Contenuto dell'articolo principale
Abstract
INTRODUCTION: dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful.
AIM: to develop a screening tool to detect dehydration in older people in hospital settings.
METHODS: this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity.
RESULTS: 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p<0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p<0.0001, 95% CI 0.69-0.86).
CONCLUSION: The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.
KEYWORDS: dehydration, aged, screening, inpatients, sensibility, specificity.
Sviluppo di uno strumento di screening per valutare la disidratazione nella popolazione anziana ospedalizzata: uno studio diagnostico, osservazionale
RIASSUNTO
INTRODUZIONE: La disidratazione è una condizione comune nella persona anziana ed è associata a numerosi rischi per la salute e ad esiti negativi. È importante il precoce riconoscimento di questa condizione, al fine di adottare strategie per prevenirne le complicanze. Per questa ragione è necessario sviluppare strumenti validati per valutare il rischio di disidratazione nelle persone anziane
OBIETTIVO: sviluppare uno strumento di screening per individuare la disidratazione nelle persone anziane ospedalizzate.
METODO: il disegno di studio adottato è di tipo diagnostico, osservazionale. Lo strumento creato è basato sul "Geriatric Dehydration Screening Tool" (GDST), che è stato modificato aggiungendo sette domande e due segni clinici, basati sulla letteratura recente. Lo strumento è stato testato in persone con un'etí maggiore o uguale a 65 anni ospedalizzate. Come reference standard è stata usata l'osmolarití sierica. È stato calcolato l'alfa di Cronbach per testare l'affidabilití della consistenza interna dello strumento e delle sue sotto scale. È stata calcolata l'area sotto la curva di ROC (AUC) per individuare il cut-off che dava il miglior bilanciamento tra sensibilití e specificití .
RISULTATI: 127 pazienti hanno partecipato allo studio. L'affidabilití dello strumento è risultata discreta (Alfa di Cronbach=0.63). L'accuratezza diagnostica, misurata con l'AUC era 0.83±0.04, p<0.0001, 95% IC 0.72-0.87. Il cut-off migliore è risultato essere il valore 6, con una sensibilití del 78% e specificití 70%. La secchezza della lingua è risultato essere il segno clinico più associato con uno stato di disidratazione (AUC 0.78, p<0.0001 95%CI 0.69-0.86).
CONCLUSIONI: il nuovo GDST ha dimostrato un'accettabile affidabilití e accuratezza diagnostica che aumenta con la valutazione di alcuni items, come la secchezza della lingua. Questo è il primo strumento che presenta un valore di cut-off promettente.
PAROLE CHIAVE: disidratazione, anziano, screening, pazienti ospedalizzati, sensibilití , specificití .
Dettagli dell'articolo
Riferimenti
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- Assessment--Its history, today's practice, and
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- 1177/0884533608321132.
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- elderly. E-SPEN. The European e-Journal of
- Clinical Nutrition and Metabolism; 5: e47-e53.
- doi:10.1016 /j.eclnm.2009.10.007.
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- Quarleri, L., Cappello, S., Turri, A., Rondanelli,
- M., & Caccialanza, R. (2016). Nutritional status
- in older persons according to healthcare setting: A
- systematic review and meta-analysis of prevalence
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- S0261-5614(16)00099-6. doi:
- 1016/j.clnu.2016.03.008.
- El-Sharkawy, A.M., Watson, P., Neal, K.R.,
- Ljungqvist, O., Maughan, R.J., Sahota, O., &
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- prospective cohort study). Age e aging. 44:943–
- doi:10.1093/ageing/afv119.
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- W.W., Channell, A.M., Chassagne, P., ... Hunter,
- P. (2015). Clinical symptoms, signs and tests for
- identification of impending and current waterloss
- dehydration in older people (Review).
- Cochrane Datebase of Systematic Reviews. 4:
- CD009647. doi: 10.1002/14651858
- .CD009647.pub2.
- Hooper, L., Bunn, D., Jimoh, F., & Fairweather-Tait,
- S. (2014). Water-loss dehydration and aging.
- Mechanism of Ageing and Development. 50 (8),
- -137. doi: 10.1016/j.mad.2013.11.009.
- Kimear, P.R., & Gray C.D. (2006) SPSS 14 made
- simple. New York: Psychology Press.
- Kinoshita, K., Hattori, K., Ota, Y., Kanai, T.,
- Shimizu, M., Kobayashi, H., & Tokuda, Y.
- (2013). The measurement of axillary moisture for
- the assessment of dehydration among older
- patients: A pilot study. Experimental
- Gerontology. 48 255–258. doi:
- 1016/j.exger.2012.10.002.
- Long, B. (2015). Dehydration (Older People):
- Clinical Information. The Joanna Briggs
- Institute. 1-3.
- Mentes J. (2006). Oral hydration in older adults:
- greater awareness is needed in preventing,
- recognizing and treating dehydration. American
- Journal of Nursing. 106(6), 40-49.
- Mentes, J., & Wang, J. (2011). Measuring risk of
- dehydration in Nursing Home Residents:
- Evaluation of the Dehydration Risk Appraisal
- Checklist. Research in Gerontological Nursing.
