Comparing clinical, cognitive, and behavioral outcomes among adults in the Elderly Nutrition Program randomized to receive hydration-related information from either an educational lesson or an informative brochure

by Paskvan, Lesley.

Paskvan Lesley L.___________ (Writer) (Last Name) (First) (Initial) Comparing Clinical, Cognitive, and Behavioral Outcomes Among Older Adults in the (Title) Elderly Nutrition Program Randomized to Receive Hydration-Related Information from Either an Educational Lesson or an Informative Brochure . Food Science and Nutrition Dr. Barbara Lohse Knous, PhD, RD, CD 12/01 202 (Graduate Major) (Research Advisor) (Month/Year) No. of Pages The American Psychological Association (APA) Publication Manual. 4th Ed. (Name of Style Manual Used in this Study) One of the fastest growing segments of the population is older adults which has led to an increased focus on the health conditions afflicting this age group. One medical condition that is considered a major health problem in older adults is dehydration. Approximately one million older adults are admitted to acute care hospitals yearly with dehydration as a component in their medical condition (Sanservo, 1997). Several factors can contribute to the development of dehydration in older adults including decreased intake, decreased sense of thirst, age-related functional decline of the kidneys, chronic or acute diseases that lead to increased fluid loss, medication effects and diminished functional status (Sanservo, 1997). The prevalence and seriousness of dehydration points out the need to develop and implement interventions to prevent this condition. iii The purpose of this study was to compare and examine the effectiveness of two methods of education on fluid and hydration issues in a sample of community dwelling older adults who were participants in the Eau Claire County and Dunn County Elderly Nutrition Programs of Wisconsin. The two methods of education were an educational lesson and an informative brochure, both of which were developed and presented by a Registered Dietitian. A two group completely randomized pre/post experimental design was used. The parameters measured were fluid intake using a food frequency questionnaire, knowledge of fluid and hydration issues, physical indicators of hydration status, cognitive status, functional status, and demographic information. During a home visit, the assessment form was completed and the randomly assigned method of education was provided. Within 14-22 days following the initial visit, a follow-up visit was conducted and the post-assessment form was completed. Prior to starting the data collection, all forms and methods of education were pilot tested. Overall, both groups were found to be homogenous as baseline differences were not significant for age, gender, level of education, time on nutrition program, functional status, Mini Mental Status Exam (MMSE) scores, fluid intake, knowledge quiz scores, physical indicators of hydration status, and the time interval between pre/post test. Fluid intake was found to be adequate among subjects of both groups prior to the education as 90 percent were consuming the recommended minimum amount of 48 ounces. No significant change in fluid intake was found post-education. Knowledge quiz scores were at 57% or less for both groups prior to the education. Following the educational intervention, no significant change in quiz scores was found in the educational lesson (EL) group, however a significant increase (p=.03) in quiz scores was found in the iv brochure group (BR). Despite the increase, scores remained at 59% or less for both groups. In the area of physical indicators of hydration status, 25 of 40 subjects presented with one or more signs of dehydration prior to the education. Following the education, an increase in the number of subjects with abnormal tongue dryness was found, however, improvements in all other indicators, except for no change in mucous membranes in the EL group, were observed in both groups. Baseline mean MMSE scores were within the normal range for both groups with no significant change post-education. Results of this study reveal that the brochure was an effective education method to increase knowledge of fluid and hydration issues among older adults, however had a minimal effect on behavior change in the area of fluid intake. Pre/post differences in quiz scores, fluid intake, and physical indicators of hydration status were not significant in the EL group. Professionals looking for an effective method to increase knowledge about fluids in older adults should not dismiss the usage of brochures. v