Improving hydration of care home residents by addressing institutional barriers to fluid consumption – an improvement project.

Abstract

Background: Older people are at risk of dehydration due to a wide range of age related physiological changes. Additional conditions such as dementia or physical frailty may contribute to low fluid intakes and further predispose the older people to dehydration. Care home residents are more likely to be admitted to hospital with dehydration, but there are few recent studies that evaluated the amount of fluids that residents consume or the barriers to hydration that they experience. Little is also known about the care they receive and how this may influence their fluid intakes. Objectives: To assess current hydration care in care homes, identify barriers to drinking adequate amounts and develop strategies to optimise fluid intakes in the older care home residents. Method: This study was conducted in one care home in London, which provides care to a multi-ethnic population of residents. The exploratory phase used observations, focus groups and questionnaires to determine how drinks were provided and to explore attitudes of staff and residents towards hydration care. The intervention phase used Model for Improvement framework to identify and test strategies to improve hydration for the residents. Results: Observations revealed that most residents consumed less than the recommended minimum of 1500ml of fluids. Hydration was not seen as a priority, and this resulted in several barriers that prevented staff to provide sufficient fluids, and the residents to consume them. Interventions were designed to overcome these issues and included: increasing the number of drink opportunities, improving preference compliance and introducing a new drinking equipment. During the testing, most interventions resulted in the residents consuming more fluids, but sustaining these interventions was difficult. Barriers to sustainability included poor leadership and task-oriented work culture. Conclusions: This study demonstrated that fluid intakes in care home residents are suboptimal. This is mostly due to insufficient number of opportunities for the residents to obtain drinks as well as not receiving adequate assistance and preferred drinks. Interventions which target these barriers have a potential to increase fluid intakes. Care homes need to implement appropriate strategies, but this requires organisational commitment with support from senior managers and strong leadership at operational level.