How to manage hydration for the people you support with Dysphagia to promote safer and independent drinking.

Managing the ladies and gents you support with Dysphagia and ensuring that they maximise on the correct levels of hydration represents a huge challenge to care managers and their teams, given that these residents are at high risk of being deficient due to finding it difficult to tolerate large volumes of fluids.

And Dysphagia is known to affect between 53%-74% of nursing home residents. It may occur in people who have a Dementia, stroke, Motor Neurone disease and other neurological conditions.

The Importance of Hydration

Water intake is often a secondary consideration in Dysphagia management. Water makes up 75% of the volume of the body and the NHS advises drinking 2.5 litres of water per day. Many older people and those with Dysphagia do not drink adequate amounts of water, consuming only 480–960 mls 2-4 glasses per day. However, drinking sufficient amounts of fluid can assist in preventing or treating the following ailments

• Pressure ulcers

• Urinary infections and incontinence

• Heart disease

• Diabetes management

• Dizziness and confusion leading to falls

• Skin conditions

• Constipation

• Kidney stones

• Low blood pressure

• Cognitive impairment

• Poor oral health

It can be challenging to assess hydration in older people however you can look out for these signs and symptoms:

Signs of dehydration

  • Dryness of the mouth, lips and tongue
  • Sunken eyes
  • Dry inelastic skin
  • Drowsiness, confusion or disorientation
  • Dizziness and low blood pressure

Dehydration is also indicated with a reduced and more concentrated urine output. As a general rule, the colour of urine can be a useful guide; urine that is odourless and pale in colour generally indicates good hydration, dark strong smelling urine is a common symptom of dehydration. However, there are a number of medical conditions and certain medications that can add colour to urine.

Monitoring fluid intake is a good guide to ensuring good hydration.

The key to maintaining hydration for people with Dysphagia is to promote safe swallowing and to ensure that the fluids are of the appropriate texture and thickness.

Advice on safer swallowing for improved hydration

  1. Ensure your resident is always sitting upright at 90 degrees when drinking.
  2. Do not give them drinks when slouched or lying down
  3. Encourage small sips of fluid and discourage gulping
  4. Make sure they have swallowed a drink before taking more in
  5. Prevent people from using drinks to wash down food.

Other strategies to help improve hydration include:

  • Thickening fluids for safer swallowing
  • Correct positioning
  • Drinking smaller quantities with each sip:
  • Investing in specialist Dysphagia drinking devices

Thickened fluids

One way of helping patients with swallowing problems to take fluids without aspirating is to consume liquid of a thicker consistency. A speech therapist can give advice about thickened fluids. Fluid can be thickened artificially with powder or bought pre-thickened.

Positioning

The adopted position for drinking can also effect swallowing. A study showed that: “The chin down posture can have a positive effect on swallowing safety and reduce the incidence of aspiration and depth of penetration, in the context of cup drinking with thin liquids.” – Fraser (2012

Drinking smaller quantities with each sip

Sometimes residents with learning difficulties or Dementia may gulp fluid too quickly, risking aspiration. It is possible that limiting the amount of fluid consumed with each swallow can also make swallowing safer.

Choosing specialist Dysphagia drinking devices for safer hydration

We provide a range of drinking devices which restrict the volume of fluid delivered and allow safer independent drinking for people living with Dysphagia.

  1. Our Internal Coned Mug – the clever cone shaped interior, which tapers towards the bottom and looks like an ice cream cone enables people to drink independently without having to tilt their head backwards. Even people who are bed-bound or have limited movement in the neck and arms can satisfy their thirst. And in contrast to the nose cut-out cups that are often used for people with physical limitations, these mugs are also intuitive to use and require no explanation 
  2. Our Spouted Non-Drip Lid (works with coned mug above) Through the special design of this spout, fluid intake is determined by suction. This not only enables spills to be limited to a couple of drips, but also minimises the risk of choking. After all, the user can simply determine for themselves how much they want to drink. 
  3. Our Wide Spout Lid for Thickened Fluids (works with coned mug above) Suitable for use with thicker fluids, this long spout means your residents with limited mobility don’t have to tilt their heads back to drink.
  4. Our Drink-Rite Cup is an ideal choice for ladies and gents who can’t tolerate thickened fluids and is a safer option for people with learning difficulties and Dementia to prevent gulping as it provides only a small, controlled volume of fluid into the mouth (either 5 or 100cc) at a time. 
  5. Our Dysphagia Cup is oval in shape to help accommodate the nose which prevents the need to tilt the head back and the safer chin tuck position can be adapted. It is also weighted to help reduce spills for those with tremors, with an optional base.

For more information or to arrange to see samples of our range of drinking vessels to help support your residents with Dysphagia, please contact Lucy by email at lucylynch@hcsuk.co.uk or on her mobile 07968 994660.

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VAT Relief Information

Conditions for VAT relief for disabled people

Some of the products which can be purchased from the Hcsuk website are available for an eligible person to purchase without paying VAT on them. HM Revenue and Customs sets out the conditions when equipment for disabled people might be free of VAT and how to claim exemption from paying VAT on these products.

Products a can only be exempt from VAT when all the following conditions are met:

  1. The customer is eligible to purchase supplies at the zero rate
  2. The goods are for the personal or domestic use of the customer
  3. The goods and services are eligible to be supplied at the zero rate

A more detailed explanation of each of these conditions is given below, but you should visit the HM Revenue and Customs Website to fully understand the conditions

The product must be being purchased for someone who is chronically ill or disabled.

A person is ‘chronically sick or disabled’ if he/she is a person:

It does not include a frail elderly person who is otherwise able-bodied or any person who is only temporarily disabled or incapacitated, such as with a broken limb.

‘personal or domestic’ use means that the supply must be made available specifically for the use of an eligible individual.

You don’t have to physically buy the goods in person. If your parent, guardian or wife or husband buys the goods and services for you, then you won’t be charged VAT.

What counts as personal or domestic use?

Personal or domestic use means that the goods or services are supplied for your own private use, rather than for business purposes. Also, the goods or services must be just for your own use – not for use by anyone else, or chronically sick or disabled people in general. However, if you and your partner are both chronically sick or disabled and you buy goods or services for both of you to use, then you won’t have to pay VAT.

Products which are offered for sale on this website which qualify for VAT relief to be claimed for an eligible person.

The products which can be bought without paying VAT are:

Only the products on our site carrying the VAT exemption price (the smaller price marked ex VAT) are eligible to be purchased this way and you must tick the box on the basket page indicating that you wish to claim VAT exemption on the items in your basket that are eligible for VAT relief.

How to claim

On the my basket page of this website a link to the online declaration form is provided if the basket contains a product that qualifies for VAT relief. You must tick the box to state you wish to claim VAT relief on the eligible product and complete in full the reason by which you are ‘chronically sick or disabled’ and name and address of the claimant. If possible the person making the claim should complete this form, but a family member, carer or medical professional may complete the form on the claimants behalf. To submit the claim and receive the VAT relief, click the ‘Submit VAT Relief Claim’ button before proceeding to the checkout.

Please note that all orders submitted with a VAT relief claim form completed are checked before the order is processed.

It is necessary to complete a separate claim form each time a qualifying product is purchased from Hcsuk.

 

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