Background: Older patients in hospital may be unable to maintain hydration by drinking, leading to intravenous\nfluid replacement, complications and a longer length of stay. We undertook a systematic review to describe clinical\nassessment tools which identify patients at risk of insufficient oral fluid intake and the impact of simple interventions to\npromote drinking, in hospital and care home settings.\nMethod: MEDLINE, CINAHL, and EMBASE databases and two internet search engines (Google and Google Scholar)\nwere examined. Articles were included when the main focus was use of a hydration/dehydration risk assessment in an\nadult population with/without a care intervention to promote oral hydration in hospitals or care homes. Reviews which\nused findings to develop new assessments were also included. Single case reports, laboratory results only, single\ntechnology assessments or non-oral fluid replacement in patients who were already dehydrated were excluded.\nInterventions where nutritional intake was the primary focus with a hydration component were also excluded. Identified\narticles were screened for relevance and quality before a narrative synthesis. No statistical analysis was planned.\nResults: From 3973 citations, 23 articles were included. Rather than prevention of poor oral intake, most focused upon\nidentification of patients already in negative fluid balance using information from the history, patient inspection and\nurinalysis. Nine formal hydration assessments were identified, five of which had an accompanying intervention/ care\nprotocol, and there were no RCT or large observational studies. Interventions to provide extra opportunities to drink\nsuch as prompts, preference elicitation and routine beverage carts appeared to support hydration maintenance, further\nresearch is required. Despite a lack of knowledge of fluid requirements and dehydration risk factors amongst staff, there\nwas no strong evidence that increasing awareness alone would be beneficial for patients.\nConclusion: Despite descriptions of features associated with dehydration, there is insufficient evidence to recommend a\nspecific clinical assessment which could identify older persons at risk of poor oral fluid intake; however there is evidence\nto support simple care interventions which promote drinking particularly for individuals with cognitive impairment
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