Older adults are more susceptible to water imbalance and ensuring they drink sufficiently is a complex and challenging issue for nurses. The factors that promote adequate hydration and the barriers which prevent older people from drinking are not well understood.
This study aimed to understand the complexity of issues associated with the hydration and hydration care of older people.
A qualitative study using multiple methods.
Two healthcare sites providing care for older people in the South West of England: a hospital ward in a major hospital and a care home providing personal and nursing care.
Twenty-one older people aged 68-96 years, were recruited to the study from the hospital ward and care home. The inclusion criteria for older people to participate were men or women aged 65 years and over and the exclusion criteria were being unable to provide informed consent, or being too ill or distressed to take part in the study. The staff participants of nurses and health care assistants totalled 21. The inclusion criterion for staff was any nurse or health care assistant providing hydration care. Seven friends or relatives participated by making anonymous comments via a suggestion box available to all friends and relatives.
Data were collected via interviews with older people, focus group discussions involving staff, suggestion box comments made by friends and relatives and twelve hours observation of hydration practice. The data were analysed using thematic analysis.
Health professionals successfully employed several strategies to promote drinking including verbal prompting, offering choice, placing drinks in older people’s hands and assisting with drinking. Older people revealed their experience of drinking was diminished by a variety of factors including a limited aesthetic experience and a focus on fluid consumption rather than on drinking as a pleasurable and social experience.
The rich and varied dimensions usually associated with drinking were lacking and the role of drinking beverages to promote social interaction was underplayed in both settings. Hydration practice which supports the individual needs of older people is complex and goes beyond simply ensuring the consumption of adequate fluids.
Many older adults do not drink adequate amounts of fluids.
Drinking is a complex activity involving a variety of physical and psychological factors.
The aspects of current hydration practice which improve oral hydration in older people and those features which deter drinking are poorly understood.
What this paper adds
Hydration care tends to emphasise fluid consumption rather than the pleasurable and social benefits of drinking thereby neglecting the complexity of the intervention.
The factors which contribute to older people’s diminished experience of drinking have been identified.
These findings provide insights into the future development of hydration care which goes beyond simply ensuring the consumption of adequate fluids.
Drinking water and other fluids is fundamental to health and well-being regardless of the person or their situation. However age-related changes make older people more vulnerable to water imbalance and many older adults do not reach their recommended daily intake of oral fluids (Keller, 2006). Drinking is a complex behaviour involving multiple physical and psychological factors played out in varied social environments. The factors promoting adequate hydration and the barriers which prevent older people from drinking sufficiently in healthcare institutions are not well understood.
Getting older adults to drink is a complex and challenging issue for nurses (Alford, 1991, Zembrzuski, 1997) and preventing dehydration in older people is important for health professionals working in both hospitals and care homes (Archibald, 2006). Suboptimal hydration is associated with increased susceptibility to urinary tract infections, pneumonia, pressure ulcers, confusion and disorientation (Chidester and Spangler, 1997, Mentes, 2006) whilst adequate hydration is associated with fewer falls, lower rates of constipation, better rehabilitation outcomes in orthopaedic patients and reduced risk of bladder cancer in men (Michaud et al., 1999, Mukand et al., 2003, Robinson and Rosher, 2002). Although the health benefits of proper hydration are well established, dehydration is prevalent in both older hospitalised adults and residents of care homes throughout the developed world (Haveman-Nies et al., 1997, Joanna Briggs Institute, 2001, Mentes, 2006). Specific interventions for improving oral hydration in older people are poorly understood (Hodgkinson et al., 2003, Ullrich and McCutcheon, 2008). The straightforward approach to improve hydration status is for older people to consume adequate fluids. Whilst a minimum fluid intake of 1500ml per day for older people is proposed (Hodginkson et al., 2003, Mentes, 2006, WHO, 2002), there is no single recommended daily intake (Hodginkson et al., 2003) since the optimal amount depends on various factors including weight, health status, and energy expenditure (Simmons et al., 2001). Drinking is a complex behaviour determined by many interrelated factors (Köster, 2009) and controlled by homeostatic mechanisms and non-homeostatic controls including social, psychological and environmental influences (Kenney and Chiu, 2001). Both drinking and hydration care could be considered complex activities given the combination of possible influences, potential interactions and variable outcomes (Richards and Borglin, 2011). The aim of this study is to investigate the complexity of issues associated with hydration and hydration care of older people by exploring older people’s experiences of drinking fluids and health professionals’ beliefs and behaviours regarding hydration care.