29 November 2019

Enhancing Hydration Care in Care Homes

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    We all need to drink well to stay healthy, to ensure that we replace fluids that we lose naturally through breathing, perspiring and producing urine and faeces.

     

    European Guidelines recommend that men drink two litres of fluid per day, and women 1.6 litres per day (with a further 20 per cent of fluids obtained from foods).  Most drinks are hydrating. What is important is that we drink the drinks that we enjoy, which may include water but also tea, coffee, milk, juices, squash and even a beer or glass of wine.​

     

    If we do not drink enough, then we become dehydrated, which is known to be associated with poor health and well-being, and increased risk of hospital admission. Older people are more at risk of developing low-intake dehydration, due to physiological, physical and cognitive changes which occur due to ageing. ​

    Our ongoing care home research programme includes PhD students involved in exploring hydration care for older people living in care homes.

     

    Research questions include: ​

    • How many older people are dehydrated, and does this vary depending on where they are living or staying (hospital, home or care home)? ​

    • Can commonly-used signs and symptoms tell us if a resident is dehydrated? ​

    • How can we help care home residents remain hydrated? ​

     

    Low-intake dehydration, when we don’t drink enough fluids to stay healthy, is very common in older people, including those living in care homes.

    It happens for all sorts of reasons, such as weakened thirst sensation, not remembering to drink, difficulties fetching, carrying, reaching and swallowing drinks, and concerns about continence.

     

    Can commonly-used signs and symptoms tell us if a resident is dehydrated? ​

    In the Dehydration Recognition in our Elders Study (DRIE) Study, we found that none of the commonly-used signs and symptoms of dehydration (feeling thirsty, dryness of the skin, eyes, or oral mucosa; loss of skin elasticity; fever; rapid pulse; hypotension; urine colour) were effective in identifying low-intake dehydration in older people living in care homes. This is when compared to the reference standard (or ‘gold standard’) of serum osmolality.

     

    Health professionals and care workers often rely on these signs and symptoms of dehydration to identify residents who they think may be dehydrated because they are easy to use, inexpensive and provide instantaneous results, so the aim for this research was to investigate the diagnostic accuracy of these commonly-used tests to know whether they work or not. It is important to establish the accuracy of tests so that health professionals and care workers can provide appropriate care. ​

     

    In our DRIE Study, 188 care home residents participated, and we found that 20 per cent of these residents were dehydrated, and none of the commonly-used signs and symptoms accurately indicated hydration status when compared with the reference standard, serum osmolality. Low-intake dehydration can only be diagnosed using directly measured serum osmolality or calculated osmolarity, both of which require venous blood samples. ​

     

    We recommend that carers and health professionals should assume that all older people are at risk of dehydration and that older people should be supported to drink well throughout the day.

     

     

    Find out more about Postgraduate Research degrees

     

     

    Exploring resident and carer views around hydration care

    For many care home residents, drinking is a supported activity involving residents and their network of carers. This is so that the ensuing social interactions become part of the process of determining what, when and how much a resident drinks.  ​

     

    In the Thinking about Drinking qualitative study, 29 residents, carers and families participated in separate focus groups to talk about their experiences of hydration care, from their perspectives. Three themes from this study were ‘meanings and experiences of drinking’, ‘caring roles’, and ‘tensions and barriers to successful drinking’. ​

     

    Experiences of drinking and hydration care inform care and responses to care. By understanding these experiences, as well as issues which arise, we can develop new and novel approaches to care. ​

     

    How can we help care home residents remain hydrated? ​

    Supporting residents to drink well is complex, so our research team has been working with care home staff in Norfolk and Suffolk to develop ‘The DrinKit’ is a four part guide to support hydration care in care homes.

     

    • Part 1 - The Making Drinking Fun Activities and Engagement Toolkit. This is a resource pack for care home Activities’ Co-ordinators, which supports development of care home activities around drinking and socialising. The focus is on making drinking fun, and making drinking a central part of day-to-day events, activities and friendly moments. ​

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    • Part 2 - 1-hour Hydration Training. This training has been designed as an introduction to hydration care for all care home staff.​

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    • Part 3 - The Drinks Diary, which enables residents to record their own drink intake and increase their understanding of drinking well for health and well-being.​

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    • Part 4 - The Hydration Champion Team Training Manual. The manual has ideas and information, based on experiential learning, for care homes to develop their own hydration champion teams. Teams can adapt and develop this training to improve and enhance staff knowledge about hydration care in their own working environments.​

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    In the next phase of our research, one of our PhD students is aiming to investigate the benefits of residents’ and care staff involvement in hydration care in care homes as well as investigating the utility of different care tools to assess dehydration and care needs for drinking.​

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