Dehydration is a concern in older people due to the potential adverse effects on function and clinical outcome; common complications include constipation, pressure ulcers, urinary tract infections, and dizziness leading to falls and fractures. As most dehydration is caused by prolonged inadequate oral fluid intake, our hydration project aim to raise awareness of good hydration to improve health and wellbeing in those who are being cared for.
Hydration in older people is a complex problem for a number of reasons; physiological age related changes in the body systems will naturally leave an older person more susceptible to dehydration. In addition it is not uncommon for individuals to suffer with health issues or to take medications which restrict the ability or desire to drink fluids. There is also a social and psychological component which may reduce motivation to drink through loneliness or fear over frequency and continence issues.
Hampshire Pilot - care homes
A project to improve hydration and associated outcomes was launched in 16 Hampshire County Council care homes (plus one other home based in Portsmouth, but being managed by Hampshire County Council) in April 2018, where staff from each home were trained as Hydration Champions. The role of 'Hydration Champion' involved raising awareness around hydration within their homes, and actively encouraging staff and residents to work together to achieve optimal or optimum hydration, with a focus on fun and creativity. Rather than recommending a set amount of drinks per day, the Hydrate approach talks about 'optimum' and 'optimal' hydration; 'optimum' hydration is the consumption of sufficient fluids to replace the fluids lost each day, whereas 'optimal' hydration is achieving the best level of hydration for an individual dependent on their current circumstances, even if this doesn’t lead to optimum hydration.
Our project was based on The Hydrate in Care Homes Project, which was developed by Kent Surrey Sussex AHSN based on the initial work by North East Hampshire and Fareham CCG in 2014.
Presentation slides from the launch event can be downloaded from the 'resources' section. Hampshire County Council's PaCT team who developed and delivered the Hydration Champion training has kindly allowed us to share their training resources on this page. Please note that the training resources are available from the 'resources' section, and will download as a .zip file for your convenience. Use WinZip (often installed as standard on PCs) or Windows Explorer to open, extract and save the files. Should you encounter any problems, please click the Contact Us button below.
Piloting an approach in domiciliary care
Wessex AHSN (in collaboration with Hampshire County Council) carried out a 3-month feasibility project in 2018. The objectives were:
a) to evaluate the provision of training to a small group of staff (carers and team leads) from one agency in Havant, Hampshire, on the importance of good hydration, how to improve hydration in the domiciliary care settings, and an overview of the project, including outcome measures to be collected - to view the training resources (including slides, session plan and evaluation resources), please download the .zip file in the 'resources' section
b) to evaluate the use of different aids to assess and improve hydration, including the Drinks Diary, ROC (reliance of a carer) to drink tool, coloured coasters and the Droplet smart hydration system
c) to complete a structured evaluation of the project with learning that could be translated into a larger pilot in 2019. To view the completed evaluation report, please download this from the 'resources' section
Following the analysis of this feasibility trial, changes were made to the approach, which included simplifying data collection forms and improving communication channels with carers. A 6-month pilot was started in August 2019 with two branches (Apex Prime Care Havant and Portsmouth). The pilot involves recruiting older people receiving care at home, carrying out some baseline data collection on perceived health and wellbeing, amounts drunk and reliance on a carer to drink. Training will then be provided in November to both agencies - which will include the importance of hydration, how to improve hydration and how to provide person-centred care as a result of a hydration assessment. Data collection will be repeated post intervention to see if there has been any difference in outcome measures. This work is of interest nationally and outcomes will be shared with the National Hydration Network.
Developing an E-learning resources
Wessex AHSN is working in collaboration with Hampshire County Council to produce an E-learning toolkit. The first step in this is to develop a traditional E-learning package suitable for any carer working in domiciliary care and care homes. A second step will involve the production of an 'advanced' package (more suited to manager and hydration champions), a learning app, podcasts, hydration leaflets and train-the-trainer packages. We are aware that there is lots of great work going on nationally to improve hydration in older people (especially since the launch of the National Hydration Network), and within our toolkit, we will be signposting to recommended resources by other organisations.
Links to useful resources:
- Good Hydration! Improving hydration for care home residents - this is a set of short films from Oxford AHSN which aim to help care home staff keep their results happy, healthy and hydrated. The six short animations offer handy hints and link to additional resources available through the award-winning Good Hydration! initiative.
- Simple Measures - this website contains archived information and resources, including training videos around the 'Reliance of Carer' (ROC) system, a simple assessment tool for risk of dehydration. A PDF copy of the ROC tool can be downloaded from the 'resources' section.
- The Hydrate toolkit - This toolkit has been designed for staff in care homes and carers in the community. It provides a practical guide to help them assist older people in their care to achieve optimum hydration. The toolkit has been developed through collaboration between Kent Surrey and Sussex AHSN, Wessex AHSN and North East Hampshire and Farnham Clinical Commissioning Group (CCG). We hope the toolkit will inspire all those who read it to promote the importance of good hydration among older people and have the satisfaction of helping the individuals they care for achieve this aim.
Links to other useful information:
ILC-UK Hydration and Older People in the UK - a PDF report (produced by the International Longevity Centre-UK, on behalf of the Parliamentary Hydration Forum) to address the problem of dehydration in older people, and understand the solutions
NHS England Commissioning Excellent Nutrition and Hydration - a PDF report providing guidance to commissioners with regard to commissioning person-centred, clinically safe and integrated services for the nutrition and hydration needs of their population, in order to ensure all people receive safe and high quality nutrition and hydration support when required