Managing hydration in later life: exploring the views and current practices of older people and their carers

Problem

Older people may be prone to dehydration due to inadequate fluid intake, loss of fluid or a combination of both. This group are at risk of dehydration due to ageing-related physiological changes, such as reduced thirst sensation and changes in homeostasis secondary to kidney dysfunction. Additional factors include swallowing or communication difficulties, environmental factors, acute illness and medication. Dehydration is associated with increased hospitalisation and mortality rates. There is little known about older people’s views around hydration, their understanding of a healthy fluid intake and what support they might need to achieve this. Aims1. To explore the views and current practices of older people on hydration, particularly in situations where fluid intake may need to be increased. 2. To identify the gaps in knowledge, barriers and facilitators to maintaining an adequate fluid intake in later life 3. To explore potential interventions for preventing dehydration in later life

Approach

Design: Qualitative study using semi-structured interviews.Setting: GP practices in London. Up to 40 interviews with community-dwelling older people aged ≥75 years, identified as malnourished or at risk of malnutrition, and their informal carers who support them with shopping or meal preparation. Data collection and analysis: Interviews are audio-recorded and transcribed verbatim. Data collection will continue until saturation of key themes. Thematic analysis is being used to identify key emergent themes and their meaning, with input from the entire research team including lay members.

Findings

Early interview findings (n=18 people) suggest that older people lack knowledge about an appropriate fluid intake and what this means. Most reported scarce or conflicting advice . Many were unaware that thirst can diminish in later life, and generally relied on thirst or habit (such as medication and meals) as prompts to drink. Some were more aware of the need to increase fluid intake with hot weather and acute illness than others. High alcohol intake was reported amongst some – patterns which had been established over years. Generally, their fluid and alcohol intake was not something they would discuss with their GP. However, some expressed feelings that they ‘should’ be drinking more, and appeared to prioritise adequate hydration over making dietary changes. Barriers to achieving this included physical problems such as urinary incontinence and lack of thirst. Most were open to advice and support from a trained health professional around maintaining a healthy fluid intake.

Consequences

These findings highlight lack of awareness amongst older people about hydration and changes preventing them from maintaining an adequate intake. Most do not discuss this with their GP but were open to support. This could be addressed through a potential primary care intervention, aiming to support people with maintaining a healthy fluid intake in order to prevent adverse outcomes related to dehydration.