An intervention to increase fluid intake in nursing home residents: prompting and preference compliance.
OBJECTIVE
To evaluate a three-phase, behavioral intervention to improve fluid intake in nursing home (NH) residents.


METHODS
Controlled clinical intervention trial.


METHODS
Two community NHs.


METHODS
Sixty-three incontinent NH residents.


METHODS
Participants were randomized into intervention and control groups. The intervention consisted of three phases for a total of 32 weeks: (1) 16 weeks of four verbal prompts to drink per day, in between meals; (2) 8 weeks of eight verbal prompts per day, in between meals; and (3) 8 weeks of eight verbal prompts per day, in between meals, plus compliance with participant beverage preferences.


METHODS
Between-meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant (3 consecutive days) at baseline and at 8 and 32 weeks into the intervention. Serum osmolality, blood urea nitrogen, and creatinine values were obtained for all participants in one of the two sites at the same three time points.


RESULTS
The majority (78%) of participants increased their fluid intake between meals in response to the increase in verbal prompts (phase 1 to 2). A subset of residents (21%), however, only increased their fluid intake in response to beverage preference compliance (phase 3). There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiveness to the intervention.


CONCLUSIONS
A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents, whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents.
Simmons
S F
SF
Department of Geriatrics, Borun Center for Gerontological Research, University of California, Los Angeles, School of Medicine, USA.
Alessi
C
C
Schnelle
J F
JF
D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000379:methods*; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003681:Dehydration / Q000097:blood / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology*; D004327:Drinking Behavior; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000523:psychology*; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000379:methods*; D006801:Humans; D016014:Linear Models; D008297:Male; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D009735:Nursing Homes; D009994:Osmolar Concentration; D010349:Patient Compliance / Q000523:psychology*; D016896:Treatment Outcome; D014705:Verbal Behavior
D003404:Creatinine