Health Promotion For Dehydration in Older Adults

Dehydration is a fluid intake or retention that is less than what is needed to meet the body’s fluid requirement resulting in fluid volume deficit, especially plasma volume (Rebar, Ignativicius & Workman, 2018). Dehydration may indicate an actual decrease in total body water due to minimal intake of fluid or higher loss of fluids; however, relative dehydration can also occur due to fluid shifts from the plasma into the interstitial space without an actual loss of total body water (Rebar et al., 2018).

Dehydration can occur at any age in both genders depending on the underlying cause or factors that are contributing to this condition. However, the focus population that will be discussed are older Hispanic adults living in Chestnut Hill Nursing Home Center in Passaic, New Jersey. Older adults are more susceptible to dehydration than young and middle-aged adults due to the pathophysiological changes that occur with the aging process (El-Sharkawy et al., 2015). The thirst sensation in older adults is diminished due to the age-related increased thirst threshold; thus, before older adults become thirsty, the osmolality of body fluids can rise higher and can result in decreased fluid intake (Potter & Perry, 2017). Older adults, in comparison to young and middle-aged adults, have decreased lean body mass that also decreases the body water weight percentages (Potter & Perry, 2017). Renal function declines as a result of aging with glomerular filtration rate reducing by 50-63% from the age of 30-80 years, resulting in decreased ability to conserve water and concentrate urine (El-Sharkawy et al., 2015).

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In a review of over 10 million hospital records from a US healthcare provider, 17% of elderly with a principal diagnosis of dehydration as per the ICD classification died within 30 days of hospital admission with a 1-year mortality of 48% (El-Sharkawy et al., 2015). The prevalence of dehydration in older adults in nursing homes ranges from 12-50%, with the United States around 30% (Masot et al., 2018). The real incidence of dehydration is unknown due to the lack of standardized methods, and a variety of ways to determine whether an individual is dehydrated or not (Masot et al., 2018). In nursing homes, many older adults may be mildly dehydrated with no clinical manifestation until dehydration becomes more severe (Masot et al., 2018). Furthermore, dehydration in older hospitalized patients can be a major concern for safety and contributes to a significant public health burden with high-cost implications (El-Sharkawy et al., 2015). Dehydration may lead to further health problems such as falls, orthostatic hypotension, and hypovolemic shock, resulting in further hospital stays and higher healthcare costs for the client despite being a preventable problem (Rebar et al., 2018)

As previously mentioned, the population-focused that will be discussed are Hispanic older adults living in Chestnut Hill Nursing Home Center in Passaic, New Jersey. Thus, it is important to create a unique and independent plan for the population to develop an effective primary prevention and health promotion strategy. According to the U.S. Census Bureau, 42.3% are Hispanic, and 14.5% are persons 65 years or older in Passaic, New Jersey population (United States Census Bureau, 2017). Also, languages other than English that are spoken at home are at 48.2% in Passaic, New Jersey (United States Census Bureau, 2017).

First, it is essential to evaluate the population's readiness to learn. Ensuring their readiness to learn will provide better collaboration with healthcare providers to achieve positive health outcomes and behavior. Prochaska and DiClemente developed the Transtheoretical model that includes five stages of behavioral change that will help guide nurses to understand the process of readiness to learn in patients; the five stages are pre-contemplation, contemplation, preparation for action, action, and maintenance (Giddens, 2017). This change model is effective in understanding that changes occur gradually in small steps and relapses are inevitable in the process of reaching a larger goal of lifelong change. At first, people may be unwilling to change during the early stages, but eventually, develop a proactive and committed approach to changing their behavior. In the focused population, the state of readiness to learn is important to consider as it will be helpful for them to engage and participate in developing primary prevention strategies to prevent dehydration.