- (2):48-156.
- Messina, E., Serri, M., Milos, R., Rancati, S., Bonetti,
- L., Rosi, I.M. (2017). La disidratazione nelle
- persone anziane: studio di prevalenza nelle unití
- operative di medicina di un ospedale per acuti.
- Italian Journal of Nursing. 23, 26-30.
- Polit, D.F., & Tatano, Beck C. (2014) Essentials of
- Nursing Research. Appraising the evidence for
- Nursing Practice- Fondamenti di ricerca
- infermieristica. Ed Italiana a cura di Palese A.,
- Milano, McGraw Hill.
- Rodrigues, S., Silva, J., Severo, M., Inácio C., Padrí£o
- P., Lopes C., ... Moreira, P. (2015). Validation
- analysis of a Geriatric Dehydration Screening
- Tool in Community-Dwelling and
- Istitutionalized Elderly People. International
- Journal of Environmental Research and Public
- Health. 12, 2700-2717 doi:
- 3390/ijerph120302700.
- Rowat, A., Graham, C., & Dennis, M. (2011).
- Dehydration in Hospital-Admitted Stroke
- Patients, Detenction, Frequency and Association.
- American Heart Association. 43(3), 857-859.
- doi: 10.1161/STROKEAHA.111.640821.
- Scarpa, N. (2012). La disidratazione dell'anziano.
- Quesito clinico assistenziali. 2(2), 1-12.
- Sedgwick, P. (2015) How to read a receiver operating
- characteristic curve. British Medical Journal, 8,
- :h2464 doi: 10.1136/bmj.h2464.
- Siervo, M., Bunn, D., Prado, C., & Hooper L. (2014).
- Accuracy of prediction equations for serum
- osmolarity in frail older people with and without
- diabetes. American Journal Clinical Nutrition.
- , 867-876. doi: 10.3945/ajcn.114.086769.
- Singh, A. (2015). Dehydration: Assessment. The
- Joanna Briggs Institute. 1-4.
- Trepiccione, F., Capabasso, G. & Lippi, G. (2014).
- Osmolarití sierica e urinaria: considerazioni
- cliniche e laboratoristiche. Giornale Italiano di
- Nefrologia. 31(5), 1-9.
- Vivanti, A., Harvey, K., & Ash, S. (2010) Developing
- a quick and practical screen to improve the
- identification of poor hydration in geriatric and
- rehabilitative care. Archives of Gerontology and
- Geriatrics. 50, 156-164.
- doi:10.1016/j.archger.2009.03.003.
- Vivanti, A., Harvey, K., Ash, S., & Battistutta, D.
- (2008). Clinical assessment of dehydration in
- older people admitted to hospital. What are the
- strongest indicators? Archives of Gerontology and
- Geriatrics. 47, 340-355.
- doi:10.1016/j.archger.2007.08.016.Wakefield, B., Mentes, J., Holman, J. & Culp, K.
- (2008). Risk factors and outcomes associated with
- hospital admission for dehydration.
- Rehabilitation nursing. 33(6), 233-241.
- Wotton, K., Crannitch, K. & Munt, R. (2008).
- Prevalence, risk factors and strategies to prevent
- dehydration in older adults. Contemporary
- Nurse. 31, 44–56.
- Wu, S., Wang, H., Yeh, S., Wang, Y. & Yang Y.
- (2010). Hydration status of nursing home
- residents in Taiwan: a cross sectional study.
- Journal of Advanced Nursing. 67(3), 583-590.
Riferimenti
Bauer, J.M., Kaiser, M.J., Anthony, P., Guigoz, Y., &
Sieber, C.C. (2008). The Mini Nutritional
Assessment--Its history, today's practice, and
future perspectives. Nutrition in Clinical Practice,
(4), 388-396. doi:
1177/0884533608321132.
Begum, M., & Johnson, C.S. (2010). A review of the literature on dehydration in the institutionalized
elderly. E-SPEN. The European e-Journal of
Clinical Nutrition and Metabolism; 5: e47-e53.
doi:10.1016 /j.eclnm.2009.10.007.
Bossuyt, P.M., Reitsma J.B., Bruns, D.E., Gatsonis,
C.A., Glasziou, P.P., Irwig, L.,...Cohen J.F.;
STARD Group. (2015) STARD 2015: an
updated list of essential items for reporting
diagnostic accuracy studies. BMJ. 2015 351:
h5527. doi: 10.1136/bmj.h5527.
Cereda, E., Pedrolli, C., Klersy, C., Bonardi, C.,
Quarleri, L., Cappello, S., Turri, A., Rondanelli,
M., & Caccialanza, R. (2016). Nutritional status
in older persons according to healthcare setting: A
systematic review and meta-analysis of prevalence
data using MNA®. Clinical Nutrition pii:
S0261-5614(16)00099-6. doi:
1016/j.clnu.2016.03.008.
