An intervention to increase fluid intake in nursing home residents: Prompting and preference compliance

OBJECTIVE: To evaluate a three-phase, behavioral intervention to improve fl uid intake in nursing home (NH) residents. DESIGN: Controlled clinical intervention trial. SETTING: Two community NHs. PARTICIPANTS: Sixty-three incontinent NH residents INTERVENTION: Participants were randomized into intervention and control gr oups. 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 par ticipant beverage preferences. MEASUREMENTS: Between-meal fluid intake was measured in ounces by research staff during all three phases of the intervention. Percentage of fluids con sumed 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 wee ks into the intervention. Serum osmolality, blood urea nitrogen, and creati nine values were obtained for all participants in one of the two sites at t he same three time points. RESULTS: The majority (78%) of participants increased their fluid intake be tween 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 r esponse to beverage preference compliance (phase 3). There was a significan t reduction in the proportion of intervention participants who had laborato ry values indicative of dehydration compared with the control participants. Cognitive and nutritional status were predictive of residents' responsiven ess to the intervention. CONCLUSIONS: A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake amo ng most of a sample of incontinent NH residents. Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired resid ents, whereas preference compliance was needed to increase fluid intake amo ng less cognitively impaired NH residents.