FEATURE Go With The Flow Phillipa Atkinson-Clow, General Manager of British Water Cooler Association

(BWCA), discusses the ever-growing problem of dehydration amongst the elderly and advises on how care organisations can prevent this from happening.

How oſten do we say it? ‘I’m simply dying of thirst.’ In the UK, in the 21st century that could never happen, surely? Not only could this happen but it does happen to vulnerable people in care homes and hospitals, especially those who are elderly.

At the BWCA, the trade association for the water cooler sector which trains and monitors standards amongst the best suppliers and distributors in the sector, we are asking care homes to put in place strategies to stamp out unnecessary dehydration and the array of mental and physical health problems that arise from the simple problem of a lack of fluid.

The topic has been debated for years and it is therefore all the more depressing and poignant to read about cases such as that of Norma Spear, a 71-year-old woman who died of dehydration aſter five weeks and four days in a UK care home. In addition, in December 2013 figures obtained from the Office of National Statistics showed that 1,158 care home residents had died thirsty between 2003 and 2012 whilst under the supervision of trained staff in care homes in England and Wales.

Most healthcare and hydration experts would perhaps question just how simple the problem really is.

Nothing could really be simpler than ensuring a patient has access to fluid and the ability to drink either with help or independently. Importantly, the fluid should be pleasant to drink; a jug of tepid tap water is oſten not appealing.

There are many ways to hydrate patients, including offering tea, milk, soup, juices and foods with a high water- content. However, plain water remains one of the best means of hydration not only for patients and residents but also staff. In turn, probably the best means of supplying water in a cost-effective, delicious and sustainable manner is to do so via water coolers. Water coolers

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can act as a constant reminder to patients and staff to stay hydrated and research has proven that having such a visible reminder does increase fluid intake.

The British Water Cooler Association was one of several industry, statutory and voluntary bodies and individuals to sit on the Cross-Party Parliamentary Forum on Hydration, led by Baroness Sally Greengross. The Forum had a simple aim: to improve hydration in elderly people.

In the final report, by Dr Lisa Wilson of The International Longevity Centre UK, a member of the Forum, a number of recommendations which seek to address the complexities of hydrating vulnerable people were made.

The report- Hydration and Older People in the UK: Addressing the Problem, Understanding the Solutions- identified various requirements and recommendations. It outlined the need for an agreed and standardised definition of dehydration; a requirement for diagnostic tools; and said that more research is needed to understand the impact of dehydration on health and

recovery from illness, as well as the cost impact it has. It also highlighted the need for more awareness of dehydration, stating that good hydration practice must become part of regulated and inspected care issues; hydration policies in hospitals and care homes should be mandatory and monitored/evaluated; and training and qualifications must be developed to meet the requirements of hydration policy and practice.

In summary, we must recognise the need, measure the need, improve current practice across all care settings, share good practice and stamp out bad practice and complacency.

Those working with elderly people who are experiencing cognitive decline must remember that these residents are especially at risk. Dementia patients don’t think to drink and this in turn impairs their cognitive acuity further, rendering dehydration an even bigger risk. It’s a vicious circle.

It is not easy to identify many of the symptoms of dehydration in elderly people, which is why one of the recommendations of the Forum report

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