Phillipa Atkinson-Clow, General Manager of The Water Dispenser and Hydration Association, explains how in hospital and care settings, the issue of dehydration is all too common
Fluid intake is fundamental to health and well-being. Yet in hospital and care settings where water should be readily available, it is all too often not prioritised.
It pays to hydrate people. It is scandalous that in the UK today, vulnerable people are dying of thirst. Apart from the human misery caused by dehydration, it costs the NHS and care homes dearly.
Despite public awareness of the benefits of good hydration, lack of fluid continues to affect vulnerable people, particularly the elderly population for whom UTIs and falls due to dehydration can cause dizziness and confusion. Dehydration leads to hospital admissions and prolongs stays in hospital. The thirst mechanism declines with age and so, for vulnerable elderly people, encouragement to drink can help maintain hydration levels.
Systems and training are in place, yet poor documentation, lack of communication, and nursing staff shortages means that this basic right can sometimes be overlooked.
Perhaps because hydration is such a basic right, research has been limited and continuous training on this aspect of care is lacking. The situation may have worsened during the COVID-19 pandemic, where care has been hindered by lack of visits from relatives.
Some solutions are simple. In hospitals, water is usually provided in plastic jugs where the fluid becomes unpleasant to drink. Often this vital water is left out of the reach of the patient. Even when the vulnerable person can reach, those who have dementia do not have the trigger mechanisms to know they need a drink unless encouraged to sip. In one hospital, for instance, a solution was found using coloured crockery, encouragement to drink and improve palatability of the water.
The Cross-Party Parliamentary Forum on Hydration (for the Elderly), led by Baroness Sally Greengross, sought to improve hydration awareness in different care settings. A report written by Dr Lisa Wilson for the International Longevity Centre (of which Baroness Greengross is the CEO). Hydration and Older People in the UK: Addressing the Problem, Understanding the Solutions drew up practical and sound actions such as the need to share good practice to ensure successful interventions. The Report concluded that hydration policies should be “mandatory with practices in place to monitor and evaluate these to ensure they are being carried out effectively.” Good hydration practice, it said, “must become a part of regulated and inspected care issues.”
The aim of all this is to banish cases like the tragedies that befell Norma Spear (71) and Anne Jones (77). Both died as a result of dehydration. Norma Spear died of thirst after five weeks and four days in a care home leading Birmingham’s deputy coroner, in 2013, to comment: “The failures I found are gross because they were so terribly simple.”
Yet lessons have not been learnt. As recently as January 2021, Anne Jones died in a hospital in Wales of multiple organ failure, triggered by dehydration amongst other factors, despite repeated daily pleas from her daughter to administer fluids – a non-medic to whom the symptoms were obvious, even on a video call.
If dehydration is so simple to prevent, why is care still lacking?
Some hospitals have hydration champions or nurse leads. But that is not enough. Hydration should be everyone’s job.
One recently retired hospital dietician believes that form filling, far from being a solution, is one of the problems. Fluid charts can be overly complicated, misunderstood, and not completed properly. She said: “There is no substitute for reviewing the patient’s symptoms. Is the mouth dry? Are the lips cracked? Does the tongue look wrong? Is the urine dark in colour? These obvious symptoms can be confirmed with lab checks.”
My Association believes that understanding the need is one part of the equation. We say: “The second part is to complete the service by knowing how to provide convenient and safe hydration. Potable water must be on hand. Whatever the means of providing water or other fluids, there is a need to service the machines or taps. It is essential to maintain the water source safely by making sure providers are audited to the highest standards. Risk assessments are necessary. Sanitisation of any touch points is a prerequisite and, in settings where people are immuno-compromised, extra safety precautions taken.”
Keeping carers hydrated as well as patients
Staff need to be well-hydrated too. On busy wards, that means having appropriately placed supplies and taps with potable water; or via conveniently located water coolers or dispensers. This is especially true when wearing hot PPE. Hydration breaks should be as much a part of working life as handwashing and mask-wearing.
The problem of dehydration is easily identified: It is one of the cheapest forms of treatment. The solution is easily provided. We need research, not into the problems caused by dehydration, but into how best to prioritise this life-saving solution. The scandal of patients dying of thirst must stop.
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