1. Dehydration can kill
An introductory session into the benefits of good hydration in older people

2. Session Objectives Understand the role of fluid in the body
The importance of enough fluid daily
Recognise the signs and risks of dehydration

3. Water is essential to life
"Water is a basic nutrient of the human body and is critical to human life”
World Health Organization - Water Sanitation and Health (WSH)
This is how the World Health Organisation se the benefits of the most basic and accessible of all fluids water.
End of course .. Only joking!

4. Almost 700 deaths in 5 years in care homes due to dehydration
667 residents have had dehydration recorded as primary cause of death the past 5 years. That’s almost two per week. You will find out later just how many other illness are caused by poor hydration.

5. How many of you have drunk a glass of water today ?
How many of you have had a drink of water today ? In fact how much have you had to drink ?
It is vital to your health as well as those in your care .
Today we are going to talk about ways you can add water to your daily routine and
why it’s so important that your body get enough water.

6. Hydration Awareness Quiz
Lets see how much you already know. Just for fun, I’m not marking it.
Take about 5 mins to go through the questions.
For those who didn’t read it properly as you’ll see from the top line the answers are on the bottom of the second side!

7. The Cost of Dehydration
Correct hydration alone could lead to savings of £0.95 billion
i.e in Leeds - Dehydration as the primary cause of treatment cost the local health care trusts £1.4 million in 2009
30% of people admitted to hospital are dehydrated
The cost to health and social care services of dehydration is almost 1 billion pounds. To give you an example of the problems in a city of 750,000 Leeds, it cost their health trusts 1.4 million to treat dehydration as the primary cause of illness, that is without the costs of all the other associated illness caused by poor hydration.
Across the country 30% of all people admitted to hospital are dehydrated and this needs treating along with the primary cause of their admission to hospital. Treating the fluid loss can add extra nights stays in hospital, and at 300 per night this vastly increases the burden on healthcare budgets.

8. Role of Fluids in the Body
Primary role to satisfy your thirst
Dissolves substances in our bodies
Acts as coolant, lubricant and transport agent
Regulates body temperature
Carries nutrients
Removes toxins and waste materials
Medium for cellular reactions
( all cells need water)
Its primary role to satisfy your thirst
That is important, but it’s not water’s most important job.
These are the other vital roles fluid is required for.
If you always wait until your mouth is dry to drink some water, then you may be waiting too long to drink.
Always remember to drink before you are thirsty and keep drinking until you no longer feel thirsty.

9. What happens to the fluid we drink
Water is lost daily:
Breathing
Sweat
Urine
Faeces
Point to remember -
The older the person the greatest risk of dehydration.
Often becoming dehydrated before they know it.
Your body needs a continuous supply of water.
This is how bodies lose water throughout the day, breathing and sweating can be over half a litre per day, urine can account for a litre and a half, whilst faeces will take up a smaller amount around 100 ml.
Older age in the UK is seen as over 65’s
The thirst sensation dimishes and continues to dimish in the over 50’s.

10. Identifying Dehydration
Thirst
Urine –
Colour
Odour
Painful
Reduced frequent
Dizziness
Fatigue
Clumsiness
Aching joints
Falling
If some on is thirsty, then this is the body’s mechanism telling you to have a drink and you are likely to be 1% dehydrated.
Another good way to make sure you’re getting enough water is checking to see that your urine is a lemon-colour instead of dark yellow.
If you have more than one incidence of dark urine let that be a warning sign to increase your liquids.
There are a few exceptions. For instance, some vitamin supplements or medications can turn your urine dark even if you are hydrated, so be aware of that also.
At 2% some of the following symptoms start to appear.
Some of the other signs are people feeling dizzy, always tired, clumsy .. Dropping things bumping into furniture, aching joints, falling over especially in older people. Research in the Anglia Water region has shown there is a direct correlation between fall and dehydration in residential care.

