary tract infections, drug metabolite accumulation, respiratory infection, blood volume deficits and resulting cerebral hypo-perfusion. Further, dehydration is the precipitant most amenable to nursing intervention. Therefore the specific aims being tested in this study are:

• Test the direct effect of a hydration management guideline (HMG) on the incidence of AC.
• Test the indirect effect of HMG on incidence of urinary tract infections in the LTC setting.

  Two Iowa Veteran Affairs long-term care facilities and two community nursing homes are being used, with this approach a stratified random sample can be obtained on gender as elderly men are a minority group in community LTC centers. We are monitoring the effectiveness and delivery of the intervention using a change in urine color, urine specific gravity, and body weight. The research assistants also measure daily intake and observe the amount of fluid nurses give to residents when their medications are administered. We are also analyzing urine specimens with photometric testing for leukocyte esterase , an indicator of urinary tract infection. With bioimpedance analysis, we are able to estimate total body water (TBW), intracellular fluid (ICF) and extracellular fluid (ECF) levels. Cases of acute confusion are based on daily observations of mental status using the Confusion Assessment Method (CAM) and the NEECHAM. We are also monitoring for changes in attentiveness with the Vigilance A screening test.