Hydration and Dignity

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12 July 2013

Hydration and Dignity

I have recently been involved in two events relating to hydration for the elderly. The first one was the launch of the Nutrition and Hydration strategy for Dorset council. I was invited to speak on the link between nutrition, hydration and dignity. The slides from my presentation are available HERE.

The second event was the network meeting of the European Hydration Institute. This meeting was held in Barcelona on 26th June 2013. It was a very hot and humid day with temperatures soaring to 27 degrees, what better day to emphasise the need for hydration. Several speakers from across Europe talked about their research in the field of hydration. It was fascinating to see how the right amount of hydration can prevent major illnesses such as heart diseases, kidney impairment and even maintaining general well-being. The issue of reduced ability to recognize the feeling of thirst was also highlighted and the need to ensure a healthy fluid balance (ratio of input vs output of fluid) of the person was mentioned.

In addition to the scientific aspects of hydration and their impact on the health of elderly, the issues around the barriers to hydration such as easy access to drinks and help with drinking were also discussed. I raised the issue of privacy and dignity such as not being able to get to the toilet in time and thus having an accident as a main cause for some elderly to reduce their intake of fluids. Older people above a certain age tend to develop a weakness of the bladder and may also have mobility problems which may make them concerned about drinking fluids particularly at night.

Lack of sufficient hydration can cause urinary tract infection, dehydration and confusion sometimes leading to falls. In many cases people with dehydration may end up in hospital thus exposing themselves to infections such as MRSA etc.

Some points to remember about hydration and elderly as highlighted by the European Hydration Institute are

• People usually drink in response to thirst, but by the age of 60, if people only drink when they are thirsty, they may not get as much water as they need.

• Renal concentrating capacity generally declines with the age, leading to an increased loss of water via urine.

• Diminished appetite and poor food choices may lead to a reduction of fluid intake from food.

• Some older adults may suffer from poor memory, immobility, or illness which may affect fluid intake. In addition, certain medications can also block the thirst mechanism.

• Dehydration can cause serious problems in older adults. Elderly people are at greatest risk of dehydration and its potentially life-threatening consequences: People aged between 85-99 years are 6 times more likely to be hospitalised for dehydration than those aged 65-69 years.

• Chronic dehydration constitutes a serious problem and is associated with an increased risk of falls, urinary tract infections, dental disease, bronchopulmonary disorders, kidney stones, constipation, and impaired cognitive function.

Being able to access and enjoy the drinks without worries about toileting are fundamental to dignity of the persons we care for. Helping Hands Live-in Carers are in a very good position to encourage their customers to drink and make it a social time. A sip of drink in time may avoid a drip in the hospital so please be mindful about the hydration and dignity for elderly particularly in summer months when it gets really hot.

A special mention must be made of those with dementia who may need help from skilled carers to ensure that they are not dehydrated. A bit of encouragement in addition to leaving a drink by their bedside may help ensure that they are sufficiently hydrated.

There are many useful resources available on the European Hydration Institute website

I would be interested in hearing the opinions of our staff especially those caring for people with dementia as to what gets in the way of providing good hydration for older people. A final point that while it is important to ensure hydration for the elderly it is equally important for our carers to drink the required amount to keep themselves hydrated.

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