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Original Article

Effects of Tailored Water Drinking on the Orthostatic Hypotension in the Elderly

Eunjoo Lee1, Eun Hee Kim2
Korean Journal of Adult Nursing 2014;26(3):341-351.
Published online: June 30, 2014

1College of Nursing ․ Research Institute of Nursing Science, Kyungpook National University, Daegu

2Department of Nursing, Suseong College, Daegu, Korea

Corresponding author: Kim, Eun Hee Department of Nursing, Suseong College, 15 Dalgubeol-daero 528-gil, Suseong-gu, Daegu 706-711, Korea. Tel: +82-53-749-7247, Fax: +82-53-749-7240, E-mail: kkkeh35@hanmail.net
This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (2013S1A5A2A03044389).
• Received: August 8, 2013   • Accepted: June 4, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of the study was to examine preventive effects of tailored water drinking on orthostatic hypotension and heart rate variability in the elderly.
  • Methods
    A non-equivalent control group pre and post time-series design was adapted. Among a total of 64 elderly people admitted to two nursing homes, 35 elderly were assigned to the experimental group and 29 were assigned to the control group. As for the elderly people in the experimental group, tailed water drink was provided according to the scheduled time for six weeks. Blood pressure and heart rate were measured twice before the intervention in both groups. The data were analyzed with SPSS program using t-test, x2-test, and repeated measure of ANOVA.
  • Results
    There were significant differences in blood pressure and heart rate variability between the two groups.
  • Conclusion
    Tailored water drinking had preventive effects on decreasing blood pressure fall as well as prevalence of orthostatic hypotension in the elderly people.
  • Key Words: Elderly; Orthostatic hypotension; Heart rate; Water
Table 1.
Homogeneity Test for General Characteristics between Two Groups (N=63)
Characteristics Categories   Exp. (n=29) Cont. (n=34) x2 or t p
n (%) or M±SD n (%) or M±SD
Age (year)⁎ 65~74   4 (13.8) 11 (32.4) 3.40 .183
75~84   14 (48.3) 15 (44.1)
≥85   11 (37.9) 8 (23.5)
  82.2±7.85 78.4±7.47 2.01 .049
Gender Female   28 (96.6) 16 (47.1) 18.20 ＜.001
Male   1 (3.4) 18 (52.9)
Education level⁎ Illiteracy   20 (69.0) 10 (29.4) 11.12 .004
Elementary   8 (27.6) 16 (47.1)
≥Middle school   1 (3.5) 8 (23.5)
Religion Yes   18 (62.1) 15 (44.1) 2.02 .155
No   11 (37.9) 19 (55.9)
No. of co-morbidity in past (numbers) ＜4   16 (55.2) 22 (64.7) 0.59 .441
≥4   13 (44.8) 12 (35.3)  
    3.28±1.00 2.82±1.03 1.77 .083
No. of co-morbidity in current (numbers) ＜4   27 (93.1) 33 (97.1) 0.54 .463
≥4   2 (6.9) 1 (2.9))  
    2.10±1.11 1.82±0.87 1.12 .267
Length of stay (year) ＜2   9 (31.0) 17 (50.0) 4.77 .092
2~4   9 (31.0) 12 (35.3)
≥4   11 (37.9) 5 (14.7)  
    3.50±1.94 2.17±1.23 3.16 .003
Water intake (mL/24 hr) AWI   911.0±201.3 901.6±201.3 0.20 .845
Expected water intake (mL/24 hr) AWI   1,865 1,900    
BP/HR (mmHg/BPM) Degree of drop SBP -11.9±7.00 -12.2±7.67 0.14 .887
  DBP -5.1±5.99 -8.5±5.95 1.78 .080
  HR -3.2±3.68 -2.9±4.71 -0.25 .806
Body weight (kg)   ＜39 8 (27.6) 3 (8.8) 4.20 .122
  40~49 14 (48.3) 18 (52.9)
  ≥50 7 (24.1) 13 (38.2)

Exp.=experimental group; Cont.=control group; AWI=average amount of water iitake per day; BP=blood pressure; SBP=systolic blood pressure; DBP=diastolic blood pressure; HR=heart rate; BPM=beat per minute; Fisher's exact test (p).