El-Sharkawy, A.M., Watson, P., Neal, K.R.,
Ljungqvist, O., Maughan, R.J., Sahota, O., &
Lobo, D.N. (2015). Hydration and outcome in
older patients admitted to hospital (TheHOOP
prospective cohort study). Age e aging. 44:943–
doi:10.1093/ageing/afv119.
Hooper, L., Abdelhamid, A., Attreed, N.J., Campbell,
W.W., Channell, A.M., Chassagne, P., ... Hunter,
P. (2015). Clinical symptoms, signs and tests for
identification of impending and current waterloss
dehydration in older people (Review).
Cochrane Datebase of Systematic Reviews. 4:
CD009647. doi: 10.1002/14651858
.CD009647.pub2.
Hooper, L., Bunn, D., Jimoh, F., & Fairweather-Tait,
S. (2014). Water-loss dehydration and aging.
Mechanism of Ageing and Development. 50 (8),
-137. doi: 10.1016/j.mad.2013.11.009.
Kimear, P.R., & Gray C.D. (2006) SPSS 14 made
simple. New York: Psychology Press.
Kinoshita, K., Hattori, K., Ota, Y., Kanai, T.,
Shimizu, M., Kobayashi, H., & Tokuda, Y.
(2013). The measurement of axillary moisture for
the assessment of dehydration among older
patients: A pilot study. Experimental
Gerontology. 48 255–258. doi:
1016/j.exger.2012.10.002.
Long, B. (2015). Dehydration (Older People):
Clinical Information. The Joanna Briggs
Institute. 1-3.
Mentes J. (2006). Oral hydration in older adults:
greater awareness is needed in preventing,
recognizing and treating dehydration. American
Journal of Nursing. 106(6), 40-49.
Mentes, J., & Wang, J. (2011). Measuring risk of
dehydration in Nursing Home Residents:
Evaluation of the Dehydration Risk Appraisal
Checklist. Research in Gerontological Nursing.
(2):48-156.
Messina, E., Serri, M., Milos, R., Rancati, S., Bonetti,
L., Rosi, I.M. (2017). La disidratazione nelle
persone anziane: studio di prevalenza nelle unití
operative di medicina di un ospedale per acuti.
Italian Journal of Nursing. 23, 26-30.
Polit, D.F., & Tatano, Beck C. (2014) Essentials of
Nursing Research. Appraising the evidence for
Nursing Practice- Fondamenti di ricerca
infermieristica. Ed Italiana a cura di Palese A.,
Milano, McGraw Hill.
Rodrigues, S., Silva, J., Severo, M., Inácio C., Padrí£o
P., Lopes C., ... Moreira, P. (2015). Validation
analysis of a Geriatric Dehydration Screening
Tool in Community-Dwelling and
Istitutionalized Elderly People. International
Journal of Environmental Research and Public
Health. 12, 2700-2717 doi:
3390/ijerph120302700.
Rowat, A., Graham, C., & Dennis, M. (2011).
Dehydration in Hospital-Admitted Stroke
Patients, Detenction, Frequency and Association.
American Heart Association. 43(3), 857-859.
doi: 10.1161/STROKEAHA.111.640821.
Scarpa, N. (2012). La disidratazione dell'anziano.
Quesito clinico assistenziali. 2(2), 1-12.
Sedgwick, P. (2015) How to read a receiver operating
characteristic curve. British Medical Journal, 8,
:h2464 doi: 10.1136/bmj.h2464.
Siervo, M., Bunn, D., Prado, C., & Hooper L. (2014).
Accuracy of prediction equations for serum
osmolarity in frail older people with and without
diabetes. American Journal Clinical Nutrition.
, 867-876. doi: 10.3945/ajcn.114.086769.
Singh, A. (2015). Dehydration: Assessment. The
Joanna Briggs Institute. 1-4.
Trepiccione, F., Capabasso, G. & Lippi, G. (2014).
Osmolarití sierica e urinaria: considerazioni
cliniche e laboratoristiche. Giornale Italiano di
Nefrologia. 31(5), 1-9.
Vivanti, A., Harvey, K., & Ash, S. (2010) Developing
a quick and practical screen to improve the
identification of poor hydration in geriatric and
rehabilitative care. Archives of Gerontology and
Geriatrics. 50, 156-164.
doi:10.1016/j.archger.2009.03.003.
Vivanti, A., Harvey, K., Ash, S., & Battistutta, D.
(2008). Clinical assessment of dehydration in
older people admitted to hospital. What are the
strongest indicators? Archives of Gerontology and
Geriatrics. 47, 340-355.
doi:10.1016/j.archger.2007.08.016.Wakefield, B., Mentes, J., Holman, J. & Culp, K.
(2008). Risk factors and outcomes associated with
hospital admission for dehydration.
Rehabilitation nursing. 33(6), 233-241.
Wotton, K., Crannitch, K. & Munt, R. (2008).
Prevalence, risk factors and strategies to prevent
dehydration in older adults. Contemporary
Nurse. 31, 44–56.
Wu, S., Wang, H., Yeh, S., Wang, Y. & Yang Y.
(2010). Hydration status of nursing home
residents in Taiwan: a cross sectional study.
Journal of Advanced Nursing. 67(3), 583-590.