hydration scientific library volume 3

Hydration Scientific Library (Volume 3)

Index

• Headache and water intake: evidence from randomized clinical investigations.

• Hydration strategies of runners in the London marathon.

• Physical signs of dehydration in the elderly.

• An exploration of the hydration care of older people: a qualitative study.

Two. randomized. clinical. trials. assessing. the. effect. of.increasing.water.intake.on.headache.have.been.published.to.date,.the.last.one.very.recently1.and.the.previous.one.in.20052..Both.these.studies.were.conducted.by.the.same.research.group.at.Maastrich.University.

Previously.published.research.work.suggested.a.positive.effect.of. increased.water. intake.on.headache,.but.most.of. the. evidence. provided. was. based. on. case. reports..In. 2005,. the. study. carried. out. by. Spigt. et. al. 2. on. 18.migraine.patients.examined.the.effects.of.regular.water.intake. on. migraine.. An. average. reduction. of. 21. hours.of. headache. time. in. 2. weeks. was. observed. at. the. end.of. the. 3. month. follow-up. period.. . Authors. recognized.some. potential. biases. (mainly. due. to. a. small. sample.size). in. their. pilot. study.. . As. a. result,. five. years. later.they.conducted.a.second.randomized.controlled. trial. in.primary.care.with.two.groups.and.a.follow-up.period.of.3. months. to. study. the. said. effects. of. increased. water.intake.on.headache2..Fifty.(50).patients.were.randomized.to. the.control.group.and.52.patients. to. the. intervention.group.. Inclusion.criteria. included.patients.who.had.had.at. least. two. episodes. of. moderately. intense. headache.or. at. least. five. mildly. intense. episodes. per. month. and.a. total. fluid. intake. of. less. than. 2.5. L/day.. Both. groups.received. written. instructions. about. stress. reduction.and. sleep. improvement. strategies.. In. addition,. the.intervention. group. was. instructed. to. increase. the. daily.water.intake.by.1.5.L..The.main.outcome.measures.were.

Migraine-Specific. Quality. of. Life. (MSQOL). and. number.of.days.with.at.least.one.moderate.headache.per.month..Drinking.more.water.resulted.in.a.statistically.significant.improvement.of.4.5. (confidence. interval:.1.3–7.8).points.in.MSQOL.. In.addition,.47%.patients. in. the.water.group.reported. significant. improvement. (6. or. higher. on. a.10-point. scale). in. perceived. intervention. effect. against.25%.in.the.control.group..However,.drinking.more.water.did.not.result.in.relevant.changes.in.the.number.of.days.with.at.least.one.moderate.headache,.as.observed.in.the.pilot.study..

Considering. the. positive. subjective. effects. observed,.it. seems. reasonable. to. recommend. that. headache.patients. increase. their. daily. intake. of. water. and. fluids.for. a. short. period. of. time. to. assess. whether. they.experience. improvement.. This. advice. should. be. aimed.particularly. at. those. patients. with. liquid. intakes. below.recommendations.

heAdAche And wAter IntAke: eVIdence from rAndomIzed clInIcAl InVestIgAtIonsA.review.by.Prof..Dr..Lluís.Serra-Majem

3. EHI Update: March 2012

Refererences:

1:.Spigt.M,.Weerkamp.N,.Troost.J,.van.Schayck.CP,.Knottnerus.JA..A.randomized.trial.on.the.effects.of.regular.water.intake.in.patients.with.recurrent.headaches..Fam.Pract..2011.Nov.23..[Epub.ahead.of.print].

2:. Spigt. MG,. Kuijper. EC,. Schayck. CP,. Troost. J,. Knipschild. PG,.Linssen.VM,.Knottnerus.JA.. Increasing.the.daily.water. intake.for.the.prophylactic. treatment.of.headache:.a.pilot. trial..Eur.J.Neurol..2005.Sep;12(9):715-8.

Previously published research work suggested a positive effect of increased water intake on headache

HYDRATION SCIENTIFIC LIBRARY

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There is very clear evidence that most marathon runners are dehydrated when they finish the distance, but a few of the slower runners drink more than they lose in sweat and actually gain weight during the event. This has attracted a lot of attention in recent years, largely because of a very small number of fatalities that have occurred in participants due to hyponatraemia caused by excessive fluid intake.

This paper aimed to establish what participants in the London marathon know about appropriate drinking behaviours, where this information came from, and what drinking strategy they adopted.

It emerged from the survey that most (93%) of the runners had read or been told about drinking fluids on marathon day and almost all (96%) of the participants had made a fluid intake plan that they intended to follow on race day. In spite of this, however, only about 1 in 5 (22%) knew the volumes of water and sports drink bottles available on the course, so it is hard to see how this plan would be implemented. About 1 in 5 participants (21%) were planning to take a drink at every one of the 24 water stations along the route. Only I in 4 (25%) planned to base

their fluid intake on how thirsty they felt at the time. Two thirds of the runners (68%) said that they were aware of the potential danger of over-drinking and hyponatraemia, but only 1 in 3 (36%) had even a basic understanding of its cause and effects.

The authors concluded from their survey that many of the participants in the London marathon have a poor understanding of the appropriate amounts and types of drinks to consume during the event and that educational interventions are still necessary to prevent over-drinking during marathons.

