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Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study.

ABSTRACT: PURPOSE:Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population. METHODS:Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (??75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three. RESULTS:After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents. CONCLUSION:This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account.

SUBMITTER: Paulis SJC

PROVIDER: S-EPMC7280358 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study.

Paulis Simone J C SJC Everink Irma H J IHJ Halfens Ruud J G RJG Lohrmann Christa C Wirnsberger Regina Roller RR Gordon Adam L AL Schols Jos M G A JMGA

European geriatric medicine 20200313 3

<h4>Purpose</h4>Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population.<h4>Methods</h4>Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing ...[more]

PMID: 32297264

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Project description:ObjectiveCommunity paramedicine programme are often designed to address repeated and non-urgent use of paramedic services by providing patients with alternatives to the traditional 'treat and transport' ambulance model of care. We sought to investigate the level of consensus that could be found by a panel of experts regarding appropriate health, social and environmental domains that should be assessed in community paramedicine home visit programme.DesignWe applied the RAND/UCLA Appropriateness Method in a modified Delphi method to investigate the level of consensus on assessment domains for use in community paramedicine home visit programme.Setting and participantsWe included a multi-national panel of 17 experts on community paramedicine and in-home assessment from multiple settings (paramedicine, primary care, mental health, home and community care, geriatric care).MeasuresA list of potential assessment categories was established after a targeted literature review and confirmed by panel members. Over multiple rounds, panel members scored the appropriateness of 48 assessment domains on a Likert scale from 0 (not appropriate) to 5 (very appropriate). Scores were then reviewed at an in-person meeting and a finalised list of assessment domains was generated.ResultsAfter the preliminary round of scoring, all 48 assessment domains had scores that demonstrated consensus. Nine assessment domains (18.8%) demonstrated a wider range of rated appropriateness. No domains were found to be not appropriate. Achieving consensus about the appropriateness of assessment domains on the first round of scoring negated the need for subsequent rounds of scoring. The in-person meeting resulted in re-grouping assessment domains and adding an additional domain about urinary continence.ConclusionAn international panel of experts with knowledge about in-home assessment by community paramedics demonstrated a high level of agreement on appropriate patient assessment domains for community paramedicine home visit programme. Community paramedicine home visit programme are likely to have similar patient populations. A standardised assessment instrument may be viable in multiple settings.

Dataset Information

Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study.

Publications

Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study.

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