Beverage Intake and Drinking Patterns—Clues to Support Older People Living in Long-Term Care to Drink Well: DRIE and FISE Studies

Abstract

Low-intake dehydration, due to insufficient beverage intake, is common in older people and associated with increased mortality and morbidity. We aimed to document the drinking patterns of older adults living in long-term care and compared patterns in those drinking well with those not drinking enough. One-hundred-and-eighty-eight people aged ≥ 65 years living in 56 UK long-term care homes were interviewed and hydration status was assessed in the Dehydration Recognition In our Elders (DRIE) study. In 22 DRIE residents, the Fluid Intake Study in our Elders (FISE) directly observed, weighed and recorded all drinks intake over 24 h. Twenty percent of DRIE participants and 18% of FISE participants had low-intake dehydration (serum osmolality > 300 mOsm/kg). Mean total drinks intake was 1787 mL/day (SD 693) in FISE participants (2033 ± 842 mL/day in men; 1748 ± 684 mL/day in women). Most drinks intake was between meals (59%, including 10% with medications). Twelve (55%) FISE participants achieved European Food Safety Authority drinks goals (3/6 men drank ≥ 2.0 L/day, 9/16 women drank ≥ 1.6 L/day). Those drinking well were offered beverages more frequently and drank more with medications and before breakfast (beverage variety did not differ). Promising strategies to support healthy drinking include offering drinks more frequently, particularly before and during breakfast and with medication.

Hydration Interventions for older people living in residential and nursing care homes: overview of the literature

“…Within this population, those with dementia or cognitive problems experience exacerbated difficulties with drinking 8-10. Jimoh et al 21 reported on the Dehydration Recognition In our Elders (DRIE) and Fluid Intake study in the Elderly (FISE) studies and concluded that overall drink intake is too low in care homes. Inadequate fluid intake can lead to many health problems, such as headaches, lethargy, inattention and dizziness 22 and even decreased quality of life, morbidity and mortality for those with dementia [23][24][25] .…”

“…There is a need for further understanding of what hydration practices and processes are effective in increasing fluid intake by care home residents. Jimoh et al 21 offer a detailed insight to drink patterns in care homes and argue that offering more drinks frequently in sufficient quantities, particularly before and during breakfast and with medications, is necessary for residents to meet daily fluid requirements. This team also stress the need for research to assess the effectiveness of hydration strategies on fluid intake and health outcomes.…”

What Serum Sodium Concentration Is Suggestive for Underhydration in Geriatric Patients?

“…There is a need to establish simple measures that could help in the screening for low-intake dehydration in geriatric patients and alert carers early enough that fluid supply is insufficient and that there is a risk of underhydration. This would allow for timely intervention before low-intake dehydration occurs [18]. Additional questions that may be asked are whether other, selected osmolytes can also possibly be used for screening dehydration resulting from insufficient fluid intake; and what concentration values of these substances should be used as limit values for the initial assessment of underhydration in older patients.…”

Intravenous Fluid Administration

“…Nonetheless, noninvasive interventions were confirmed to be more efficient given their simplicity of application and had fewer adverse effects (Masot et al 2018). Those drinking well are also offered beverages more frequently and drank more with medications and before or during breakfast (Jimoh et al 2019). In institution settings, it should be recognized that intravenous fluid administration is often difficult in practice, and the practice of timely oral fluid administration will help prevent or minimize morbidity and needless expensive hospitalizations.…”