Given that a very high proportion of participants in this and other big city marathon events are taking part to raise money for charity and have done little preparation, this finding is perhaps not surprising, but it does raise concerns about how educational messages that potentially save lives – even if only a few – can be disseminated.

hydraTIon sTraTegIes oF rUnnersIn The london maraThonA review by Williams J, Tzortziou-Brown V, Malliaras, P, Perry M, Kipps C

3. EHI Update: June 2012

Refererences:Williams, J; Tzortziou Brown, V; Malliaras, P; Perry, M; Kipps, C. Hydration Strategies of Runners in the London Marathon. Clinical Journal of Sport Medicine, 22:152-156, 2012.



2. EHI Update: October 2012



It is widely recognised that dehydration is a common condition in the elderly and that it is a frequent cause of hospitalization among older people, in spite of efforts by caregivers to prevent its development. Successful prevention strategies will require early identification of individuals at increased risk, which in turn means that knowledge of simple but reliable signs of mild dehydration is required. In this study, various physical signs were examined as clinical signs of dehydration in elderly. In this study, 27 consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Based on a definition of dehydration as a calculated serum osmolality of more than 295 mOsm/kg, 9 patients were classified as dehydrated (mean osmolality of 310 mOsmol/kg) and 18 as non-dehydrated (mean osmolality of 279 mOsmol/kg).

All patients were observed for physical signs of dehydration: decreased consciousness level; dry axilla; dry mouth; sunken eyes; decreased skin turgor; delayed capillary refill time. Blood and urine chemistry analyses were also compared between the two groups. For the physical signs, dry axilla had moderate sensitivity (44%) and good

specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). As expected, the mean serum sodium concentration in the dehydrated group (146 mmol/l) was higher (p<0.01) than that in the non-dehydrated group (134 mmol/l). During the hospitalization, 44% of patients in the dehydrated group died, while 17% in the non-dehydrated group died. The authors concluded that physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. They suggested that evaluation of the axillary moisture could help assess dehydration in situations where laboratory analysis was not available. Although the number of subjects in the study was small, these preliminary results help raise the awareness of the need for careful observation of vulnerable elderly individuals.

References:

Shimizu M, Kinoshita K, Hattori K, Ota Y, Kanai T, Kobayashi H, Tokuda Y.Physical signs of dehydration in the elderly. Intern Med (Tokyo) 2012;51(10):1207-10.

PhysIcAl sIgns of dehydrATIon In The elderlyRecently published paper summarized by Professor Ron Maughan, chair of the EHI Science Advisory Board

3. EHI Update: December 2012



Older people may be more vulnerable than younger adults to mild or severe dehydration. This is attributed in general to age-related changes in physiology, psychology, physical and cognitive abilities and living conditions. The specific factors that promote or inhibit appropriate drinking behaviour, particularly in healthcare institutions are not well understood. Consequently, ensuring adequate hydration is a challenging issue for nurses and others involved in providing care.

The aim of this new study was to investigate the complex issues associated with hydration and hydration care of older people by exploring older people’s experiences of drinking fluids and health professionals’ beliefs and behaviours regarding hydration care.

The study was conducted in South West of England at a hospital ward in a major hospital and in a care home providing personal and nursing care. Participants were 21 older people aged 68-96 y, 7 friends or relatives and 21 nurses and health care assistants. A multi-method approach, which refers to multiple information sources (older people, staff, and relatives) and multiple ways of gathering data (focus groups, interviews and observations) was employed. Data were analysed using thematic analysis.

Older people and relatives discussed topics such as the availability, choice and quality of drinks, the desire and preference of drinks, and perceived physical barriers to drinking. Health professionals provided their views on current hydration practice. Six key themes emerged from the data: availability of drinks, pleasure of drinking, understanding the importance of hydration, help and assistance with drinking, barriers to drinking and diminished experience of drinking.

Each key items had 4-6 subcategories, which were discussed and analysed in detail.

Older people revealed that drinking experience was diminished by a variety of factors: lack of thirst sensation, weakness in drinking associated with frailty and subsequent loss of dignity, hedonic limitations such as the taste or the temperature of the drink, and the perception of fluid consumption as being compulsory rather than a pleasurable and social occasion. These observations suggested some factors that can be employed to enhance the drinking experience. Encouraging relatives and friends to support hydration and to drink alongside older people was suggested.

Health professionals successfully applied several strategies to promote drinking including verbal prompting, offering choice, placing drinks in older people’s hands in cups that were of appropriate material, shape and/or weight and assisting with drinking. However, insufficient time provided for hydration or viewing hydration care as one of several, parallel tasks that need to be balanced were some of the identified barriers in hydration care.

The findings of the study revealed the complexity of hydration care and identified issues that go beyond simply ensuring the consumption of adequate fluids. Supporting the individual needs of older people requires attention to their physical or physiological limitations and the consideration of various practical, perceptiual and social issues.References:

Godfrey,H et al.International Journal of Nursing Studies 49 (2012) 1200–1211

an explOraTiOn Of THe HydraTiOn care Of Older peOple: a QualiTaTiVe sTudyProf. Maria Kapsokefalou

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hydration scientific library volume 3

Education