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Drinks are important in care
It is a basic and important part of maintaining health that we should all drink enough fluids throughout the day. However, this is one of the principles of nutrition which is often overlooked in providing care and support.
The Scottish Government guidelines say that a person should drink no less than 1.5 litres of fluid per day. This can be equivalent to 7 or 8 typical drinks, of e.g. tea or water during the daily routine. But it is important to note that this is a minimum. Research by the Royal Society of Medicine reported by the BBC last year showed that one in five older people living in care homes or on their own at home do not get enough to drink.
Effects of dehydration
The effects of dehydration are potentially very serious. Confusion, falls, lack of confidence, constipation, risk of pressure ulcers, increased infections, high blood pressure and heart disease can be among the outcomes.
Older people may not drink enough because their sense of thirst becomes less sensitive as they age. Another factor may be because they fear incontinence, or having to go to the toilet too often (or more worryingly, care staff may restrict drinks to cut down these visits). Forgetfulness may be a factor also, as well as some medical conditions which may mean the person needs to increase their fluid intake.
How can we address this problem for people being supported? One obvious step is to increase staff awareness of the nutritional need for fluids. A cup of tea should become not just a traditional break and sit-down, but a vital part of maintaining our health. Simple reminders to have a drink may often be enough to increase intake.
Include fluids in the nutritional assessment
Another important part of support is to include fluids in the nutritional assessment of people who are being cared for. Also, this assessment must be regularly reviewed, and any sign of decreased fluid intake should be urgently acted upon and monitored. Increased disorientation or anxiety should not automatically be taken as an inevitable part of ageing: perhaps the person is not drinking enough?
Where a person is reluctant to drink, alternatives can be suggested, such as increased fruit or salads intake, drinks of milk, soup or fruit juice.
More than the minimum intake of fluids should be aimed for given the possibility of missing a meal or not finishing drinks.
Greater awareness and training in this area should hopefully reduce the concerns which have been expressed in recent research.
Tony Clarke – QCS Expert Scottish Care Contributor