GETTING THE MEASURE OF HYDRATION

Hydration is key and has health benefits for us all, especially for people living in care homes.

However, ensuring the correct levels of hydration necessary for good health are consumed by care home residents can present a number of challenges for care managers and their teams on a daily basis.

When managing the ladies and gents you support, monitoring their drinking levels is not always easy so it is reassuring to know there are a number of simple yet effective tweaks that can be made to keep hydration levels at an optimum and in a healthy range.

There’s been a recent rise in the number of enquiries we have received about hydration and looking for ways to maximise on the correct levels of hydration. Promoting good practice in hydration care is essential, especially when it comes to the health of older people.

There are some very basic and simple steps that people can take which can make a big difference to how much the people they care for drink.

Water makes up 75% of the volume of the body and the NHS advises drinking 2.5 litres of water every day. While we can go without food for about two weeks, we can only go without water or fluids for about three days.

What are the associated complications for someone who is dehydrated?

  • Increased confusion
  • Increased risk of constipation, which can be very dangerous for an elderly person
  • Increased risk of pressure ulcers
  • Urinary infections
  • Increased risk of falls

A lack of hydration can cause dizziness and confusion which can lead to falls.

The hospital admissions for people from care homes with dehydration is higher than it is from the general community.

So how can we tell whether someone is dehydrated?

There are some tell-tale signs to look out for including:

  • Sunken eyes
  • Dryness of the mouth, lips and tongue
  • Disorientation, drowsiness and confusion
  • Low blood pressure and dizziness

Monitoring the intake of fluids is a good guide to ensuring good hydration.

I recently attended an event where we heard from a hydration nurse specialist who was talking about hydration in care homes. She explained that previously there had not been a recognised tool to use to measure and support people with good hydration in care homes.

LATEST INDUSTRY INNOVATION IN HYDRATION ASSESSMENT

Reliance On a Carer (ROC) is the first ever hydration care assessment tool for use in elderly care and its founder, Naomi Campbell RGN, is widely recognised as the UK’s first hydration specialist nurse and is dedicated to developing simple and practical solutions to help improve hydration care.

ROC supports the Care Quality Commission (CQC) Regulation 14 ‘Meeting nutritional and hydration needs’ and an independent evaluation of ROC in care homes proved to reduce the number of people needing emergency admissions to hospitals due to urine infections, falls and broken hips.

ROC highlights how, depending on your level of dependence, how reliant you are on other people to get the correct levels of fluid you need for your body to function as well as it can.

https://www.hydrationcareconsultancy.co.uk/roc-hydration-care-assessment-tool/

This is something I have experienced personally with my Mum who recently spent over two weeks in hospital, where she was refusing to eat and drink. I witnessed first-hand how fast she went downhill. When she received IV fluids I saw how quickly she recovered, she started eating and drinking and looked 20 years younger.

The difference was quite phenomenal and really hit home to me just how important it is that care homes have the right tools to work with to help promote good hydration.

HYDRATION HACKS

There are some basic tweaks people can make that can make a big difference to help how much people drink.

Colour

Something that is really important is colour, particularly for people who have dementia, they need contrast. If you put a clear glass or beaker full of water in front of someone that is living with dementia, they won’t see it, so they won’t know there is a drink there, therefore they won’t drink.

Studies have revealed people will have consumed up to 50% more fluids just because of a change of colour of glass or drinking vessel.

Within our product ranges there are lots of different drinking vessels to help support people to get the right levels of hydration they need.

https://hcsuk.co.uk/dementia/dignified-dining-solutions/independent-eating-and-drinking-solutions

We have some beautiful brightly coloured glasses, and beakers which help promote the visual aspect of hydration.

Assessing Independence Levels

Another simple tweak is to make sure you know whether the resident you are trying to ensure drinks enough can actually drink independently and also ensure you know if they are left or right-handed. Then leave their drink in the appropriate place so they can reach it.

Quite often people don’t think about where they place a drink so they will put it down but not in the person’s eye line. So make sure it is within their eye line and is within reach.

We also provide specialist drinking vessels for people with Dysphagia or swallowing difficulties. Those with the condition are particularly at high risk of dehydration as they find it difficult to tolerate large volumes of fluids.

The condition is known to affect between 53 – 74% of nursing home residents and may occur in people who have dementia, stroke, Motor Neurone Disease and other neurological conditions.

https://hcsuk.co.uk/dementia/dignified-dining-solutions/managing-dysphagia-swallowing-difficulties

Use of Fluid Charts

If somebody is at risk of dehydration a fluid chart can help. It allows you to monitor how well people are drinking and how much they are having by recording volumes of fluid that are consumed at various times of the day.

Prompts and Reminders – Favourite Drinks and Cups

A lot of people with dementia will forget to drink and need lots of encouragement, regular prompts and reminders.

