Exploration of the hydration habits, morning balance, and morning blood pressure of institutionalized older adults
OBJECTIVE: This study examined the Person-Environment-Occupation fit of the everyday beverage experience of institutionalized older adults to identify potential hydration habits and routines that act as supports or disruptors of intermediaries of falling like resident fluid consumption, morning blood pressure (BP) and morning standing balance. METHOD: The exploratory study used within-subjects differences, correlation, and regression to examine the daily beverage habits and routines, BP, and balance of a purposive sample of 57 North Central Indiana older adults living in assisted and skilled care settings. Day 1 consisted of meal and non-meal observations. Day 2 consisted of measuring early and midmorning sit to stand BP and standing balance (force plate) before and 30 – 60 minutes after consuming the observed breakfast. MoCA, FES, and PHQ-9 scores, fall history, medical conditions, and medications were identified. RESULTS: Participants consumed 1257 ml of daily beverages mostly during meals with breakfast being the largest meal. Sixty-one percent of consumed fluids were preferred but less than two daily beverage types were preferred indicating that institutionalized older adults experience an occupational deprivation for drinking preferred varieties of daily beverages. High beverage intake was associated with drinking preferred beverages during all three non-meal periods. Participants had a mean rise in BP when fasting during morning standing reflective of mild hypertension (M = 145.98 mm Hg ± 24.47 SD) and possible dehydration. Orthostatic hypotension (OH) occurred in the early morning for 21% participants using modified cutoff scores and 10% per traditional scoring and in 19% participants after breakfast regardless of OH cutoff score. The participants had relatively stable morning balance that was consistent with aging. There was a non-significant trend for high beverage consumption at breakfast to attenuate a postprandial drop in BP upon standing after breakfast. CONCLUSION: Occupational therapy has the expertise to address the PEO fit of beverage habits and routines of institutionalized older adults and meaningful beverage occupations which are crucial components of daily resident care for promoting fluid intake and hydration, managing BP, optimizing balance and subsequently for possibly preventing falling.