Understanding, recognising and preventing dehydration in older residents living in care homes: a mixed methods study

Abstract Aim To recognise and understand how to prevent water-loss dehydration occurring in older people living in care homes. Background Water-loss dehydration is common and linked to poor drinking, but prevention is likely to be multi-faceted. Methods Three independent studies investigating hydration care in older care home residents were conducted and the findings integrated (mixed methods, convergent parallel design): Diagnostic accuracy of clinical signs and symptoms of dehydration. Systematic review investigating effectiveness of interventions and associations of modifiable environmental factors on improving fluid intake and/or hydration status. Qualitative study involving residents, families and care-staff in focus groups, exploring challenges and facilitators in hydration care. Results In the diagnostic accuracy study, 188 residents (mean age 85 years, 66% women) were recruited from 56 care homes. Clinical signs and symptoms were ineffective in identifying older people with dehydration. The 23 included studies in the systematic review addressed a range of strategies at carer, institutional and societal (‘macro’) levels to improve fluid intake and hydration status, but high risk of bias in many studies meant findings were inconclusive. Three themes emerged from the qualitative study: ‘meanings and experiences of drinking’, ‘caring roles’, and ‘tensions and barriers to successful drinking’. Integrated findings identified residents’ and families’ contributions to residents’ hydration care and preventing dehydration requires a multi-faceted approach. The researcher-led quantitative studies of the systematic review indicated how macro factors may impact on hydration care (along with institutional and carer-led factors). Findings from the diagnostic accuracy should inform national guidelines at the macro level. The qualitative study provided experiential perspectives and insights into relational care between each care level and how these have positive and negative impacts on residents’ drinking. Conclusion Fluid intake is a physiological necessity to prevent dehydration. Supporting care home residents to drink involves multi-levels of care and is a social experience. (300 words) Medline medical subject headings (MeSH): aged; beverages; dehydration; diagnostic tests, routine; drinking; geriatrics; long-term care; osmolar concentration; qualitative research; residential facilities; review, systematic