It is worth remembering the elderly people we look after are no different to you and I.  Like most of us they are likely to have their favourite cup, mug or glass, things they prefer to drink out of.

Think about the person’s glass or cup preference but also their drink preference. My mum loves tonic water, tea and coffee. She is not very keen on water so if we want to encourage her to drink more, we are going to give her the drinks she enjoys the most and that we know she will drink more, as is the case with all of us.

Ask what is their favourite cup, mug or glass and also their drink preferences and how do they like their favourite drink served?

Somebody might like a china cup and saucer to drink their tea out of whereas I prefer a big mug, the bigger the better for me!

Person Centred Hydration Plans

Make a hydration plan that is very person centred to the individual.

What do we need to take into consideration?

  • What drinks do they like?
  • How do they like that drink? My mum loves her tea with four sugars.
  • Think about that person and yourself and how you like your drink, I like my tea strong but milky
  • Think about making that drink as attractive as possible to the individual depending on what they like.

Introducing High Water Content Foods

Try anything that works and remember hydration is not just about drinks, some foods have high water content.

Broths and soups are water-rich food options along with plain yoghurt and cottage cheese, all of which are easily digested.

Increase hydration levels by including vegetables and fruits which have high water levels including melon with a water content of 91% and pear 84%.

There are a range of other fruit and vegetables which have a high-water content in the region of 80 – 96% and are versatile enough to be eaten as part of meals or as snacks while boosting hydration.

 

Which fruit and vegetables can help to top up water levels?

  • Cucumber
  • Tomatoes
  • Spinach
  • Mushrooms
  • Cauliflower
  • Broccoli
  • Lettuce
  • Oranges
  • Apples
  • Apricots
  • Plums
  • Blueberries
  • Pineapple
  • Strawberries
  • Peaches

So, it is a case of also thinking about what foods the ladies and gents you look after might like to eat to help hydrate them.The Use of Hydration Stations In some of the care homes I visit there are hydration stations in various locations around the home, so there is always access to drinks throughout the day and people can help themselves to juices, tea and coffee.I learnt recently that sometimes people with dementia can see there is a drinks machine there, but they may not know what it does, and they may not know they are able to access it.

So it is a good idea to put signage up to invite people to have drink and explain what the purpose is of the hydration station. Normally pictures and words together work well. Again, include contrast with bright colours so signage stands out.

There is a lot of information focused at the moment on oral care. A NHS Health Education England guide for health care professions heighted how poor oral health can lead to dehydration and malnutrition for hospitalised patients resulting in delayed recovery and an increased hospital stay.

Obviously if you haven’t got good oral care then you don’t feel like eating or drinking, say if you have a toothache or a mouth ulcer, which sometimes makes it painful to eat or drink.

Activities Promoting Hydration

A lot of homes encourage activities to help hydration so they will hold tea parties, they might hold a mocktail making session to get residents involved with helping make mocktails and tasting them. These are different and fun activities that help with promoting good hydration.

Technology Tools

Person Centred Software

I am currently doing a mealtime observations project with an outstanding care home where they use some fantastic person-centred software to aid hydration for residents.

The carers carry around small mobile devices, much like a mobile phone and can go onto the device and check on every resident to see how much they have drunk that day in mls. Using a simple colour coded system it also tells them whether they have had enough fluids.

I love the idea that you could literally look at every particular resident and see how much they have drunk and you can update it as you go along, all at the touch of a button.

 

Innovative Mobile Hydration App

Hydr8 is an example of an innovative mobile hydration app aimed to facilitate accurate recording and communication of residents’ fluid intake and increase care quality and patient safety. These are exciting developments centred on hydration and I think it is brilliant.

Simple Solutions

To help promote hydration we have a range of products perfect to encourage drinking while monitoring the amounts being consumed. These include our graduated beakers so you can see how much they hold and can measure easily how much fluid that person has had.

We do lots of different options for drinking with different styles of handles to make sure that people, who may have arthritis or difficulty holding a cup, can have the option of a two handled beaker.

http://hcsuk.co.uk/housekeeping/catering/drinking-aids

We look specifically to make sure the handles are user friendly because sometimes, with the best will in the world, you can give somebody a drink but they can’t get their fingers through the handles. They can’t hold it steady or it is too heavy,

We think about all of those things, about weight, about colour, what’s the person’s favourite colour?

We even do unbreakable wine glasses and beer tankards and champagne glasses. So if people want to have a little tipple they can have it in the right glass.

It is about creating the best experience for them to encourage hydration. It is really important that we give that thought to the people we care for.

To request your copy of our Dignified Dining Guide which is designed to help people with dementia please email us at [email protected] or call us on 01773 713713 today.

In case you missed it, here is another previous blog I have written that maybe useful and helpful for you.

http://hcsuk.co.uk/news/how-to-manage-hydration-for-the-people-you-support-with-dysphagia-to-promote-safer-and-independent-drinking/

 

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