Supporting drinking – helping older people to drink well
Systematic review
Water –loss dehydration is associated with poor fluid intake, and it is the type of dehydration most commonly found in older people, especially those living in care homes, where it is sometimes difficult for residents to drink enough to stay healthy. This is for a number of reasons, such as forgetting to drink, being unable to easily access a drink (if it is placed out of reach, for example) or choosing not to drink, if there are concerns about continence. In addition, as our thirst mechanism works less efficiently as we age, we need to be more aware of what we drink and when.
We are carrying out two studies to help us understand how to help older people living in residential care to drink well. Both studies are led by Diane Bunn, a PhD student working with Lee Hooper. Both studies are contributing to her PhD which is being supervised by Lee Hooper and Fiona Poland.
1. Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review
As drinking more prevents dehydration and its consequences, we systematically searched 13 databases to identify studies which had investigated ways of helping people in care homes to drink more or prevent dehydration.
The protocol for this systematic review is published at: http://www.crd.york.ac.uk/Prospero/display_record.asp?ID=CRD42012003100
Aim. The aim of this systematic review was to assess the efficacy of interventions and environmental factors on increasing fluid intake or reducing dehydration risk in older people living in care homes. Methods: We searched 13 databases looking for intervention and observational studies investigating modifiable factors aiming to increase fluid intake or reduce dehydration risk in older people (≥65 years) living in long-term care.
Results: We found 23 studies (19 intervention and 4 observational) from 7 countries which fitted our criteria. These studies investigated factors at resident, institutional and policy level. Unfortunately, as many studies were either too small or had a high risk of bias, their findings may not be immediately useful. However, the range of different interventions and ideas which were investigated may provide us with ideas on how to plan studies in the future. Investigations and associations included:
- greater choice and availability of drinks
- providing drinks in a more attractive way
- increased training and information for staff
- increased staff assistance with drinking and toileting
- regular assessment and monitoring of dehydration levels and fluid intake
- using high-contrast red cups
- modifications to the dining environment to make it less-institutionalised
- advice to residents about drinking
- impact of type of ownership (whether a home was privately owned, part of a chain, or part of a charity)
- impact of staffing levels and level of training
Conclusions. We concluded that increasing fluid intake and reducing dehydration prevalence in long-term care facilities is likely to require multiple strategies involving policymakers, management and care staff, but these require further investigation using more robust study methodologies.
For the published paper and posters about this study see the outputs tab.
Thinking About Drinking
Using a qualitative approach, this study aimed to identify issues which may help or inhibit healthy drinking and dehydration prevention in older residents living in care homes.
Care staff, residents and their relatives were invited to join a focus group (a group discussion) to talk about drinking (tea, coffee, water, juice) – what helps older people to drink well, and what may make this difficult. The focus groups were recorded and discussions transcribed, so the discussions can be considered in depth. These discussion will help us learn about drinking from the perspectives of older people living in residential care, their relatives and care staff.
The research has been checked and approved by the National Research Ethics Service Committee, London-Camberwell St Giles (14/LO/0127) on 31st January 2014. More information about the National Research Ethics Service can be found here.
