Dehydration is common and costly: Dehydration is characterized by a decline in total body
water. Dehydration is considered to be hypotonic when accompanying salt loss occurs and
hypertonic if caused solely by water loss. Hypertonic dehydration is associated with
mortality and severe short- term and long-term neurological sequelae. Annual costs of
hospitalization primarily due to dehydration have been estimated at $1.36 billion.
Approximately 17% of older adults hospitalized for dehydration die within 30 days, as
often multiple organ systems are detrimentally affected by dehydration. Dehydration is
not only widespread among older adults, but also an independent predictor of mortality. A
number of studies have reported mortality rates associated with hypernatremia (a high
sodium level that often accompanies dehydration) at greater than 40% and are commonly
related to the underlying disease processes.
The cost of dehydration is twofold - one is the direct cost of dehydration on the patient
and US healthcare; and second is its indirect effects as a comorbidity of another
disease. For example, delirium is commonly caused by dehydration among older adults. In
individuals with underlying dementia mild dehydration causes further cognitive impairment
and possibly hallucinations, delusions, anxiety, and agitated behavior. Dehydration can
also trigger other medical complications, such as infections, constipation, kidney stone
formation, worsening aortic stenosis, valvular disease, adverse drug reactions, urinary
tract infection, pneumonia, pressure ulcers, metabolic imbalance, uncontrolled diabetes,
gastroenteritis, and some forms of cancer. According to an AHRQ study of the Nationwide
Inpatient Sample (NIS) representing all patients in acute care hospitals, dehydration was
diagnosed more commonly as a comorbidity than as a principal diagnosis. Dehydration was
the second most common comorbidity, occurring in 14% of all hospitalizations. Thus,
dehydration may contribute to the increase of medical costs in an indirect way. It may be
a marker of the severity of the underlying disease, or it may add its own complications
to those of the underlying disorder. Using direct costs alone, the potential annual U.S.
savings from avoidable hospitalizations in these patients could have been as much as
$1.14 billion. Dehydration is difficult to detect in real-time with traditional
technologies: Primary reasons for the high prevalence of chronic dehydration among older
adults are: (1) Older persons have metabolic and olfactory changes (2) medication
regimens and disease consequences that can alter to their own fluid intake or the body's
ability to maintain fluid levels (3) In older patients, access and maintenance of proper
hydration is more difficult; for example, behavioral changes can include not wanting to
drink to avoid incontinence in public and (4) traditional technologies do not present a
simple, straightforward approach to measuring dehydration. Traditional measurement
techniques are either obsolete, time consuming, inaccurate or not feasible. In our market
survey, the investigators found that in current care settings care personnel check
dehydration primarily through the use of visual signals or inferentially via blood-based
indicators (e.g. sodium levels, creatinine). Skin elasticity checks, by pinching on hand
or on the forehead, or checking the tongue (dry mouth), are still common. Not only are
these methods are obsolete and inaccurate, care personnel are often skeptical of the
results. Far too often, care personnel do not detect a dehydration in an older person
until they are seriously ill and in need of emergency medical care.
Current Laboratory methods to detect dehydration: There are a few existing methods that
can detect dehydration i.e. measure Total Body Water (TBW), intracellular water (ICW),
and extracellular water (ECW). The tests involving urine, blood, or isotopic dilution are
generally invasive, impractical or have not been adopted in either acute care or home
settings. Furthermore, these tests can be difficult or impossible to repeat at regular
intervals, precluding the opportunity to be used proactively and prevent dehydration.
Total body composition machines on the market, which are based on bioimpedance
measurement techniques have shown to be accurate and to deliver acceptable results in
real time. However, a critical limitation of these devices is their size and thus ease of
use in everyday setting. Other important barriers to using these devices for routine
detection of dehydration include the electrode placement requirement (wrist to ankle or
both hands and feet), equipment cost (>$10,000 per device) and no way of measuring the
changes in the body fluids over time. To date, these devices are used almost exclusively
in research or subspecialty care settings. Thus, even though these methods show promise
of detecting dehydration in general, a simpler efficacious solution for measuring
dehydration among community living older adults is highly desirable.
The D.R.INK device can detect falling hydration levels and alert individuals and care
personnel to respond appropriately. Our proposed project will provide evidence for how
our solution is transformative for inpatient, institutional care and community care
settings alike by 1) making it user friendly to the population 2) ensuring its accuracy
based on previously identified clinical and laboratory parameters 3) testing accuracy and
effectiveness in a randomized observational setting and 4) determining how DRINK changes
behavior and improve clinical outcomes. Thus the investigators expect that our real-time
and accurate hydration monitoring device, has the potential to greatly reduce costly
acute care among older adults. The band is expected to not only improve the overall
quality of life older adults but also reduce the morbidity and mortality, by enabling the
proactive detection of an avoidable condition: dehydration.
A key advantage of the DRINK technology over other methods is that the device can detect
changes in fluid levels by collecting longitudinal data within person at regular
intervals outside of the clinical settings. In addition to the immediate benefits in our
proposed work the investigators expect a wide range of future applications and the
ability to uncover tremendous health insights.
This project aims to:
Examine the effectiveness of continuous home monitoring of fluid levels. Hypothesis
1: A wearable hydration device improves recovery after acute care for dehydration
Hypothesis 2: A wearable hydration device reduces acute negative health events among
a vulnerable population of older adults at risk for dehydration.
Combine clinical expertise and results from outcomes measurement to define
measurement indicators, propose clinically actionable thresholds, safety guidelines
and improved visualizations for patients and care teams.