Malnutrition and dehydration in care settings is not a new issue.
Back in 1859 (way, way back), Florence Nightingale claimed “Every careful observer of the sick will agree that thousands of patients are annually starved in the midst of plenty, from want of attention to the ways which make it possible to take food”.
Ensuring that people are well nourished and hydrated has a great impact on their overall well being.
Poor intake affects people’s energy levels, mobility, and their ability to recover from illness.
Older people are particularly susceptible to dehydration as the typical trigger of thirst to encourage fluid intake can diminish with age.
“Age-related changes include a reduced sensation of thirst, and this may be more pronounced in those with Alzheimer’s disease or in those that have suffered a stroke. This indicates that thirst in older people may not be relied on as an indicator of dehydration”.
Implications of poor nutrition
- Weight loss
- Deficiency of vitamins and nutrients
- Poor wound healing and increased likelihood of pressure sores
- Lethargy and sluggishness
- Poor recovery from illness
- Muscle weakness and wastage
- Increased hospital admissions
Implications of poor hydration
- Urinary tract infections
- Low BP
- Increased falls
- Worsened cognitive impairment
- Increased likelihood of pressure sores
- Frail, dry skin
Managing poor nutritional and fluid intake
There are many simple measures that carers can introduce to ensure residents are well nourished and hydrated.
- Encourage people to eat little and often
- Offer portion sizes that will not over face people
- Ensure that meals and drinks are appetising and appealing. Meals should be well presented, and glasses of water could include ice and lemon
- Provide accessible menu choices. For people with dementia this may involve the use of pictorial menus, or showing them two plated meals and asking them to choose
- Ensure that residents have access to appropriate adaptations and equipment, such as cutlery, plate guards, two handed cups etc.
- Assist residents to get into a suitable position for eating and drinking
- Check that resident’s dentures fit correctly and that their oral health is good. This can prevent people from eating and drinking
- Keep a record of intake and consider referral to the resident’s GP or Dietician if intake is not adequate
- Manage incontinence worries. If a resident is worried that they cannot access the toilet, then it often prevents them from drinking adequate amounts
- Ensure that fluids are always available to residents. They may lose the sensation of thirst, but if a drink is within reach they will often take sips
- Fortify food and drinks for residents with poor intake or who are losing weight. For example; use full fat milk, offer milky drinks, add butter, cheese and cream to dishes like mashed potatoes
- Try to create a social experience during mealtimes to encourage people to enjoy eating and drinking