Embracing technology; trialling the consumer acceptability, cost-effectiveness and usability of a novel dehydration testing device in residential aged care

Background and Aims

1. To explore and identify the feasibility of the standard hydration assessment approach and the MX3 hydration assessment system, from economic and procedural perspectives. 
2. To explore and identify the acceptability of the standard assessment approach and the MX3 hydration assessment system from the perspective of residents, their family members, and residential aged care staff and management. 
3. To establish the preferred method of assessing hydration status by comparing and contrasting the use of the MX3 and the standard protocol. 
4. To highlight the urgent need to address the gap in current care procedures and evidence recommendations on assessment of hydration status in older adults in aged care.

What we did

We investigated the potential of a new technology for monitoring dehydration in older adults living in residential aged care. Over an 11-week period, we used the MX3 device, which measures Salivary Osmolality (SOSM), three times a week with 47 residents. We aimed to assess the feasibility and effectiveness of using the MX3 device by comparing it with traditional hydration methods. To do this, we collected clinical hydration data from two sites: one that used the MX3 device along with a hydration protocol, and another that followed standard hydration practices. We informed medical practitioners operating at the intervention site of the study, including a statement on current guidelines recommending gold standard hydration testing (serum osmolality) and monitored frequency of this test request.

Outcomes

1. Data from the trial period embedding the MX3 into the nutrition protocol show that it was acceptable to residents (VAS affect data always positive), with survey and qualitative interview data reflecting this.
2. Across the 11 weeks of the intervention, there were more than 398 occasions detected where a resident was either mildly, moderately or severely dehydrated, and over 102 occasions where a resident was moderately or severely dehydrated detected. The overall cost of the new hydration management system was $117.68 per occasion of moderate or severe dehydration detected. While we are unable to make a definitive statement on the cost-effectiveness of the new hydration management system from this study, it is worth noting that the intervention was relatively low-cost per participant when compared to other similar interventions implemented in aged care or community settings (e.g. ranged from $99 to $740.76 (per person). 
3. Hydration levels at the site that used the MX3 device appeared to improve from week 5 of the 11-week trial period, with the exception of week 9 (which may be due to high temperatures the day prior to the first assessment that week). 
4. When considering clinical resources used, at the aged care site (hydration procedure implemented), there are notably more pulse and blood pressure checks compared to the other aged care site (hydration procedure and MX3 device implemented). Conversely, the aged care site which implemented the hydration procedure with the MX3 device had significantly fewer requests for bowel chart reviews and signs of shock, as well as fewer recorded falls and UTIs.  
5. Assessed through the Cognitive Impairment Scale (PAS), cognition was not associated with hydration levels or acceptability of the use of the MX3. 
6. Staff and residents suggested that; the frequency of testing could be reduced to once a week for the broader population, more frequent testing for those residents considered to be at higher risk of dehydration. Economic assessment suggests that this approach may be more cost effective.  
7. Family members mentioned that testing would be helpful, but would be dependent on the resident's 'mood' at the time. 
8. There were multiple occasions in the interviews (from staff and residents) where concepts relating to deinstitutionalisation of the residential aged care environment and care itself were raised. This included information about it being the residents’ home and the personal choice, independence, and dignity aspects associated with the testing process.

Impact on aged care and workforce

• The MX3 device was well-received by residents, as indicated by consistently positive VAS affect data and supportive feedback from surveys and interviews. This suggests that integrating such technology into residential aged care might enhance effectiveness of monitoring and managing hydration levels. 
• Over the course of the 11-week trial, the MX3 device detected 398 instances of dehydration at varying levels of severity, including 102 cases classified as moderate or severe. The relatively low cost per detection of these more severe cases suggests that the MX3 device may offer a cost-effective solution. This cost efficiency, coupled with the observed improvement in hydration levels from week 5 onward (with a brief decline in week 9 due to external factors), supports the use of the MX3 device in conjunction within an organisational Hydration procedure for managing hydration in aged care settings. 
• In this study, the integration of the MX3 device resulted in a reduction in specific clinical interventions. The site utilising the MX3 device saw fewer requests for bowel chart reviews, signs of shock, falls, and UTIs compared to the site without the device. However, there was an increase in pulse and blood pressure checks at the MX3 site. This suggests that while the MX3 may prompt more frequent monitoring in some areas, it could reduce the need for other interventions, potentially streamlining care and allowing resources to be focused on more critical needs. 
• The study found no association between residents’ cognitive impairment and their hydration levels or the acceptability of the MX3 device. This means that the effectiveness and acceptability of the MX3 device are consistent across residents with varying levels of cognitive function, making it a versatile tool in diverse aged care populations.

Resources developed

Throughout the project, resources were developed to aid the process of the project. These aren’t publicly available, but could be recourses/tools used in future similar project. 

• Nutrition & Hydration Procedure (CARE 081P) adapted for use of MX3  
• Work Instruction Using the MX3 LAB device (used in the MX3 training sessions) 
• MX3 Training Guide (used in the MX3 training sessions) 

Next steps

The limited number of validated screening and assessment tools for measuring hydration levels in older adults, particularly in residential aged care, underscores the challenge of researching this area, as identified by the Helping Hand project stakeholders. This challenge remains the primary reason for the project's importance. Conducting research in an operational environment presents difficulties that deter many researchers, contributing to the lengthy translation of research from clinically suitable (or modified) environments to practical implementation, which can take years, if not decades, to effect change in practice and improve care.

This research topic and environment is challenging, but with the support of ARIIA, research partners, organisational engagement and support, this project has further explored the acceptability of the MX3 device within residential aged care. The Helping Hand members of the stakeholder group are very excited about the results and look forward to presenting the data and results to executive members of Helping Hand to determine future directions and potential of replicating this project. 

Following these discussions, the next step will be to share the results with residents, families, helping hand staff, and the broader community. Presentations and peer-reviewed publications will be key to gaining traction within the medical and aged care communities. The Helping Hand project stakeholders and research partners are currently preparing an open access publication to facilitate this dissemination.