11. Identifying Dehydration
Skin flushing
Shriveled skin
Dry skin, mouth or chapped lips
Furrowed tongue
Dry and/or sunken eyes
Constipation
Drop in blood pressure
Rise in pulse
Weight loss.
Other symptoms –
flushed or shrivelled skin
Dry mouth chapped lips often leading to a furrowed tongue.
Constipation, water is vital in ensuring the stool is formed and can pass easily.
In hospital settings drops in blood pressure and rise in pulse rates can be noted.
Weight loss is another indicator as the body no longer retains water.

12. Identifying Dehydration
Loss of appetite
Difficulty swallowing
Lack of fluid intake
Headache
Drowsiness
Heat intolerance
Nausea and vomiting
Absence of sweat
Changes in mental status - confused
These are all further symptoms of dehydration.
The last one confusion is often caused by infections caused by poor dehydration i.e. Urinary Tract Infections (UTI)
Core cognitive processes can be disrupted, particularly working memory. Although it is commonly regarded as reversible, induction of confusion in people with dementia due to Alzheimer's disease appears to accelerate cognitive decline, suggesting that efforts to prevent and minimize the induction of confusional states in the elderly should be given high priority.

13. Reminders Use posters from Water UK website.
Downloads of A4 posters like this are available from the Water UK site – ( – water for health – resources – posters). A good reminder for carers and service users alike.

14. People in Care
They need at least 1.6 litres of fluid per day – 8 x 8 oz. cups .. the same as you! The heavier the person the more fluid they need
Every body needs the same base line of fluid intake, it is then our output e.g activity that determines how much more and when.
Older people need the same as us …. Eight 8-ounce glasses of fluid every day
The heavier a person the more fluid they need to intake as their bodies require more to function properly.

15. What are the problems and barriers to those you support not drinking enough water throughout the day ?
Any ideas ?

16. Fear of an Accident Plan the water intake
Toilets accessible
Go before the urge is too great
Reduce before bedtime
More fluid reduces the need to go
It’s not as concentrated!
Many older adults are hesitant about drinking more water because they fear having an accident.
Trips think toilet stops .. Yes Kath you really did say you’d do this course for me LOL!
As you can see from what we have talked about today, drinking less fluid is not the answer.
Let’s talk about some suggestions for how you can prevent accidents. When you’re at home or close to a restroom you, and residents, can drink more water than when you are far from a toilet!
It’s also always a good idea to go to the toilet when you have the chance to, even if the urge isn’t strong at that time.
Choosing a time a few hours before you go to bed to drink less water may help residents avoid an accident too.
Take a look at your daily routine to see what is best for you without cheating your body out of the water it needs.
Lets talk about some ways each of us can increase our fluid intake.
The more fluid you and residents drink the less you have the urge, as your pee is less concentrated so your bladder does not communicate to your brain that has a full load and needs to empty.

17. Dehydration is linked with ....
Pressure Sores
Constipation
Urinary Infections & Continence
Kidney & Gallstones
Heart Disease
Low Blood Pressure
Pressure Sores – poor hydration doubles the risk of these. Good hydration encourages healing. The cost of pressure sores is upto 25 K to treat.
Constipation – Inadequate fluid intake one of the major causes of chronic constipation. Risk higher in elderly people. Increasing water = increased stool frequency. Around 10% of district nurses time is taken with treating constipation or 1 in 10 visits and it is preventable through good hydration and diet.
UI’s & Continence – fluid helps maintain a health urinary tract & kidneys, through having enough good clear urine to flush out the UT. Evidence shows that restriction of fluid does NOT reduce incontinence. On average it costs 1,500 to treat a UTI with all the other complications and hospital admission related to this.
Stones – Reduces kidney stone risk by 39%. Water dilutes bile, stimulates bladder emptying & reduces gallstone risk though preevention f crystallisation
Heart Disease – reduces risk by 46% in men and 59 % in women. Protects against blood clot formation
B.P. – many old people on standing suffer drop of blood pressure causing passing out. Drinking a glass 5 mins before standing prevents this.

