Improving hydration of care home residents by addressing institutional barriers to fluid consumption – an improvement project

Bak, Aggie (2018) Improving hydration of care home residents by addressing institutional barriers to fluid consumption – an improvement project. Doctoral thesis, University of West London.

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Abstract

Background: Older people are at risk of dehydration due to a wide range of agerelated physiological changes. Additional conditions such as dementia or physical frailty may contribute to low fluid intakes and further predispose to dehydration. Care home residents are more likely to be admitted to hospital with dehydration, but there few recent studies that evaluated the amount of fluids that residents consume or the barriers to hydration that they experience. Objectives: To assess current hydration care in nursing homes, identify barriers to drinking adequate amounts and develop strategies to optimise fluid intakes in the older care home residents. Method: This study was conducted in one care home in London, which provides care to a multi-ethnic population of the residents. Focus groups conducted in preparatory phase investigated factors necessary to provide adequate hydration care. Exploratory phase used observations, focus groups and interviews to determine how drinks are currently provided and to explore attitudes of staff and residents towards hydration care. The intervention phase used Model for Improvement framework to identify and test strategies to improve hydration for the residents. Results: Observations revealed that most residents consumed less than the recommended minimum of 1500ml of fluids. Hydration not seen as a priority resulted in several barriers that hindered staff ability to serve adequate amounts of fluids, and residents’ enjoyment and ability to consume them. Interventions were designed to overcome these issues and included: training, increasing the number of drink opportunities, improving preference compliance and introduction of a new drinking equipment. During the testing, most interventions resulted in the residents consuming more fluids, but sustaining these interventions was difficult. Barriers to sustainability included poor leadership and task-oriented work culture. Conclusions: This study demonstrated that fluid intakes in care home residents are suboptimal. This is mostly due to insufficient number of opportunities for the residents to obtain drinks as well as not receiving adequate assistance and preferred drinks. Implementation of the interventions which address these barriers increases fluid intakes. Care homes need to implement appropriate strategies, but this requires organisational commitment with support from senior managers and strong leadership at operational level.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Care homes, dehydration, fluid intakes, improvement science, older people
Subjects: Medicine and health
Depositing User: Camille Regnault
Date Deposited: 12 Dec 2019 12:21
Last Modified: 12 Dec 2019 12:40
URI: http://repository.uwl.ac.uk/id/eprint/6605

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