Principal Investigator: Dr Lee Hooper
Lead institution: University of East Anglia
Award amount: £74,869
Creating a “pro-drinking” environment: developing and testing an innovative low-cost activity-based intervention to support care home residents in keeping hydrated
This grant was awarded in April 2016 and sought to tackle the concerning issue that a significant proportion of care home residents were dehydrated, with no clearly effective interventions for increasing their fluid intake in place.
Dehydration in care homes is often a result of older people not being aware of the need to drink (the sense of thirst declines with age), or forgetting to drink, or because in care homes, drinks may not be offered how and when they are wanted and that the drinks offered can be dull. Care home residents might also decide to limit their own drinking due to fears concerning incontinence or not wanting to be a burden on the staff by needing to go to the toilet too frequently. These problems become particularly acute in older adults with dementia, diabetes or kidney problems.
Dr Lee Hooper and her team developed a new approach to improving care home hydration, which took advice from care home residents and staff and built on the evidence-base to create a “pro-drinking” environment and addressed these reasons for dehydration.
The team worked with activities coordinators, other care staff, residents and family members from six care homes across Norfolk and Suffolk to develop and test an activities toolkit. Activity themes included:
- a direct focus on drinking (e.g. tea parties, lemonade-making),
- sharing a drink during a pleasant activity (e.g. afternoon film matinees, board games), and
- activities with a whole care home approach (e.g. tea-tasting, festive tea trolleys).
Following this initial research, which also included interviews with residents and staff, an activities toolkit was produced, which discusses the importance of drinking. It recommends how much older people should drink and gives tips on how to support drinking well in care homes. The toolkit also includes ideas for care staff to run their own range of activities.
The research team found that more enjoyable, drink-focused activities for older people encouraged more drinking and therefore helped to prevent low-intake dehydration-related illnesses. Furthermore, the project revealed that by making drinking more sociable and by facilitating social contact between residents, visitors and staff drinking became more enjoyable too. As Dr Hooper discussed, drinking is a social activity during our life course and this should continue in later life: “We all go through life with drinking being a very social activity – if we have visitors to our homes one of the first things we do is pop the kettle on and we generally enjoy drinking with other people.”
Overall, activities were found to be engaging for residents, especially those with dementia and the research also found that new spatial arrangements could enhance hydration, for example the creation of a social space with a kettle or coffee machine where family and friends could sit, chat and drink with residents. This could also help with serving drinks during activities. In addition, training was key to helping all staff understand the importance of drinking and developing confidence in how to support residents to drink well.
Florence Jimoh, senior research associate, who has been working on this project said “Taking part helped residents, staff and families support each other to drink more, have fun and socialise. Some residents found new drinks they enjoy in addition to their usual tea and coffee, these are now offered regularly and incorporated in their care plans.”
Since the beginning of November the project is being piloted with residents and care home staff at a care home in Martham, Norfolk (see video and photos). They have been taking part in a range of activities from lemonade-making to tea-tasting – all developed as part of this project – and have featured in the local news and radio.
This project will substantially benefit older care home residents. By increasing fluid intake and reducing dehydration, the health, cognition and well-being of frail older people will be improved. Other benefits may include fewer urinary tract and respiratory infections, incontinence episodes, acute kidney injuries, unplanned hospital admissions and falls.