Table 2.
Average Fluid Intake and Urine Output by Weeks between Two Groups (N=63)
Variables Groups 1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
M±SD M±SD M±SD M±SD M±SD M±SD
Fluid intake Exp. (n=29) 1,884±306.1 1,917±270.5 1,859±233.6 1,901±245.2 1,913±267.3 1,887±272.5
  Cont. (n=34) 665±131.5 713±129.5 715±129.5 594±131.7 594±131.0 506±131.9
Urine output Exp. (n=29) 1,887±320.2 1,920±271.9 1,916±332.1 1,896±241.2 1,972±486.2 1,881±258.4
  Cont. (n=34) 768±133.1 773±170.7 763±129.7 453±130.6 584±133.9 360±132.1

Exp.=experimental group; Cont.=control group.

Table 3.
Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)
Variables Groups Intervention Source p
1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
M±SD M±SD M±SD M±SD M±SD M±SD
OH SBP Exp. (n=29) -12.8±7.00 -11.0±8.23 -6.2±9.79 -9.7±6.18 -9.0±5.30 -5.5±7.39 Group ＜.001
(mmHg) Cont. (n=34) -11.1±7.67 -13.2±8.24 -10.9±7.93 -17.4±11.63 -15.0±10.80 -18.8±8.44 Time .014
  t (p) -0.71 (.478) -0.98 (.331) -2.10 (.040) -3.38 (.001) -2.77 (.008) -6.61 (＜.001) G*T ＜.001
OH DBP Exp. (n=29) -7.9±5.99 -6.2±5.59 -7.2±6.32 -4.5±6.88 -4.8±3.71 -5.5±6.32 Group .001
(mmHg) Cont. (n=34) -7.4±5.95 -10.6±8.34 -11.8±9.96 -9.1±8.53 -10.0±8.46 -12.1±8.80 Time .290
  t (p) 0.32 (.748) -1.99 (.050) -2.19 (.032) -2.16 (.035) -2.62 (.011) -3.34 (.001) G*T .117
OHR Exp. (n=29) -3.9±3.68 0.8±6.02 0.3±3.23 0.8±3.30 1.7±6.85 1.7±3.06 Group ＜.001
(BPM) Cont. (n=34) -2.0±4.71 1.1±7.79 5.3±3.90 8.2±5.37 5.9±11.80 11.3±9.74 Time ＜.001
  t (p) 1.46 (.150) 1.28 (.206) 4.02 (＜.001) 6.73 (＜.001) 1.69 (.055) 5.09 (＜.001) G*T .003

Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.

