Simmons S F, Alessi C, Schnelle J F
Department of Geriatrics, Borun Center for Gerontological Research, University of California, Los Angeles, School of Medicine, USA.
J Am Geriatr Soc. 2001 Jul;49(7):926-33. doi: 10.1046/j.1532-5415.2001.49183.x.
To evaluate a three-phase, behavioral intervention to improve fluid intake in nursing home (NH) residents.
Controlled clinical intervention trial.
Two community NHs.
Sixty-three incontinent NH residents.
Participants were randomized into intervention and control groups. The intervention consisted of three phases for a total of 32 weeks: (1) 16 weeks of four verbal prompts to drink per day, in between meals; (2) 8 weeks of eight verbal prompts per day, in between meals; and (3) 8 weeks of eight verbal prompts per day, in between meals, plus compliance with participant beverage preferences.
Between-meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant (3 consecutive days) at baseline and at 8 and 32 weeks into the intervention. Serum osmolality, blood urea nitrogen, and creatinine values were obtained for all participants in one of the two sites at the same three time points.
The majority (78%) of participants increased their fluid intake between meals in response to the increase in verbal prompts (phase 1 to 2). A subset of residents (21%), however, only increased their fluid intake in response to beverage preference compliance (phase 3). There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiveness to the intervention.
A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents, whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents.
评估一项三阶段行为干预措施，以提高养老院居民的液体摄入量。
对照临床干预试验。
两家社区养老院。
63名失禁的养老院居民。
参与者被随机分为干预组和对照组。干预包括三个阶段，共32周：（1）16周，每天在两餐之间进行四次口头饮水提示；（2）8周，每天在两餐之间进行八次口头提示；（3）8周，每天在两餐之间进行八次口头提示，并根据参与者的饮料偏好提供饮料。
在干预的所有三个阶段，研究人员以盎司为单位测量两餐之间的液体摄入量。研究人员还估计了每位参与者在基线以及干预的第8周和第32周时，共九餐（连续三天）期间用餐时摄入的液体百分比。在两个地点之一的所有参与者在相同的三个时间点测量血清渗透压、血尿素氮和肌酐值。
大多数（78%）参与者因口头提示增加（从第1阶段到第2阶段）而增加了两餐之间的液体摄入量。然而，一部分居民（21%）仅在根据饮料偏好提供饮料时（第3阶段）增加了液体摄入量。与对照组相比，干预组中实验室检查结果显示有脱水迹象的参与者比例显著降低。认知和营养状况可预测居民对干预的反应性。
一项包括口头提示和根据饮料偏好提供饮料的行为干预措施，有效地增加了大部分失禁养老院居民样本的液体摄入量。仅口头提示对认知障碍较重的居民增加液体摄入量有效，而对于认知障碍较轻的养老院居民，则需要根据偏好提供饮料来增加液体摄入量。
