Annals of Long Term Care

PROGRESS IN GERIATRICS

Hypodermoclysis to Treat Dehydration: A Review of the Evidence

Ruth Remington, PhD, RN, and Todd Hultman, PhD, RN

Dehydration is a serious acute condition in older adults associated with significant morbidity and mortality. Hypodermoclysis (HDC; the infusion of fluids into the subcutaneous tissue) can provide an alternative to intravenous (IV) rehydration of older adults.

This article reviews the relevant literature on the use of HDC to treat mild to moderate dehydration in older adults. A comprehensive search of the literature was conducted to identify research reports on the use of HDC to treat dehydration in older adults. Articles published in English during the previous 10 years were reviewed to reflect current standards of practice. One systematic review; two randomized, controlled trials; and six cohort studies were identified and appraised. Only one study was conducted in the United States; the remainder were conducted in Europe, Asia, and Canada. The evidence indicated that HDC is as effective as IV rehydration of older adults with mild to moderate dehydration. The literature cites advantages of HDC over IV hydration, including the same number of or fewer complications, cost savings, greater patient comfort, and less nursing time to start and maintain the infusion. It remains unclear from the literature why HDC is used infrequently in the United States. J Am Geriatr Soc 2007; 55(12):2051-2055.

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Inconsistency Over Time in the Preferences of Older Persons with Advanced Illness for Life-Sustaining Treatment

Terri R. Fried, MD, John O’Leary, MA, Peter Van Ness, PhD, and Liana Fraenkel, MD, MPH

OBJECTIVES: To determine whether preferences for future attempts at life-sustaining treatment change over time in a consistent and predictable manner.

DESIGN: Observational cohort study

SETTING: Community.

PARTICIPANTS: One hundred eighty-nine community-dwelling persons ages 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.

MEASUREMENTS: Participants were asked, if faced with an illness exacerbation that would be fatal if untreated, whether they would undergo high-burden therapy for a chance to avoid death and risk an impaired health state to avoid death. Interviews occurred at least every 4 months for up to 2 years.

RESULTS: When asked their willingness to undergo high-burden therapy for a chance to avoid death, 35% had an inconsistent preference trajectory (e.g., becoming more and then less willing over time or vice versa). The proportion with inconsistent trajectories increased to 48% and 49% when asked their willingness to risk physical or cognitive disability, respectively, to avoid death. Participants with variable health states over time were more likely to have inconsistent trajectories, although inconsistent trajectories were also common in those with stable health states.

CONCLUSION: A large proportion of older persons with advanced illness have inconsistent trajectories of willingness to undergo burdensome therapy or risk an impaired health state for a chance to avoid death. Variability in their health state over time explained this in part, although the frequency of inconsistent trajectories even in those with stable health states suggests that preferences are influenced by transient factors rather than representing stable core values. J Am Geriatr Soc 2007; 55(7):1007-1014.

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ETHNOGERIATRICS AND SPECIAL POPULATIONS

Ethnic Disparities in Hospice Use Among Asian-American and Pacific Islander Patients Dying with Cancer

Quyen Ngo-Metzger, MD, MPH, Russell S. Phillips, MD, and Ellen P.