Table 4.
Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)
Variables Reduce of vital sign Intervention
1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont.
n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
OH SBP (mmHg) ≤-20 12 (41.4) 13 (38.2) 13 (44.8) 14 (41.2) 9 (31.0) 20 (58.8) 2 (6.9) 19 (55.9) 2 (6.9) 18 (52.9) 1 (3.4) 26 (76.5)
-10~-19 11 (37.9) 13 (38.2) 9 (31.0) 16 (47.1) 13 (44.8) 10 (29.4) 24 (82.8) 10 (29.4) 21 (72.4) 10 (29.4) 17 (58.6) 5 (14.7)
0~-9 6 (20.7) 5 (14.7) 5 (17.2) 4 (11.8) 6 (20.7) 4 (11.8) 3 (10.3) 5 (14.7) 6 (20.7) 5 (14.7) 8 (27.6) 3 (8.8)
≥1 0 (0.0) 3 (8.8) 2 (6.9) 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.9) 3 (10.3) 0 (0.0)
Fisher's exact test (p) 2.60 (.494) 3.38 (.315) 5.51 (.103) 26.21 (＜.001) 18.34 (＜.001) 6.23 (.030)
OH DBP (mmHg) ≤-10 21 (72.4) 20 (58.8) 14 (48.3) 23 (67.6) 15 (51.7) 26 (76.5) 11 (37.9) 22 (64.7) 13 (44.8) 25 (73.5) 14 (48.3) 29 (85.3)
0~-9 8 (27.6) 11 (32.4) 12 (41.4) 11 (32.4) 12 (41.4) 8 (23.5) 18 (62.1) 10 (29.4) 15 (51.7) 8 (23.5) 15 (51.7) 5 (14.7)
≥1 0 (0.0) 3 (8.8) 3 (10.3) 0 (0.0) 2 (6.9) 0 (0.0) 0 (0.0) 2 (5.9) 1 (3.4) 1 (3.4) 0 (0.0) 0 (0.0)
Fisher's exact test (p) 2.74 (.280) 4.45 (.080) 0.14 (.467) 7.13 (.016) 5.71 (.041) 9.90 (.002)
OHR (BPM) ≤-20 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 0 (0.0)
-10~-19 1 (3.4) 4 (11.8) 2 (6.9) 2 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (8.8) 0 (0.0) 1 (2.9)
-9~9 28 (96.6) 29 (85.3) 27 (93.1) 27 (79.4) 29 (100.0) 24 (70.6) 28 (96.6) 20 (58.8) 27 (93.1) 18 (52.9) 29 (100.0) 15 (44.1)
10~19 0 (0.0) 1 (2.9) 0 (0.0) 4 (11.8) 0 (0.0) 10 (29.4) 1 (3.4) 14 (41.2) 1 (3.4) 9 (26.5) 0 (0.0) 11 (32.4)
≥20 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (11.8) 0 (0.0) 7 (20.6)
Fisher's exact test (p) 2.44 (.296) 4.63 (.201) 10.14 (.001) 12.28 (＜.001) 15.90 (.003) 23.20 (＜.001)

Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension; SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.

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    • The Effect of a Biofeedback-Based Integrated Intervention for Older Adults with Orthostatic Hypotension: A Secondary Analysis on Psychological Health Outcomes in a Non-Randomized Pilot Trial
      Nahyun Kim, Jeonghwa Han, Hyunwook Kang
      Healthcare.2024; 12(21): 2143.     CrossRef

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    Effects of Tailored Water Drinking on the Orthostatic Hypotension in the Elderly
    Korean J Adult Nurs. 2014;26(3):341-351.   Published online June 30, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.3.341
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    Effects of Tailored Water Drinking on the Orthostatic Hypotension in the Elderly
    Korean J Adult Nurs. 2014;26(3):341-351.   Published online June 30, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.3.341
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    Effects of Tailored Water Drinking on the Orthostatic Hypotension in the Elderly
    Effects of Tailored Water Drinking on the Orthostatic Hypotension in the Elderly

    Homogeneity Test for General Characteristics between Two Groups (N=63)

    Characteristics Categories   Exp. (n=29) Cont. (n=34) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Age (year)⁎ 65~74   4 (13.8) 11 (32.4) 3.40 .183
    75~84   14 (48.3) 15 (44.1)
    ≥85   11 (37.9) 8 (23.5)
      82.2±7.85 78.4±7.47 2.01 .049
    Gender Female   28 (96.6) 16 (47.1) 18.20 ＜.001
    Male   1 (3.4) 18 (52.9)
    Education level⁎ Illiteracy   20 (69.0) 10 (29.4) 11.12 .004
    Elementary   8 (27.6) 16 (47.1)
    ≥Middle school   1 (3.5) 8 (23.5)
    Religion Yes   18 (62.1) 15 (44.1) 2.02 .155
    No   11 (37.9) 19 (55.9)
    No. of co-morbidity in past (numbers) ＜4   16 (55.2) 22 (64.7) 0.59 .441
    ≥4   13 (44.8) 12 (35.3)  
        3.28±1.00 2.82±1.03 1.77 .083
    No. of co-morbidity in current (numbers) ＜4   27 (93.1) 33 (97.1) 0.54 .463
    ≥4   2 (6.9) 1 (2.9))  
        2.10±1.11 1.82±0.87 1.12 .267
    Length of stay (year) ＜2   9 (31.0) 17 (50.0) 4.77 .092
    2~4   9 (31.0) 12 (35.3)
    ≥4   11 (37.9) 5 (14.7)  
        3.50±1.94 2.17±1.23 3.16 .003
    Water intake (mL/24 hr) AWI   911.0±201.3 901.6±201.3 0.20 .845
    Expected water intake (mL/24 hr) AWI   1,865 1,900    
    BP/HR (mmHg/BPM) Degree of drop SBP -11.9±7.00 -12.2±7.67 0.14 .887
      DBP -5.1±5.99 -8.5±5.95 1.78 .080
      HR -3.2±3.68 -2.9±4.71 -0.25 .806
    Body weight (kg)   ＜39 8 (27.6) 3 (8.8) 4.20 .122
      40~49 14 (48.3) 18 (52.9)
      ≥50 7 (24.1) 13 (38.2)

