Supporting older adults to drink more for their health

Dehydration can cause serious health problems, particularly for older adults and other vulnerable people. Despite this, the importance of effective hydration is sometimes overlooked, and preventative strategies for dehydration remain underutilised. 

Working in partnership with South West London Integrated Care Board, the HIN recently welcomed more than 850 delegates from across the UK to a series of events focusing on improving hydration.  

 In this blog, HIN Senior Project Manager Isabel Rodrigues de Abreu and the London Regional Hydration Programme Lead, Charlotte Trumper, reflect on recent work in this area highlighted during the events, and share some simple steps any professional working with older adults can take to avoid dehydration as we head into the hottest part of the year. 

 The importance of keeping hydrated can sometimes be undervalued by the public. We inherently know that drinking enough fluids and keeping hydrated is good for us, but do we know why?  

A proper understanding of hydration is especially important for people working with older adults; as we get older, the risks associated with not drinking enough increase and the signs that we would usually rely on to tell us that we are dehydrated are not as clear cut. Evidence shows that one in four older people are dehydrated.  

We’re all familiar with the proverb, ‘prevention is better than cure’ and when it comes to hydration the effects of dehydration can be quite severe for us personally and costly to the NHS.  

Drinking and remaining well hydrated helps us to: keep focussed and more alert, swallow and absorb medication, digest and process waste in our bodies, dilute our urine so that we don’t get a build-up of bacteria, and helps our bladder to function correctly. It also helps lubricate our joints, helps with the delivery of Oxygen cells and aids the manufacture of hormones and neurotransmitters.  

Conversely, being dehydrated can lead to several health and wellbeing issues. These include tiredness, dizziness which can cause falls, headaches, confusion, problems with our kidneys and infections such as urinary tract infections (UTIs).  

Sometimes worsening dehydration caused by excessive sweating, increased respiration, diarrhoea or vomiting and excessive bleeding, can cause serious complications such as sepsis, acute kidney injury, chronic kidney disease, pressure ulcers, constipation, an increased risk of stroke, and longer lengths of hospital stay. These can all lead to poor health outcomes and burden individuals with ill health and the NHS with associated costs. They can also cause death in frail, vulnerable individuals.   

For older adults – whose functional reserve is more likely to be compromised by comorbidities or frailty – the importance of managing hydration is further heightened by changes which naturally take place physically and to our social environment as we age.  

These include:

• We have fewer opportunities to drink as we engage in less social activities or live alone.  

• We may have difficulty getting our own drinks because of various health reasons so we rely on other people to support us to drink. 

• Our ability to feel thirst declines so being asked if we’re thirsty won’t get a helpful answer. 

• We become more worried about visiting the toilet and start to avoid drinking to reduce going to the loo. 

• Urine colour is often already lighter so is no longer a good indicator of dehydration. 

• If we are breathing more through our mouths because of respiratory problems, we will tend to lose more liquid in this way when we respirate. 

Making the hydration of older adults a priority 

NHS England’s Antimicrobial Resistance (AMR) Programme funded a hydration pilot in seven regions across England from 2022-2024. The aim was to expand the knowledge base as to which interventions could help drive up hydration and thereby reduce infections. The London region pilot was delivered by South West London Integrated Care Board (SWL ICB) who focussed on the #ButFirstADrink campaign targeting mostly the care home population. 

#ButFirstADrink was developed by a dietitian at Royal Cornwall NHS Trust. It is a very simple strategy for health and social care staff to encourage patients/residents to have a sip/drink every time they interact with them. For it to work, it needs the staff to be engaged, enthusiastic and prepared to change behaviours.  

The London pilot, which Charlotte led, reported: 

• An increase in the number of opportunities to drink.  

• A subsequent increase in fluid intake – averaging at 46%. 

• No London Ambulance Service callouts for Urinary Tract Infections for the last 4 months for those care homes taking part in the pilot. 

If you work within health and social care and you would like to implement #ButFirstADrink in your care setting, you are welcome to use these resources to train your staff: 

• Train the Trainer presentation 1 – Hydration Health in Social Care (PDF) 

• Train the Trainer presentation 2 – Dementia and Hydration (PDF) 

What can we do to support older adults to take on more fluids and keep hydrated?

 
Anyone working with older adults can take practical steps to improve the hydration of the people they care for. Many of these steps need no training or additional funding, but can make a significant difference in terms of outcomes: 
 

• Monitor fluid intake. It can be easy for people to lose track of how much they have drunk, so keeping a record of fluid intake removes guesswork around hydration. 

• Ask people if they would like a drink rather than asking them if they are thirsty. 

• Increase choice and availability of fluids so that people are more inclined to say yes to having a drink. 

• Help people find a drink they like so that they are encouraged to drink more frequently. However, you do need to be aware of drinks that are high in sugar or caffeine. 

• Checking-in regularly on preferred drinks to ensure that any changes in taste (e.g. as a response to changes in medication) are taken into account. 

• Encourage people to sip often and throughout the day. 

• Being aware of national guidance on hydration (between 6-8 glasses of fluids per day) and support people where they’re struggling to maintain this. 

• Serving drinks in preferred cups/glasses to make them more appealing. 

• Considering how to increase fluid intake through foods such as soup, fruits or vegetables. 

• Making drinking fun - offer social activities which can help increase fluid intake such as tea parties, making drinks together, taste tests etc. 

• Importantly, we need to remember that keeping hydrated goes hand in hand with going to the toilet. We need to remind people that we care for that it’s perfectly normal to go to the toilet several times a day, and reassure them that they will receive any support needed to do so.