Four years ago I started a PhD investigating ways of trying to prevent dehydration in older people living in care homes. Dehydration is linked to poor fluid intake – when people don’t drink enough for their needs, but that is a simplistic view of a complex problem, and one that we need to understand more about because dehydration in older people is common.

Media reports sensationalise incidences of older people being admitted to hospital with dehydration, particularly those that have been living in care homes. But why is this? Is it just due to poor care, as the media would like us to think? The answer is that it is far more complex than that, and although poor care may be a contributory factor in some cases, there are many reasons why older people may become dehydrated, and it is probably more common than we think. We know that 1 in 5 older people living in care homes is dehydrated, but a study in the US also showed that older people living in the community had reasonably high levels. One reason for this may be that there are higher numbers of older people with medical conditions, but another major reason is that as we get older, we are just more prone to getting dehydrated because of physiological reasons. This is because we don’t feel thirsty until a later stage, our kidneys don’t function so well, so we produce more dilute urine (so we need to go to the toilet more often) and our bodies store less water, so there is less in reserve. This means that as we get older we need to drink more frequently. But as we get older we often need more help with drinking, whether that’s making a drink, carrying it somewhere comfortable to sit and drink it, remembering to drink or actually needing physical help with lifting a cup.

So how will a study ‘Thinking about Drinking’ help? In this study, I asked care home residents, their families and care staff to take part in focus groups to think about and talk about drinking (drinking of any kind – tea, coffee, water, cold drinks and alcohol), what kinds of drinks they liked and disliked, how they liked them served, the times when they may have particularly enjoyed a drink and the times when drinking may have been a less enjoyable experience. I was also interested in the kind of help residents said they needed and the kind of help staff and families were able to provide and if there were any types of help that they felt was needed but didn’t seem to happen, and what the reasons for that may be.

The focus groups all took part in care homes, and the ENRICH coordinator in Norwich helped to put me in touch with care homes who were willing to take part, which was great –  I think that the coordinator did a great job in helping and supporting both the care homes and me to work together to make the study happen.

I had some really interesting conversations with people (residents, families and care staff), and learnt so much about their views and experiences – what people thought about drinking both now and throughout their lives. For all of us, our views and past experiences influence the way we live, which includes our attitudes, memories and thoughts about drinking. If we can understand a bit more about the context in which residents drink and what influences their carers, who are providing help with drinking, then that may help us do a better job of preventing dehydration.

I am writing up the findings from this study, but some of the interesting observations were the way in which residents particularly, reminisced about their family life and the times that visitors called and they all sat and had a drink together – usually tea! Families described some of their distress about seeing their loved one become so dependent, and their worries about whether they were getting enough help to drink. Care staff talked about some of the frustrations involved in caring, especially when residents refused to drink or when they were faced with dilemmas about care and there was not enough time or staff, so care needs had to be prioritised. Care staff were particularly upset by media reports which reported cases of dehydration following on from poor care, suggesting that this could be found in many care homes and without any understanding of the difficulties sometimes faced by care staff when delivering care.

So what’s next? The residents, families and care staff who took part in the study have provided some unique insights into the kinds of issues which influence residents’ drinking and carers’ approaches to care. I hope that when I have finished writing up the findings from this study we will be able to build on these insights when thinking about new ways to help residents drink well, and so prevent dehydration in this group of people.

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Diane Bunn MSc, BSc (Hons), RGN, RM

Diane is a nurse, midwife and researcher, working at the University of East Anglia, UK as a Research Assistant and PhD student.  She works with Dr Lee Hooper on the Dehydration Recognition in our Elders (DRIE) study (http://driestudy.appspot.com/), which aims to develop a practical screening test to detect early dehydration in older people living in residential care. Diane is working on a mixed methods PhD investigating the diagnostic utility of commonly used tests to detect dehydration, a systematic review examining the effectiveness of interventions and associations to increase fluid intake or prevent dehydration and the third part is an exploratory qualitative study using focus groups to explore the views and experiences of care home staff, residents and their families to increase our understanding of issues surrounding drinking – what may help and what may hinder residents from drinking well.

Prior to joining the UEA, Diane was a research nurse and Clinical Manager of the Norfolk Arthritis Register, a longitudinal observational study of inflammatory polyarthritis (IP) aiming to establish the cause, incidence and outcome of IP. She was responsible for a team of nurses and support staff involved in data collection. This involved recruitment from primary and secondary care, and follow-up of the 3,500 participants recruited since 1990.

Contact: d.bunn@uea.ac.uk, +44 (0)1603 59 1966

Publications: https://www.uea.ac.uk/medicine/people/profile/d-bunn