Date Presented 04/05/19
Institutionalized older adults (IOA) have an elevated risk for dehydration, falling, and poor blood pressure (BP) regulation due to aging, comorbidities, medications, and a person’s beverage habits. Poor fluid habits can negatively affect health, participation, and performance. This study examines the PEO fit of beverage habits of IOA to identify influencers (plus or minus) of morning balance and BP and subsequently possible falls. The research findings provide evidence for use in a hydration program.
Primary Author and Speaker: Carol Rice
Contributing Authors: Noralyn Pickens
PURPOSE: This descriptive study examined the Person-Environment-Occupation (PEO) fit of the everyday beverage experience of institutionalized older adults to identify potential hydration habits that act as supports or disruptors of intermediaries of falling such as balance and blood pressure. Dehydration is potentially reversible but has adverse consequences for balance and blood pressure and can be irreversible leading to death. Institutionalized older adults experience 1.5 falls per year and are likely to be dehydrated and have cognitive impairment which may lead to failing to initiate drinking fluids. Occupational therapists are experts in assessing PEO factors of daily habits to promote health and well-being across the lifespan which includes the body’s fluid balance, standing balance performance skills, and body functions such as blood pressure (BP) regulation. The primary research questions included,
What are the characteristics and differences of the early and midmorning standing balance for institutionalized residents aged 65 years and older?
What are the characteristics and differences of the early and midmorning seated and standing blood pressure for institutionalized residents aged 65 years and older?
DESIGN: The exploratory observational study examined the daily beverage habits of a purposive sample of 57 Midwestern adults aged 65 years or older who consumed food and fluid orally, could step independently onto a force plate, and who resided in three long-term care facilities owned and managed by the same company.
METHOD: Standing balance was measured by a Bertec force plate and blood pressure (BP) by a wrist BP cuff with an indicator for correct positioning. Data were analyzed through descriptive analyses, Spearman Rank correlation, and regression to identify the characteristics, including relationships, of beverage habits with morning balance and blood pressure and Wilcoxon analyses to assess differences between early and midmorning values.
RESULTS: Participant early morning balance was characterized by poor (fast) mediolateral balance when stepping up onto the force plate which improved (slowed) after consuming breakfast fluids but did so non-significantly. Participant blood pressure was characterized as normal when seated and rose with standing (pre- and post-breakfast) resulting in mild hypertension when participants were fasting (M = 145.98 mm Hg ± 24.47 SD) reflective of possible early morning dehydration. There were significant differences between seated and standing BP in the early morning and in the midmorning, but the postural BP change was not significant for early versus midmorning. Drinking preferred fluids was associated with the next morning rise in BP. Socialization during breakfast was associated with BP drop whereas drinking a variety of beverages or high quantities of fluids during breakfast was associated with BP rise. The amount of fluids consumed at breakfast predicted 43% of the variance in diastolic BP during position change and acted protectively to raise blood pressure thereby avoiding orthostatic hypotension.
CONCLUSION: Key beverage habit factors (e.g., beverage amount, timing, variety, and preference) affect a good PEO fit and act as supports or disruptors of morning balance and blood pressure regulation for institutionalized older adults. These factors can inform a hydration program. Occupational therapists are experts at addressing the PEO fit of beverage habits for institutionalized older adults and incorporating meaningful beverage occupations as crucial components of daily care for promoting fluid intake and balanced hydration status, optimal standing balance, and blood pressure regulation which subsequently may prevent falling.
References
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