    Exp.=experimental group; Cont.=control group; AWI=average amount of water iitake per day; BP=blood pressure; SBP=systolic blood pressure; DBP=diastolic blood pressure; HR=heart rate; BPM=beat per minute; Fisher's exact test (p).

    Average Fluid Intake and Urine Output by Weeks between Two Groups (N=63)

    Variables Groups 1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
    M±SD M±SD M±SD M±SD M±SD M±SD
    Fluid intake Exp. (n=29) 1,884±306.1 1,917±270.5 1,859±233.6 1,901±245.2 1,913±267.3 1,887±272.5
      Cont. (n=34) 665±131.5 713±129.5 715±129.5 594±131.7 594±131.0 506±131.9
    Urine output Exp. (n=29) 1,887±320.2 1,920±271.9 1,916±332.1 1,896±241.2 1,972±486.2 1,881±258.4
      Cont. (n=34) 768±133.1 773±170.7 763±129.7 453±130.6 584±133.9 360±132.1

    Exp.=experimental group; Cont.=control group.

    Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)

    Variables Groups Intervention Source p
    1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
    M±SD M±SD M±SD M±SD M±SD M±SD
    OH SBP Exp. (n=29) -12.8±7.00 -11.0±8.23 -6.2±9.79 -9.7±6.18 -9.0±5.30 -5.5±7.39 Group ＜.001
    (mmHg) Cont. (n=34) -11.1±7.67 -13.2±8.24 -10.9±7.93 -17.4±11.63 -15.0±10.80 -18.8±8.44 Time .014
      t (p) -0.71 (.478) -0.98 (.331) -2.10 (.040) -3.38 (.001) -2.77 (.008) -6.61 (＜.001) G*T ＜.001
    OH DBP Exp. (n=29) -7.9±5.99 -6.2±5.59 -7.2±6.32 -4.5±6.88 -4.8±3.71 -5.5±6.32 Group .001
    (mmHg) Cont. (n=34) -7.4±5.95 -10.6±8.34 -11.8±9.96 -9.1±8.53 -10.0±8.46 -12.1±8.80 Time .290
      t (p) 0.32 (.748) -1.99 (.050) -2.19 (.032) -2.16 (.035) -2.62 (.011) -3.34 (.001) G*T .117
    OHR Exp. (n=29) -3.9±3.68 0.8±6.02 0.3±3.23 0.8±3.30 1.7±6.85 1.7±3.06 Group ＜.001
    (BPM) Cont. (n=34) -2.0±4.71 1.1±7.79 5.3±3.90 8.2±5.37 5.9±11.80 11.3±9.74 Time ＜.001
      t (p) 1.46 (.150) 1.28 (.206) 4.02 (＜.001) 6.73 (＜.001) 1.69 (.055) 5.09 (＜.001) G*T .003

    Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.

    Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)

    Variables Reduce of vital sign Intervention
    1 wk 2 wk 3 wk 4 wk 5 wk 6 wk
    Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont. Exp. Cont.
    n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
    OH SBP (mmHg) ≤-20 12 (41.4) 13 (38.2) 13 (44.8) 14 (41.2) 9 (31.0) 20 (58.8) 2 (6.9) 19 (55.9) 2 (6.9) 18 (52.9) 1 (3.4) 26 (76.5)
    -10~-19 11 (37.9) 13 (38.2) 9 (31.0) 16 (47.1) 13 (44.8) 10 (29.4) 24 (82.8) 10 (29.4) 21 (72.4) 10 (29.4) 17 (58.6) 5 (14.7)
    0~-9 6 (20.7) 5 (14.7) 5 (17.2) 4 (11.8) 6 (20.7) 4 (11.8) 3 (10.3) 5 (14.7) 6 (20.7) 5 (14.7) 8 (27.6) 3 (8.8)
    ≥1 0 (0.0) 3 (8.8) 2 (6.9) 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.9) 3 (10.3) 0 (0.0)
    Fisher's exact test (p) 2.60 (.494) 3.38 (.315) 5.51 (.103) 26.21 (＜.001) 18.34 (＜.001) 6.23 (.030)
    OH DBP (mmHg) ≤-10 21 (72.4) 20 (58.8) 14 (48.3) 23 (67.6) 15 (51.7) 26 (76.5) 11 (37.9) 22 (64.7) 13 (44.8) 25 (73.5) 14 (48.3) 29 (85.3)
    0~-9 8 (27.6) 11 (32.4) 12 (41.4) 11 (32.4) 12 (41.4) 8 (23.5) 18 (62.1) 10 (29.4) 15 (51.7) 8 (23.5) 15 (51.7) 5 (14.7)
    ≥1 0 (0.0) 3 (8.8) 3 (10.3) 0 (0.0) 2 (6.9) 0 (0.0) 0 (0.0) 2 (5.9) 1 (3.4) 1 (3.4) 0 (0.0) 0 (0.0)
    Fisher's exact test (p) 2.74 (.280) 4.45 (.080) 0.14 (.467) 7.13 (.016) 5.71 (.041) 9.90 (.002)
    OHR (BPM) ≤-20 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (3.4) 0 (0.0) 0 (0.0) 0 (0.0)
    -10~-19 1 (3.4) 4 (11.8) 2 (6.9) 2 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 3 (8.8) 0 (0.0) 1 (2.9)
    -9~9 28 (96.6) 29 (85.3) 27 (93.1) 27 (79.4) 29 (100.0) 24 (70.6) 28 (96.6) 20 (58.8) 27 (93.1) 18 (52.9) 29 (100.0) 15 (44.1)
    10~19 0 (0.0) 1 (2.9) 0 (0.0) 4 (11.8) 0 (0.0) 10 (29.4) 1 (3.4) 14 (41.2) 1 (3.4) 9 (26.5) 0 (0.0) 11 (32.4)
    ≥20 0 (0.0) 0 (0.0) 0 (0.0) 1 (2.9) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (11.8) 0 (0.0) 7 (20.6)
    Fisher's exact test (p) 2.44 (.296) 4.63 (.201) 10.14 (.001) 12.28 (＜.001) 15.90 (.003) 23.20 (＜.001)

    Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension; SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.
    Table 1. Homogeneity Test for General Characteristics between Two Groups (N=63)

    Exp.=experimental group; Cont.=control group; AWI=average amount of water iitake per day; BP=blood pressure; SBP=systolic blood pressure; DBP=diastolic blood pressure; HR=heart rate; BPM=beat per minute; Fisher's exact test (p).

    Table 2. Average Fluid Intake and Urine Output by Weeks between Two Groups (N=63)

    Exp.=experimental group; Cont.=control group.

    Table 3. Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)

    Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.

    Table 4. Degree of Blood Pressure and Heart Rate Change between Two Groups (N=63)

    Exp.=experimental group; Cont.=control group;; OH=orthostatic hypotension; SBP=systolic blood pressure; DBP=diastolic blood pressure; OHR=orthostatic heart rate; BPM=beat per minute.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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