Study On The Dehydration And Its Influencing Factors Of Elderly Inpatients With Stroke

Objective:The dehydration status of elderly inpatients admission with stroke were described.This paper explored the influencing factors that affect their dehydration status,and determined the risk factors of dehydration.It aims to provide support for nursing intervention,reduce the incidence of dehydration as well as its complications,and improve the elderly health condition and caring quality.Methods:In this study,a total of 257 elderly inpatients with stroke at admission to hospital from March 2017 to October 2017 in Bengbu Third Municipal Hospital were investigated by biochemical indexes and scales.Serum osmolality and BUN/Cr were used to detect the dehydration.In addition,urine color chart was added to determine dehydration of the voluntary principle.This study adopted a demographic questionnaire,the Barthel Activity of Daily Living index(ADL),the Mini Mental State Examination(MMSE),the Geriatric Depression Scale(GDS),Mini-nutritional Assessment(MNA)and 24-hour fluid intake records to explore dehydration influencing factors.The occurrence of dehydration and its factors were analyzed.The influencing factors were analyzed by single factor.Then,a logistic regression analysis was used to test each of the independent variables(P < 0.05)in univariate analysis.Results:(1)This study collected 257 cases of biochemical laboratory sheet.According to the Japanese related study in Asia,dehydration was defined by serum osmolality ?295mmol/L.In 257 participants,44.7%(115)were dehydrated.A BUN/Cr ratio of >15 was used as the cut-off for dehydration,the dehydration rate was 69.3%.When the threshold was 20,the rate of dehydration was 37.4%.The urine color chart wasintroduced from the United States,101 urine samples were collected at admission,and approximately 43.6% of the participants were dehydrated based on urine color score ?5.(2)There were positive correlations between BUN/Cr and urine color scores with serum osmolality(P < 0.01).(3)A total of 257 questionnaires were distributed and returned in this study,the effective recovery rate was 100%.Of the 257 patients,138 patients had daily activity disorder,and 54.3% of them were dehydrated at admission.37.7%(97)had cognitive dysfunction,and the dehydration rate was 56.7%.46.7%(120)suffered from depression,and 54.2% of them were dehydrated.The incidence of malnutrition and malnutrition rate was 39.3% and 17.5% respectively,and there was no statistically significant difference in the effect of different nutritional status on hydration status(P > 0.05).The average fluid intake of 257 subjects was 1042.80 ± 350.99 ml,and only 34(13.2%)patients met the minimum standard of 1500mL/day.There were negative correlations between the average fluid intake with serum osmolality(P <0.01).(4)Univariate analysis showed that there were significant differences in sex,diabetes mellitus,Ace-inhibitors,? blockers,daily activities,dysphagia and depression status(P<0.05)in dehydrated and non-dehydrated patients.There were significant differences in age,activities of daily living,cognitive status and average total fluid intake(P<0.01).(5)Multifactor analysis showed that the incidence of dehydration increased significantly with the increasing of age,the increasing of the activity type and decreasing of activities of daily living(P<0.01).The incidence of dehydration decreased with the normal cognitive function,average fluid intake increased(P<0.05).Female gender and ? blocker are risk factors for dehydration in stroke patients.Conclusion:(1)According to the‘Gold Standard' measure of dehydration was based onserum osmolality ? 295mmol/L.Incidence of dehydration in elderly inpatients with stroke admission was higher compared with other similar studies abroad.(2)The accuracy was higher,when BUN/Cr ratio > 20 was used as the cut-off for dehydration.But it is necessary to combine with serum osmolality to improve the accuracy.Urine color chart could be used as a tool for assessing dehydration status elderly in our country.It's recommend to be introduce it and convenient for aged people to prevent dehydration.(3)The age,sex,daily activities or exercise types,? blockers,activities of daily living,cognitive function,fluid intake are the main influencing factors for dehydration in elderly stroke inpatients.Clinical nursing should be focused on these factors and intervene them aiming to prevent dehydration and promote health in elderly patients with stroke.