Hydration at Home

Dehydration is a concern in older people due to the potential adverse effects on function and clinical outcome. Common complications include constipation, pressure ulcers, urinary tract infections, and dizziness leading to falls and fractures. As the majority of cases of dehydration in older people is caused by prolonged inadequate oral fluid intake, our hydration projects have aimed to raise awareness of good hydration to improve health and wellbeing in those who are being cared for in the community.

Hydration in older people is a complex problem for a number of reasons. Physiological age related changes in the body systems will naturally leave an older person more susceptible to dehydration (e.g. reduced thirst mechanism; reduced kidney function). In addition it is not uncommon for individuals to suffer with health issues or to take medications which restrict the ability or desire to drink fluids. There may be social and psychological components which can reduce motivation to drink through loneliness or fear over frequency and continence issues. Finally, some older people will find find it physically difficult to get (e.g. mobility issues affecting ability to make and get drinks; dexterity issues affecting ability to pick up drinks and cups). 

Improving hydration in Care Homes

A project to improve hydration and associated outcomes was launched in 16 Hampshire County Council care homes (plus one other home based in Portsmouth, but being managed by Hampshire County Council) in April 2018, where staff from each home were trained as Hydration Champions. The role of 'Hydration Champion' involved raising awareness around hydration within their homes, and actively encouraging staff and residents to work together to achieve optimal or optimum hydration, with a focus on fun and creativity. Rather than recommending a set amount of drinks per day, the Hydrate approach talks about 'optimum' and 'optimal' hydration; 'optimum' hydration is the consumption of sufficient fluids to replace the fluids lost each day, whereas 'optimal' hydration is achieving the best level of hydration for an individual dependent on their current circumstances, even if this doesn’t lead to optimum hydration. 

Our project was based on The Hydrate in Care Homes Project, which was developed by Kent Surrey Sussex AHSN based on the initial work by North East Hampshire and Fareham CCG in 2014. 

The following files can be downloaded from the 'resources' section:

• The executive summary highlighting what we did, what our key findings were and our call to action (published in January 2020)
• The full evaluation report, published in January 2020
• Presentation slides from the launch event
• Hydration Champion training resources - training was developed and delivered by Hampshire County Council's PaCT team, and they have kindly allowed us to share their training resources on this page. Please note that the training resources are available from the 'resources' section, and will download as a .zip file for your convenience. Use WinZip (often installed as standard on PCs) or Windows Explorer to open, extract and save the files. Should you encounter any problems, please click the Contact Us button below. 
  

Improving hydration in domiciliary care

Wessex AHSN (in collaboration with Hampshire County Council) carried out a three-month feasibility project in 2018. The objectives were:

a) to evaluate the provision of training to a small group of staff (carers and team leads) from one agency in Havant, Hampshire, on the importance of good hydration, how to improve hydration in the domiciliary care settings, and an overview of the project, including outcome measures to be collected - to view the training resources (including slides, session plan and evaluation resources), please download the .zip file in the 'resources' section

b) to evaluate the use of different aids to assess and improve hydration, including the Drinks Diary, ROC (reliance of a carer) to drink tool, coloured coasters and the Droplet smart hydration system

c) to complete a structured evaluation of the project with learning that could be translated into a larger pilot in 2019. To view the completed evaluation report, please download this from the 'resources' section

Following the analysis of this feasibility trial, changes were made to the approach, which included simplifying data collection forms and improving communication channels with carers. A six-month project was started in August 2019 with two branches (Apex Prime Care Havant and Portsmouth). The project involved recruiting older people receiving care at home, carrying out some baseline data collection on perceived health and wellbeing, amounts drunk and reliance on a carer to drink. Training was provided in November to both agencies - which included the importance of hydration, how to improve hydration and how to provide person-centred care as a result of a hydration assessment. Data collection was repeated post intervention (March 2020) to see if there has been any difference in outcome measures. The evaluation report from this project was published in July 2020. This work is of interest nationally and outcomes will be shared with the National Hydration Network, of which we are an active part of. The latest information from the National Hydration Network can be found here: National Hydration Network Annual Conference 2021

The project documentation, including the training slides, data collection forms, questionnaires and focus group guide can be downloaded from the 'Domiciliary Care Project Files (.zip)' file in the 'resources' section.

Wessex AHSN has worked in collaboration with Hampshire County Council to produce the Hydration at Home e-learning toolkit. This toolkit has been designed for community carers (although the key messages are suitable for all carers, including those in acute care settings). The toolkit includes an e-learning module (hosted by Health Education England and Hampshire County Council for their internal staff), links to recommended resources, 'Grandad's Story' (a case video showing how easy it is to get dehydrated) and our resources (as shown in the above section). For more information, please visit our Hydration at Home Toolkit page.

Trialling Droplet on the Isle of Wight

The Isle of Wight Technology Enabled Team trialled the use of Droplet (a smart hydration aid) with residents in four of the island's care homes. Wessex AHSN was approached to help write up the evaluation report to highlight the findings from their work. The trial showed that using Droplet improved fluid intake (by around 169ml per day, representing a 12.7% increase on baseline) and enabled more residents to achieve their recommended daily fluid intake (this appeared to be through a combination of reminding residents to drink through the light and/or voice features, and also prompting care staff to remind residents to drink). A limited number of resident stories and feedback from care staff provided anecdotal evidence suggesting that Droplet also helped facilitate an improvement in health and wellbeing, e.g. increased alertness and reduced UTIs. The work also suggested several design limitations that could be considered for further product development, such as the addition of handles and spout. A copy of this evaluation report can be downloaded from the 'resources' section on this page.

Links to useful information and resources:

• Top Tips for Tricky Times - Top tips on eight topics, displayed on one side of A4, which can be easily printed off. Designed to support care home staff during the pandemic. Topics include 'Hydration and Covid-19' and 'supporting residents at End of Life care where there is uncertainty'
• Staying hydrated during self-isolation - Suite of four posters / images from NHS West Hampshire CCG. These have been designed to help give simple good hydration advice to people who are self-isolating and can be accessed from the Resources section on the right (downloads as a .zip file)
  
• The Hydrate toolkit - This toolkit has been designed for staff in care homes and carers in the community. It provides a practical guide to help them assist older people in their care to achieve optimum hydration. The toolkit has been developed through collaboration between Kent Surrey and Sussex AHSN, Wessex AHSN and North East Hampshire and Farnham Clinical Commissioning Group (CCG)
• Good Hydration! Improving hydration for care home residents - this is a set of short films from Oxford AHSN which aim to help care home staff keep their results happy, healthy and hydrated. The six short animations offer handy hints and link to additional resources available through the award-winning Good Hydration! initiative.
• I-hydate toolkit - a downloadable resource pack to help support hydration in care home residents
  
• DrinKit toolkit - this resource, produced by the University of East Anglia, is a 4-part guide which helps support hydration among older people living in care homes, including their 'making drinking fun activities and engagement toolkit', hydration training and a hydration champion team training manual
  
• Hydration Care Consultancy - this website contains information on the 'Reliance of Carer' (ROC) tool, a simple tool to highlight the level of support an older person needs to obtain good hydration