Prevention of dehydration of independently living elderly people at risk by education and technological support

Dehydration of elderly people is a very important public health issue. It increases the risk of diseases and fatality and is an important cause of hospitalisation.
This study compares two interventions to prevent dehydration of elderly people at risk: an educational intervention and an educational intervention in combination with a drink reminder device. The educational intervention is given by practice nurses of the general practice de Keen in Etten-Leur. The Dutch Regional Public Health Service West-Brabant develops and provides information materials, coordinates the interventions and together with Tilburg University and will conduct the study on effects of the interventions.

People of 80 years and older and people of 65 years and older who have a heart disease receive a letter from the general practice in which they are asked if they want to participate in the study and if so to return the form. People who want to participate and whose daily fluid intake is insufficient are randomised to receive either the educational intervention or the educational intervention in combination with a drink reminder device (called the Obli).
The participants are asked to fill in a questionnaire before the intervention, 6 weeks after the start of the intervention and at 6 months follow-up. The two groups will be compared with regard to fluid intake, knowledge, awareness (of the risks of dehydration) and quality of life by means of multivariate analysis. MANOVA repeated measures will be used to compare the changes in mean total scores on fluid intake within and between the two groups.
Countries of recruitment: the Netherlands,

There are no effective interventions to prevent dehydration of elderly people available. Therefeore the RPHS West-Brabant, together with the Gneral Practice de Keen, decided to develop and analyse the efffect of an education strategy. Besides that we decide to access the effectiveness of a recently developeed drink reminder device.

All participating elderly people are asked to answer questions on a questionnaire. We measure the fluid intake, the knowledge and awareness (of risks of dehydration) and the quality of life at the following moments:
- at baseline, during a home visit or consultation with the pratice nurse, before the intervention starts
- 6 weeks after the start of the interventions during a home visit by the health promoter of the Regional Public health Service West-Brabant
- and at 6 months follow-up during a home visit by the health promoter

Since, to our best knowledge, no validated questionnaires to measure the fluid intake, knowledge and awareness of the risks of dehydration are available, we designed one for measuring these parameters in our study.

Intervention 1. Education
The elderly people in this group recieve information from a practice nurse during a home visit or consultation. Information is given on the recommended daily fluid intake and the risks of insufficient fluid intake. The elderly also recieve materials on the subject and are shown how to incorporate sufficient fluid intake into their daily routines.
Interventie 2. Education in combination with a drink reminder device.
The elderly in this group receive the same information as mentioned in intervention 1 as well as a demonstration of the drink reminder device which they are asked to use during 6 weeks. A caregiver or familymember can be present at the demonstration. The drinkreminder device (called Obli) measures the fluid intake and gives a visual (red) and auditive signal if the daily fluid intake is insufficient, so the elderly can adjust their drink behavior. The intensity of the signal can be adjusted to the preference of the elderly. The device registrates the quantity of fluid taken from the decanter placed on the device-base. If the elderly drinks coffee/tea (not from the decanter or not at home) a button on the device can be pushed so this quantity of fluid intake is also measured.
The device registrates the fluid intake and sends the data to a remote computer from which the practice nurse can monitor the fluid intake. If the amount of fluid intake is reason for concern the pratice nurse contacts the elderly to offer some advice if needed. With the consent of the eldery also caregivers or careworkers who frequently visit the elderly will be informed about the project.