Just add water

Water makes up 50-70 per cent of an adult’s body weight. And this needs to be maintained. If it isn’t and you lose water and essential body salts (electrolytes) from your body, you will dehydrate and vital organs such as the kidneys, brain and heart won’t function properly.

Last year, Deborah Lawson, a sister at Stoke Mandeville Hospital, Buckinghamshire, spent six months or so auditing the reasons why people attended the accident and emergency department where she worked. She was surprised, if not shocked, to find that more than 30 per cent of older people came in with a dehydration-related illness. And that many of them had come in from residential or nursing care homes.

“The county council and health services got together and felt the best way of tackling this was through an educational training programme among care homes,” says older people’s service manager, Simon Temerlies, the Buckinghamshire County Council lead on the Thirst 4 Life project. “We identified appropriate trainers but some homes felt threatened and were resistant – so we only went into homes that welcomed us.”

Professional carers were given training in diets for older people and the simple need for water – on average about two litres a day.

“There was a lack of awareness, for example, that tea and coffee – what most people were drinking in care homes – doesn’t rehydrate you,” says Temerlies. “Similarly, care workers didn’t realise that fruit and vegetables are good for rehydration.”

Indeed, cucumber has a higher water content – 96 per cent – than a water melon, which is 92 per cent. Even a baked potato is three-quarters water.

Older people are more prone to dehydration, not least through mobility problems which may limit their ability to pour their own drinks. Also they may restrict their drinks intake because of concerns over incontinence. “We also did some training on continence management,” says Temerlies.

At first, Thirst 4 Life was piloted in about 50 care homes. “We contacted the local office of the Commission for Social Care Inspection but they weren’t doing anything around this. People admitted to care homes didn’t have a full nutritional assessment – they do now,” says Temerlies.

The impact has been impressive and immediate. Between November 2004 and March 2005, there was a 45 per cent reduction in A&E attendance at Wycombe General Hospital from care homes.

Naturally, the campaign has now made a splash across the county. The council’s community meals supplier, Fresh CM, has agreed to reduce the salt content of its foods and provide and pour a Thirst 4 Life branded tumbler of water with every one of its 120,000 delivered meals (at a cost of 7p a cup to the council).

Launched at a conference in May by celebrity TV chef Sophie Grigson, who also donated two soup recipes as soup has a high water content, the county-wide campaign goes from strength to strength. It is widely advertised through posters, leaflets, drinks coasters and awareness packs.

The training continues to be carried out by health professionals, including district nurses and “tissue viability” nurses, who specialise in skin and soft tissue wounds, such as pressure ulcers.

In addition, A&E nurses are teaching techniques to recognise the early stages of dehydration in older people.

What is appealing about the campaign is that it is obvious and natural. “It’s an incredibly simple idea,” says Temerlies. “A county councillor said we were promoting an invaluable message ensuring that family carers and social and health care professionals are made aware of this high incidence of dehydration among our frail elderly and how easily that can be reversed by something as natural as water. And he’s right. It’s a simple solution to an enormous problem that’s costing a fortune to health and social care.”

I’ll drink to that.

Lessons learned

  • plenty of fluids. Have at least six drinks a day. Aim to have at least two non-caffeinated drinks a day, such as water, fruit juice, milk or squash. For frail older people, consider fluids which are high in energy and nutrients, such as milkshakes, Horlicks, smoothies or ice cream sodas. Even puddings, such as custard, yoghurt, trifle and rice pudding, are 80 per cent water.
  • As well as practical training it is important to widely advertise the campaign to heighten awareness. The Thirst 4 Life branded tumblers and drinks coasters have been particularly effective in marketing the message.
  • Things don’t have to be complicated – some answers really are simple and natural.


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