In terms of reading level and learner engagement, it is important to determine the population’s educational and literacy level to develop an effective teaching approach. According to the U.S. Census Bureau, only 27% of the population carry a bachelor’s degree or higher, and 83% of the rest have a high school or some college as the highest level of education in Passaic City (United States Census Bureau, 2017). Therefore, as a nurse, considering the target population’s level of education and literacy can be beneficial to develop an individualized plan and material within their reading level and help them improve their basic health literacy.

Primary prevention can include educating the target population regarding the importance of adequate fluid intake and understanding the clinical signs of dehydration. This can be done in the large community room in Chestnut Hill Nursing Home Center in Passaic. Teaching sessions may be scheduled in mid-morning after breakfast when patients’ energy levels are high, and consider splitting longer sessions on different days to avoid lengthy session that may fatigue the audience (Potter & Perry, 2017). Also, the use of medical terminology must be minimalized and replaced with lay terms (Potter & Perry, 2017). Presentations can be done and educational materials such as brochures that are appropriate to the audience’s language and literacy level can be provided that includes information on recommended fluid intake, the risk of dehydration, and possible solutions (Konings et al., 2015). As a result, elderly patients may develop a new appreciation and understanding of the importance of water and hydration in health and can be incorporated into their lifestyle (Picetti et al., 2017). In addition to the presentation, a set of questions can be asked during sessions and provide a survey to evaluate the effectiveness of teaching.

Culture and family are important in terms of health promotion to prevent dehydration. As mentioned, the population of Hispanic in Passaic City is about 42.3% which corresponds with higher Hispanic culture that includes often use of Spanish language at home (United States Census Bureau, 2017). Thus, Spanish speaking older adults may face difficulties engaging in the plan of care due to language barriers that are present between them and the healthcare provider. Furthermore, diet can be a huge factor that may contribute to dehydration. The Hispanic population has a higher risk for type 2 diabetes due to hereditary, uncontrolled blood glucose, and lifestyle (CDC, 2017). Some of the clinical manifestations of type 2 diabetes that can lead to dehydration include increased urination, and increased thirst (Rebar et al., 2018). The typical diet of a Hispanic culture includes higher consumption of rice and sodium and less consumption of vegetables, which may contribute to the development of type 2 diabetes (Hispanic and Latino Diet, 2019). Family is another important variable that should be considered when caring for older Hispanic adults. Hispanic families tend to use less long-term or home care services because of their cultural values and beliefs about caregiving services and practices (Miyawake, 2016). Familism is one of the core values of a Hispanic culture where family members play the major role as the primary caregiver for elderly members and have a sense of obligation and reciprocity to respect and give back the love and support extended to them when growing up (Miyawake, 2016).

Finances is another variable that has an impact on health promotion for dehydration. In the United States, about 10.8% of the total population is uninsured (CDC, 2017). However, the total Hispanic or Latino origins that are uninsured in the United States are at 21.4%, with Mexican or Mexican American being the largest part of the Latino origin uninsured at 24.1% (CDC, 2017). Also, the median household is only at $34,920 with a poverty percentage of 33.1% in Passaic, New Jersey (CDC, 2017). Thus, many of the Hispanic older population in Passaic City have low socioeconomic status and may have difficulty obtaining healthcare, especially for undocumented older adults.

Support from family and friends can influence one’s health beliefs and practices, which can contribute to the psychosocial variable aspect. Social support, optimism, and strong familial and social ties are common among Hispanic families which can help alleviate stress and potentially be protective among Hispanics despite their higher risk profile (Rodriguez et al., 2014) Thus, families and support systems should be involved during education about the importance of hydration to prevent dehydration as they can help support and motivate individuals to adhere to the plan of care and achieve better health outcomes. Furthermore, elder Hispanic Immigrants tend to have a smaller social network outside of their kin members due to the complex and advancement of technology (Miyawaki, 2016). Thus, nurses can assist them by demonstrating how to use mobile phones to connect with other family and friends to prevent social isolation (Miyawaki, 2016).

References

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