Wellbeing
Screening and control to prevent dehydration
Sophie Murray, head of nutrition and hydration for Sunrise Senior Living UK and Gracewell Healthcare, considers the problem of dehydration and provides tips on how to ensure care home residents are encouraged to drink more in order to avoid it
Hydration and nutrition are essential components for maintaining good health. They are also areas that feature prominently in care home inspections. Ensuring that residents are well hydrated and well nourished is important and can provide an opportunity for them to interact with others, as well as enhancing quality of life. There are also various policies, protocols, procedures, screening tools, training and practice tips that can support and improve hydration in care home residents.
Dehydration is a serious issue in the healthcare sector, particularly in care homes. A patient safety study on dehydration highlighted that there is a 30 per cent greater risk of dehydration in those over the age of 65 years. A report by the Hydration for Health Initiative in 2012 indicated that between 50 per cent and 92 per cent of nursing home residents have inadequate fluid intakes. According to another report, one-quarter of all cases of care home residents being admitted to hospital are due to dehydration.1
Currently, there are no official figures available to show the hydration status of the general population. This may partly be due to the lack of a universal measurement tool, such as the Malnutrition Universal Screening Tool (MUST) which is used to measure nutritional status.
Sufficient fluid intake in older adults is associated with fewer falls, lower rates of constipation and lower rates of laxative use, as well as with better rehabilitative outcomes in orthopaedic patients.2,3 Mortality rates and the development of various morbidities, such as salivary dysfunction, constipation, orthostatic hypotension, hyperthermia, impaired cognitive function, falls and poor control of hyperglycaemia in diabetes, have all been linked with dehydration. Elderly people can be at greater risk of dehydration, with mitigating factors
Screening
It is important to identify the best screening methods to help staff recognise those residents who are showing signs of dehydration. Screening of hydration varies widely and there is no accepted assessment tool, so screening undertaken in care homes becomes reliant on observing for a list of signs, as well as urine colour and using fluid charts.
Many care homes use urine colour charts and while they are not always reliable for all individuals, they are easily understood by staff as well as residents. Odourless, pale urine indicates good hydration, while dark, strong smelling urine can be an indicator of poor hydration.
Urine colour charts provide good talking points, especially if they are displayed in appropriate areas such as toilets. Urine colour is an essential element to indicate dehydration and therefore enables staff to initiate the right steps immediately.
Even mild cases of dehydration can affect both physical and mental performance
including dysphagia, which means they require thickened fluids, and dementia, which results in impaired cognitive functions.
According to the NHS,4 dark coloured
urine and thirst are early signs of dehydration, although in elderly people this is not quite as straightforward as they may experience a loss of thirst sensation. Researchers conclude that even mild cases of dehydration can affect both physical and mental performance. As little as two per cent dehydration can cause a 20 per cent reduction in performance in physical and cognitive activities.
May 2017 •
www.thecarehomeenvironment .com
Staff should also be trained to use fluid charts as a monitoring tool that requires immediate action. They can be used to support care plans, indicating to staff when someone drinks, what they drink and how much they drink in one go. This can then be used to support individuals to drink more or receive medical intervention if appropriate. In practice, if a resident is drinking 800 ml and their goal is 1500 ml, this indicates that action needs to be taken. For example, this could mean purchasing a new, larger glass or mug, offering a milky drink at night or providing a full cup of fluid to be drunk with medication three times a day. If residents are reluctant to drink water, staff should think of other ways to increase their fluid intake. This could include encouraging them to try other drinks that they may prefer or providing foods that have a higher fluid content,
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