Cornwall Hydration Project focused on solving the long term problem of dehydration in elderly & vulnerable care Innovator and lead Naomi Campbell RGN Supported by NHS Innovations South West and Peninsula Community Health CIC ©2012 Naomi Campbell- Cornwall Hydration Project

©2012 Naomi Campbell- Cornwall Hydration Project Every day thousands of vulnerable elderly people are suffering with the effects of dehydration The associated costs to our NHS is estimated to be billions per annum ©2012 Naomi Campbell- Cornwall Hydration Project

All Parliamentary Hydration Forum Cornwall Hydration Project: National Profile 2010 -2012 All Parliamentary Hydration Forum House of Lords

2011 Naomi was commissioned by the Nursing Times Author Naomi Campbell 2011 ©2012 Naomi Campbell RGN Cornwall Hydration Project

Dehydration in elderly care is avoidable... How? By simply encouraging and helping our vulnerable elderly population to drink adequate daily fluids Solving this avoidable problem must be made a healthcare priority The following slides provide an over view of the scale of the problem ©2012 Naomi Campbell- Cornwall Hydration Project

©2011 Naomi Campbell- Cornwall Hydration Project-VIP Helping a patient to drink... Very little has changed over the past 50 years! Helping a frail elderly or vulnerable person to drink... Is NOT always a simple task... Above all it needs ‘time, kindness & patience’ ©2011 Naomi Campbell- Cornwall Hydration Project-VIP

What do I mean by the term avoidable dehydration? ‘Where dehydration could have been prevented or treated by simply giving the patient enough to drink according to individual needs’ Universal agreement suggests a minimum of 1500mls per day is needed to prevent the onset of dehydration © 2012 Naomi Campbell 'Cornwall Hydration Innovation Project'

©2012 Naomi Campbell- Cornwall Hydration Project A reminder... This study from 1984 highlights that dehydration is a long term global problem in health care 2012 – dehydration remains a persistent problem & is escalating along with the aging population ©2012 Naomi Campbell- Cornwall Hydration Project

2005 Despite many initiatives – why does dehydration remain a problem? HOW Can we support our ‘carers’ To Solve this problem WHY Is it still a Problem ? How much longer must elderly people suffer 2005 ©2012 Naomi Campbell- Cornwall Hydration Project

Cornwall Hydration Project Provides a global ‘Birds Eye’ view of the problem of dehydration... The UK is not alone – Dehydration of Vulnerable Infirm Patients is an International problem USA & Australia have led nursing research But More research is desperately needed.. Europe is working together through the Cornwall Hydration Project - Naomi Campbell © 2012

Ageing Population (millions) % UK population This shows Government population projections from 2010 to 2035. Key impacts are that those who have the largest costs to the NHS are set to increase significantly. Population of : Over age 60s will increase by half. Over 75s will increase by 80% Over 85s will increase to 2.5 x the 2010 total from 1.4m to 3.5m. REF: http://www.statistics.gov.uk/hub/population/ageing/older-people ©2012 Naomi Campbell- Cornwall Hydration Project

more will require help to drink & eat 1000’s more will require help to drink & eat ©2012 Naomi Campbell- Cornwall Hydration Project

We know the risk factors Tdddd Dependent on Carers to safely hold a cup Reduced thirst response Reduced mobility ↑ Demands on Carers “ the Nurses are so busy” ↑ Need for toilet ↑ Disturbance and pain Drinks out of reach Too heavy to handle Loss of Dignity Dementia / Diuretics / Age / Disabilities COPD Swallowing problems Cornwall Hydration Project - Naomi Campbell © 2012

Dehydration why is it so complex? No gold standard to measure or define dehydration Normal Age related changes can mimic dehydration symptoms No absolute agreement on how much individuals should drink Blood & urine tests can not reliably detect early stages of dehydration © 2012 Naomi Campbell 'Cornwall Hydration Innovation Project'

Universal agreement Dehydration can be prevented or treated by having enough to drink (approx 1600mls ) We already know the risk factors... But still the problem is increasing! Simple well know symptoms provide a good indicator of hydration e.g. Urine colour / dry mouth Monitoring how much people are drinking is vital © 2012 Naomi Campbell 'Cornwall Hydration Innovation Project'

But we can safely say it is costing the NHS billions! What is the actual cost of dehydration? Nobody really knows as dehydration is often not cited as a primary cause But we can safely say it is costing the NHS billions! ©2012 Naomi Campbell- Cornwall Hydration Project

Early signs of dehydration Helping a person to drink – saves lives and saves money Early signs of dehydration Confusion / delirium Pain & frequency Increased nursing care High temp / malaise Anti-psychotic medications GP - Antibiotics Acute Admission Urine Infection Enemas Indignity Laxatives Loss appetite Constipation Acute Admission Malnutrition Loss appetite Loss of confidence Loss of independence PRESSURE ULCERS Reduced mobility Injury Acute Admission Dizziness & Falls Fractures 999 A&E Admission Surgery Rehab Discharge IV fluids Antibiotics Higher skill mix Medical expertise Multiple medications Length of stay & Costs Risk Hospital Acquired Infections Morbidity & Mortality © Cornwall Hydration Project – Naomi Campbell RGN 2012

Dehydration is directly linked to Malnutrition Falls Pressure Ulcers Urine Infections Constipation Increased length of stay Increased morbidity £7.3 billion per annum £0.15 billion £2.1 billion £1.24 billion £0.6 billion £ unknown Ref:NHS III 2009 ©2012 Naomi Campbell- Cornwall Hydration Project

©2012 Naomi Campbell- Cornwall Hydration Project What can Cornwall Hydration Project offer to solve this long standing problem? Raise awareness about the daily challenges of ‘Helping an elderly person to drink enough’ A review of current practice Highlight the weakness and gaps in the current systems and processes that supports hydration care Developing innovative new measures to improve assessment / monitoring / equipment / staff training & health promotion ©2012 Naomi Campbell- Cornwall Hydration Project