We often speak about the importance of good nutrition and the risks of malnutrition, but dehydration is often lost amongst both of these, and I wanted to write about the importance of hydration and the risks to people who are or could become dehydrated.
Our body needs plenty of water to work. It helps to lubricate joints, eyes, improves balance, helps with concentration, memory and mood and also helps our bodies digest food, flush out waste and keep the skin healthy. However, according to a study and figures from the Office for National Statistics, dehydration has killed 345 patients in hospitals and care homes during the first wave of the pandemic alone. More information can be found here.
Signs of dehydration
Improving hydration can bring better wellbeing and better quality of life for the people we support. Additionally, it can prevent illnesses and reduce the use of medications. But how do we spot the signs that someone may be dehydrated? Some common signs and symptoms include:
- Feeling thirsty – often the first sign you are dehydrated
- Dry mouth, lips and/or tongue
- Sunken eyes
- Dry inelastic skin
- Confusion and disorientation
- Lightheaded and dizziness
- Low blood pressure
Consequences of dehydration
Often the above signs are picked up but are thought to be the cause of another underlining health condition and treatment is not given quickly enough. Some of the consequences of dehydration include:
- Hospital admission/mortality
- Reduction in mental health, including memory, attention, concentration and reaction
- Weakness and dizziness which in turn increases the risk of falls
- Pressure sores and skin conditions
- Kidney infections
- Passing more or less urine than usual which can lead to urinary infections and incontinence
So, we now know some of the signs and consequences, but what puts someone at a higher risk of dehydration? Some of the risk factors include:
- Ageing – some people experience a reduction in the sensation of thirst, this is especially common in those living with dementia or people that have had a stroke
- Reduced renal function – kidneys play a vital role in fluid regulation however they deteriorate with age and as they do so, the hormonal response they produce to dehydration reduces as well which leads to impairments in fluid balance
- Cognitive Impairment and people experiencing difficulty in swallowing
- Some medications, including diuretics and laxatives
- Lack of access to fluids, such as people who are bed-bound, have mobility issues, require support with eating and drinking or have poor dexterity
- Lack of staff knowledge or training around the importance of hydration
- Incontinence – losing more fluids from your body than putting in.
Top tips to improve hydration
But what can we do to prevent dehydration and increase fluids? The main thing I often hear is to make sure they drink more, but what happens if you have someone who is not wanting to drink due to fear of incontinence, someone living with dementia who tells you they have had a drink or someone who just doesn’t drink enough? Here are some tips that could help:
- Recognising that they don’t drink enough is the biggest step. Once you have realised this, then actions and steps can be put into place to encourage and support the person to drink more.
- Make drinking a social event and not a task.
- Offer a range of different drinking receptacles, including tumblers, mugs, glass sizes and colours. You could even support someone to purchase a new drinking receptacle that they like or support them to purchase a specially adapted cup to aid independence such as a double-handled mug.
- Leave drinks in a place where the person can reach them, but ensuring that they are not too heavy for the person to lift and drink independently and ensure they are available at all times of the day and night, not just set times
- Train staff.
- Set fluid goals.
- Use bottles with visual prompts for drinking.
- Find out preferred drink choices.
- Offer hot and cold drinks.
Include food in your hydration measures
It is important to remember that everyone is different and that we do not assume one trick or tip will work for everyone. One tip I will share with you all, that I used to train my care teams in was using food to increase the percentage of fluids per day as simple changes can soon add up to around 20% of fluid intake and this included:
- Adding milk to cereal – can increase fluid intake by 100ml
- Encouraging more water with medications, instead of a small tumbler or water, offer a larger one (remembering the weight vs the person’s ability to hold it)
- Puddings such as custard, yoghurts, jelly and milk puddings can increase fluids by up to 200ml
- Ensuring empty glasses are topped up when they are empty
- Use fresh fruit and vegetables in main meals but also as snacks
- Drinks before bedtime
- Ice lollies – 70ml
- Slice of melon – 140ml
- 1 tomato – 80ml
- Humous dip – 30ml
- Pureed fruit pouches.
The list is not exhaustive but it is so important that all fluid intake is recorded, especially where there are concerns around the fluid intake of someone we are supporting.
Professional standards to keep in mind
It is also important to recognise that Care Quality Commission Standards apply to hydration as well as nutrition and focus on identification and assessment, monitoring fluid intake and care. These include:
- Staff identify when a person is at risk of dehydration
- Those identified as at-risk have their fluid intake monitored
- Hydration requirements are identified and reviewed and communicated
- The care plan identifies how the risks will be managed
- Patients can be confident staff will support them to safely meet their drinking needs.
Some top tips of what else you can do:
- Keep a chart of all drinks consumed.
- If you are supporting or are someone who doesn’t drink before you are worried that you will need to go to the toilet, you can order a toilet card from Age UK for free here but it is also important you speak to your GP
- Remember that the colour of your urine is not always a sign of being dehydrated and that this is a myth that if you are hydrated your urine is clearer. I remember believing this for years until being told by an incontinence nurse who told me it was the most frustrating myth she knew.
- Make a plan and guide for ensuring good hydration.
- Ensure you and your team members and colleagues are aware of the importance of good hydration.
- Make fluids fun, not a chore.
- Ensure you know who is at risk of dehydration.
- Create a drinks station within your service with different available juices and find out which is the most popular.
- Introduce new drinks, new flavours and textures.
- Ensure drink rounds are not a task/chore, they are a sociable event.
- Try Jelly Drops which are 95% water sweets and have been proven to boost water intake.
You can find out more about hydration and access the BNF healthy hydration guide here and the Care Quality Commission Regulation (14) on Meeting Nutritional and Hydration Needs here.