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We never know the worth of water until the well is dry!

May 2021 might have been registered as the coldest May on record but that’s now a memory as the UK is welcomed a heatwave during June with soaring temperatures.  Here, leading meals provider apetito’s In House Dietitian, Emily Stuart, gives some advice as to the warning signs of dehydration, shares the importance of ensuring good hydration, and gives some helpful hints and tips as to how to keep residents well hydrated during these Summer hot spells….

While we tend to focus a lot of our time and energy on food — deciding what we’d like to eat for lunch or dinner — water is essential.  In fact, we can go up to 3 weeks without food but wouldn’t last more than 3 or 4 days without water.

And, as the weather finally gets into the Summer swing, care home’ teams will be very conscious of the need for good hydration for their residents during these hot spells. Many will be planning in advance of the sunshine.  And don’t let’s forget that care homes can be hot places to live, and that’s before the sun even makes an appearance. 

As we get older, adults are more vulnerable to dehydration due to age-related changes in our bodies.  Commensurately, residents may be more reluctant to drink adequate fluid for fear of incontinence or a desire not to visit the toilet so often.  It’s important to note that this is a common misperception.  In the long run, increasing fluid intake will not lead to more visits to the toilet. 

For care home teams, there are certain conditions prevalent among older adults which can reduce sensitivity to thirst sensations, e.g., Alzheimer’s or in people who have experienced a stroke.  It’s very important to monitor those individuals during hot spells to ensure they are ingesting enough fluids.

Hot weather and higher body temperatures can lead to increased fluid needs (as with any illness and spike in temperature), and therefore it’s importance that fluid intake is given a higher priority during these times.

In the UK, the Eatwell Guide suggests we should all aim for 6-8 glasses of water and other liquids each day to replace normal water loss – that’s around 2 litres a day.   Water, milk and sugar-free drinks, including tea and coffee, all count, but remember that caffeinated drinks like tea and coffee can make the body produce urine more quickly.   

Fruit juice and smoothies also count, but because they contain ‘free’ sugars (the type we are encouraged to cut back on), most residents should ideally not drink more than a daily combined total of 150ml per day.

There is also the question of ‘hidden hydration’.  This is fluid that we ingest from eating food.  Many of the foods we eat do contribute to our fluid intake – for example, dishes like soup, ice-cream and jelly, as well as fruit and veg with a high-water content, such as melon, courgette or cucumber.

How to tell if a resident is becoming dehydrated?

Signs and symptoms of dehydration in older adults requires a focus on several areas and it can be a challenge.

One of the warning signs to tell if a resident is becoming dehydrated is by checking the colour of their urine.  If it looks clear, or pale yellow, then that is a good sign.  But if a resident is passing smaller amounts of concentrated, strong smelling urine (usually darker yellow or an amber colour), then it’s often time to hydrate.  Darker urine colour can also be due to other things such as a side effect of medication, and therefore, is not always reliable as a sign of dehydration in older adults and it’s important to keep these others factors in mind.

Other warning signs can include thirst, headache, a dry mouth and lips, bad breath, a swollen tongue, experiencing tiredness or feeling lightheaded.  It can also make a person crave sugar and feel sluggish.

There are more severe symptoms of dehydration which need medical attention right away, such as a resident experiencing confusion, dizziness, heart palpitations or even fainting. 

Why it’s important to keep hydrated…

When a person drinks enough water, they’re helping their body function at its best.  They may even experience some impressive health benefits, which can include:

It helps us keep cool – when we overheat (whether because it’s a sunny day or a fever), our bodies produce sweat to cool down.  Sweat is mostly made of water, so we need to stay hydrated to keep us at the right temperature and replace those fluids lost as a result of sweating.   

Good hydration helps to keep muscles and joints to work at peak performance.  Because our cells work better when fully hydrated, it can increase the body’s ability to perform.  Water helps lubricate our joints, making it easier to move.

People who are well hydrated usually have regular bowel movements.  Hard bowel movements or constipation can be a sign that a resident is not getting enough water.  

Good hydration also can help in the prevention of falls.   Older adults who are dehydrated are more likely to have slips, trips and falls.

Handy Hints and Tips to ensure Good Hydration…

Recognising the warning signs and dangers of dehydration are all key to helping manage and prevent it.  Education of teams within care homes is very important, alongside encouragement, assisting, and prompting residents to drink more – the trick here is usually ‘little and often’…

Education is also valuable for families and residents themselves especially across elements such as they do not need to be worried about increased toilet use.  Increased drinking within recommended levels will not lead to increased need for toileting.  Working with family and friends is always at the forefront of good care.

It may sound obvious but it’s good for care homes to have the right drinking vessels and assistance on hand where needed.  Make sure that residents have access to drinks at any time, in a variety of places.  For non-mobile residents, ensure that drinks are always in reach and can be picked up with ease and safety.

Check on residents at regular intervals and check the colour of their urine and for other symptoms that they may be becoming dehydrated.

Giving residents choice is also very important.  Sometimes, plain water isn’t to everyone’s taste and sharing knowledge across the team that tea, coffee, other hot drinks, juice, squash, and milk all count toward overall fluid intake, can be very important and helpful.  How fluids are presented can make a difference too.  For example, “what would you like to drink’, and then offer a choice works much better than “would you like a drink” to which it’s easy to say; ‘no thanks’.

Social interaction can help residents drink more as we all like to chat and have a cup of coffee or tea whilst we are socialising.

Ensure good oral hygiene, as a sore mouth or teeth can be a deterrent from drinking.

Food can also help e.g. soups (making sure they don’t replace the main meal but complement it due to lower calorie and protein content of soups compared to a main meal), refreshing fruit salads, ice lollies good selection of fruit and vegetables alongside main meal components.

Keep a fluid chart for each resident and make sure the team knows that it should be kept up to date – and also to escalate up the line management if there is any concern.

Always Remember…

Staying well hydrated can really improve wellbeing and quality of life. Even mild dehydration can have a negative impact. 

Make sure YOUR residents are kept hydrated and healthy this Summer.

apetito is a leading provider of meals to the Care Home sector offering great food and a superb dining experience.  Check out how your business could benefit:  www.apetito.co.uk

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