The Initial Development of a Checklist for Assessing Thirst in Patients With Advanced Dementia.

BACKGROUND: Patients with advanced dementia (PwAD) often have difficulty expressing their needs verbally because of cognitive impairments. PwAD thus often communicate these needs through behaviors and psychological symptoms. Understanding the behavioral characteristics of certain needs is critical for caregivers and clinicians when caring for PwAD.

PURPOSE: The purpose of this study was to develop a checklist that may be used to assess the thirst status of PwAD.

METHODS: A mixed method design was used. The checklist was developed using qualitative interviews and surveys. The initial items were developed through interviews with 10 professional nurses who were caring for PwAD. Four experts in dementia assessed the content validity of these items. PwAD caregivers from eight facilities were then invited to complete the checklist based on their current PwAD patient care experience. Data obtained in this study were analyzed with regard to content validity, interrater reliability, internal consistency, and exploratory factor analysis.

RESULTS: The content validity of the initial 18 items was .96, interrater reliability was -.33 to 1, and internal consistency reliability was .52. Exploratory factor analysis identified seven checklist items, including repetitive movements, squirming, restlessness or anxiety, persistent or unreasonable demands, pacing back and forth, repeating a sentence or question without purpose, and slow reaction. The factor loadings of these seven items accounted for 49.3% of the total variance. The reassessed internal consistency reliability was .66.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Caregivers may use this checklist as an aid to identify the thirst or fluid needs of PwAD who are unable to communicate their needs effectively.