How effective are hydration initiatives in reducing the risk of developing delirium in geriatric inpatients?

Oral Rehydration to Reduce Delirium in the Elderly.

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Introduction

Hydration is essential to human life and adequate fluid intake is fundamental to metabolism, digestion, temperature regulation and other aspects of bodily functioning (Bunn et al., 2015). In a normal and healthy individual, dips in hydration are detected by membrane osmoreceptors, via reduced arterial circulating volume or risen plasma osmolarity, which triggers vasopressin, thirst, incentivised fluid intake and antidiuresis (Hooper et al., 2014). However, in the geriatric patient, this normal process can be compromised due to a reduction in thirst sensation and urinary concentrating ability, which can contribute to delirium (Hooper et al., 2014). The geriatric, or older person, is defined as an individual who is aged 65 years or older, but frailty is thought to play a bigger role than a strict age band in practice (NHS, n.d.). The result is an increased risk of dehydration in the older patient.

An exploration of the potential use and application of hydration initiatives in geriatric patients is required to prevent avoidable causes of dehydration. This is particularly relevant given that more than one in five of the United Kingdom (UK) population is over the age of 60 and this is expected to rise from 14.9 million in 2014 to 18.5 million in 2025 (Office for National Statistics, 2015). Likewise, between 2007 and 2017, the number of A&E attendances by patients over 60 years old increased by two-thirds, a greater rise than was expected in reflection of demographic changes alone (NHS, 2017). Thus, maintaining safety and preventing delirium in geriatrics represents a growing concern among hospital wards.

Research Question

A research question has been developed to help direct the search. The research question is: How effective are hydration initiatives in reducing the risk of developing delirium in geriatric inpatients? The PEO (Population, Exposure, Outcome) framework was used to structure the research question; a breakdown of the research question in PEO format is shown in Table 1. This framework was selected to improve the specificity and conceptual clarity of the clinical issue presented (Booth et al., 2006).

Aim

The aim of this project is to introduce earl oral rehydration as a measure to prevent the onset of delirium in geriatric patients.