The effect and safety of subcutanous fluid therapy versus intravenous fluid therapy in the elderly people in nursing homes: a systematic review

Abstract

This master thesis consists of two parts, an introduction, and a systematic review article. The introduction describes the background of our review question, methods used, and our decisions made along the way in undertaking a systematic review. Background Dehydration in the elderly in nursing homes is a problem that the healthcare- professionals must address daily. It`s already a lot of research on the field, but the systematic review findings are of poor quality. We wanted to investigate the effect of subcutaneous fluid therapy in the elderly compared to intravenous fluid therapy and see if there are any new research that will help enlighten our question. Objectives The objective of this study is to identify, appraise and synthesize studies examining the effect of interventions of fluid therapy in the elderly population in nursing homes. The research question is “What is the effect of subcutaneous fluid therapy versus intravenous fluid therapy on dehydration in elderly people in nursing homes?” Methods A systematic review and meta-analysis were conducted. Systematic search for randomised clinical trials was conducted via the databases of the following platforms: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and Epistemonikos in April 2020. Two reviewer authors (LH and GH) independently performed study selection, data extraction and risk of bias assessment with the Cochrane Collaborations tools and resources. Results A total number of 5595 studies were found after conducting a literature search. After 740 duplicates were removed, we screened title and abstract of 4855 studies. 26 full-text studies were assessed for eligibility. 21 studies were excluded and in the end, we included 3 randomised conrolled trials in this systematic review. The quality of the included studies were low or had some concerns or high risk of bias. The results indicate a small beneficial effect towards subcutaneous fluid therapy. Author’s conclusions The small number of included studies, their heterogeneity and low methodological quality inhibits any firm conclusions on the effects of subcutaneous fluid therapy versus intravenous fluid therapy on dehydration in elderly people in nursing homes. The results indicate a small effect towards subcutaneous fluid therapy compared to intravenous fluid therapy, but the result must be interpreted with caution because of the low certainty of evidence.