18. Dehydration is linked with …
Diabetes
Reduced Cognitive Impairment
Mental performance
Confusion
Falls
Hospitalisation in older people
Increased length with heart disease
Mortality increases two fold with strokes
Skin
Cancer – water helps dilute the toxins
Diabetes – Essential part of mgt of illness. High output of urine can increase risk. Good hydrations helps maintain blood sugar levels.
Cognitive – symptoms include light headedness, dizziness, headaches, and tiredness as well as reduced alertness and ability to concentrate. Once thirst is felt mental function will be affected by 10%, and increases as dehydration increases & reduces quality of life.
Falls – Dehydration is one of the risk factors in older people. Good hydration can prevent this, remember falls often lead to broken bones and long traumatic recovery.
Hospitalisation – two fold increase in mortality of hospitalised stroke cases. Long stay for community acquired pneumonia. If someone has had a stroke and are admitted to hospital dehydrated their risk of death increases.
Skin – Keeps skin health and good looking. Mild hydration causes skin to appear flushed, dry ,& loose. More noticeable on face than lower limbs.

19. The role of you the carer
Ensure fluids are freely available
Physically accessible
Encourage service users to drink –especially between meals
Consume more fruit & veg which are approx 80-90% water
Make sure drinks are available and accessible though out the day, we’ll find out more in a minute of ways of achieving this.

20. How to increase fluid intake
Have fluids readily available
Explain that decreasing fluid intake does not decrease incontinence
Offer fluids after providing care
Offer type/temperature of fluids people like
Involve family members
Offer small amounts of fluid frequently
Offer ice cubes
Provide good oral hygiene
Encourage people to drink all fluids offered with
meals and medication
Encourage fluid-rich foods
Keeps drinks readily available, keep delivering the message of why the service users need to drink more.
Offer the type of drink someone will take if it’s extra cups of tea, that’s okay, ideally it would be water or smoothies, but the aim is to increase intake. If it’s not drunk then there is no intake!!!
Good oral hygiene is vital to anyone drinking, if there is a problem in the mouth through the sensations of pain when drinking either hot or cold fluids people will not drink enough.
Always have a drink with a meal .. Water, squash or juice, then offer a drink after as well.
Encourage more fruit and veg to be eaten as this is high in fluid content.

21. How to increase fluid intake
Use lightweight water jug and cup
Use assistive drinking devices
Offer assistance if needed
Offer full cup of water with medications
Use verbal prompts when needed
Position person properly in order they can drink
Monitor room temperature
Add cup holders to wheelchairs
Give people water bottles to carry around
Take fluids on outings and offer frequently
Include beverage break in all activities
Remember the service user has to be confident in pouring water from a jug, if it’s lighter it is easier. If they can’t pour their own, offer to help.
Are there other devices that can help maintain their independence, or enable them to drink with out spilling ?
Provide a fuller cup or glass with medication, as it is likely to be consumed when a person is taking tablets.
When drinking or eating, ensure the person is sat up at 90 degrees so the drink will pass easily down the digestive system, and encourage the person to remain sat up for 30 mins after.
Make sure room are not too hot, and therefore dehydration the person. If the room is warm offer more drinks to counter act this.
If you are having an activity … craft, bingo etc. or meeting with a service user and their family , offer drinks

22. The benefits to you Less urine / incontinence to deal with
Less complex issues / support plans
If you put in place an action plan to improve the hydration in your care setting then these are the benefits to you as a member of care staff.
Add to this the improvement of the quality of life of those in your care and everyone is a winner!

23. Bottom slide !
Encourage service users to drink regularly .. Especially between meals
Drink a variety of fluids
Drink enough fluid through out the day
..and remember the more active they are the more fluid they need.
Increase fluids during acute illness & hot weather.
Hopefully you’ve taken enough of this fresh information on so you remember to do it yourself and help prevent dehydration in the future for both yourself and those in your care.
We’ve looked at the basics today so remember the more active a person the more food and water needed just to get by.

24. Any Questions ? internet details www.thenacc.co.uk www.water.org.uk
Thankyou
Any Questions ? internet details
Any questions ?
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