1. Promoting Health and well being
The role of Nutrition and Hydration

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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
If in doubt, keep a fluid balance chart, comparing with the day’s target.

9. 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

10. 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)

11. 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

12. Useful references
DRIE: BDA : RCN Hydration best practice toolkit: