Promoting Health and well being The role of Nutrition and Hydration

The facts Dehydration is prevalent in elderly care home residents 1 in 5 care home residents are dehydrated (DRIE study) 70% of people with dysphagia are at risk of dehydration There is no individual test to recognise dehydration ~80% care home residents are prescribed laxatives

An adequate fluid intake will help to: Keep service users, residents and staff well hydrated Improve quality of life and well being Reduce the incidence of constipation, urinary tract infections, falls Maintain normal body temperature Prevent headaches, confusion, dizziness and irritability. Free up staff time to spend with residents

Fluid requirements will be affected by: Warmer weather conditions Clothing Extra physical activity Vomiting and diarrhoea Large stoma output or wound exudates Some medication e.g. Diuretics Personal preference/taste

Residents and service users most at risk are those who: cannot independently maintain an adequate fluid intake avoid drinking due to incontinence require assistance/adapted equipment to eat or drink. choose to remain in their own room have dysphagia and require either a  texture modified diet or thickened fluids forget to drink/ have a reduced stimulus to drink

Constipation: a common problem, linked to: reduced intake of foods that are rich in fibre e.g wholegrain bread, cereals, pulses etc Reduced/insufficient fluid intake decreased physical activity decreased physiological function e.g. reduction in peristalsis of the bowel Some medicines e.g. opiates

What can you do to help? Encourage and support residents/service users to eat more foods that are naturally rich in fibre, eg fruit, vegetables, wholegrain breads and high fibre breakfast cereals. Encourage and support individuals to take more fluids if more fibre is taken. Discuss what food and drinks residents would like to be offered and in what format: offer tasting sessions; plan menus together; use reminiscence activities

How much is enough? No national recommendations on fluid intake Care inspectorate suggests min 1500ml/day Aim for 30ml/kg/day (> 65) or 35ml/kg (<65) (BAPEN) Remember to offer more: in higher temperatures, if pyrrexial, during D@V If in doubt, keep a fluid balance chart, comparing with the day’s target.

Supporting improved fluid intake Offer drinks as part of a daily routine Include drinks as a means of socialising e.g. Pot of tea for two Avoid taste fatigue; have trial sessions of new types of drinks/flavours Offer drinks before breakfast Encourage more fluids with medicines Support individuals to take a drink with each meal or snack and at bedtime

Useful strategies Consider puddings and soups, which have a higher fluid content In warm weather, offer ice cream, jelly, ice lollies, crushed, flavoured ice Have small fridges around the home making access easier and encouraging independence. Focus on what the resident prefers (hot or cold drinks, flavours, timing of drinks etc)

Menu planning Instead of: White bread White rice Potatoes Puddings Try: 50:50, bread rolls, oatcakes, wheat crackers Brown rice or white rice cooked with peas or corn Salad potatoes, potato wedges or cubes cooked in skins Chopped, bite size fruit slices; dried fruit or fruit cake

Useful references DRIE: http://driestudy.appspot.com BDA : https://www.bda.uk.com/foodfacts/home RCN Hydration best practice toolkit: www.waterforhealth.org.uk