Dehydration in the elderly

Hi Sam

Sounds like a really interesting project. I hope that you will be able to take on board the fact that all of us have very different normal hydration levels and expectations. I so often find that 'professional' forget to ask the individual what is normal for them. I have friends who would find it impossible to drink during the course of a day the amount of fluid that I feel is normal for me, and I certainly would feel very ill if I only drank the amount they do. The importance of establishing the norm for the individual rather than grouping us into categories based on age and weight is to me fundamental to the inherent dignity that must be encompassed in such devices and proposals. I hope you get volunteers and I would be happy to talk further if you wish.

Hi Liz,

Thanks so much for your encouragement and insights regarding hydration. I agree that fluid intake varies enormously and I'm constantly amazed by how little some people drink with seemingly no obvious side effects. I feel 'off' on anything less the 1.5 litres a day!

I don't suppose you happen to work in a care home or for a care service do you? I'd love to hear how each type of employer deals with this difficult issue,

Many thanks again,

Sam

Hi Sam,

I'm not sure of Liz's precise background (beyond her DiC/DiA deep involvement) - but a good starting point is to assume that 'Liz knows everything' until the assumption is proven incorrect. I'm being 100% 'straight up' there - Liz is enormously 'clued up' on 'care issues'.

Have you considered joining the Dignity in Action Facebook group, and posting your question there as well ?

Hope your project goes well, Mike

Hi Sam, sounds a great project your doing ,I work in respite care of elderly and it's always a battle lots of the time with fluid intake. Fluid charts are a great help especially as when working in the community as to keep other support workers updated and family members informed .
Seen a lot of clients over years who through not taking enough fluids end up dehydrated confused and at risk of uniary infections and falls with being dizzy .
A device like your working on would be a great help in combating and encouraging clients to drink more.Good luck .

By the way, and this is just 'a thought'. No 'evidence' - just a thought.

I think the elderly tend to lose their sense of taste. There is an awful lot of 'healthy nutrition guidance' about what people should be eating and drinking.

But perhaps, for the elderly, 'eat and drink what appeals to you' should be the idea, with much less stress on 'eat and drink 'healthily'' ?

What a great idea.
I manage a domiciliary care service and would be happy to help.

Thanks so much Neil, Mike and Stephanie for your input.

Neil - how do the fluid charts work? Is it a case of you noting down what drinks you've got for the person or are you noting what is left in their cup or glass when you arrive? Apologies for the daft question - I just want to make sure that I fully understand the various methods for tracking hydration at the moment.

Mike - you're definitely right. I've been researching the subject and I believe that they've scientifically proven that decreased thirst sensation exists as we move beyond 65. From what I've read most of us get around 30% of our fluids from food too so I'm with you - any food or drink is better than nothing. Although my 90 year old Nan claiming that her little afternoon glass of sherry should be counted as fluids always makes me smile :)

Stephanie - that would be fantastic. I'd love to know how whether your team utilise fluid charts or have some other method. I'd also like to give you more details about the device I'm working on and perhaps you can tell me if I've overlooked something critical? My email address is [log in to view email address], perhaps you could send me an email when you get a moment.

Thanks again everyone - what a helpful and friendly forum this is, I'm so glad I found you :)

Hi Sam
Fluid charts are worked out with total intake of intravenous fluids and oral fluids being added together versus output of fluids urine ,vomit ,wound drainage.
Add up totals of ml intake against output ml and you should have a bigger balance on intake side.
Hope this helps .

Hi Sam,

I'm early 60s and I think my taste isn't what it was - although the two questions of 'is the food the same as it was' and 'do the lingering after-effects of my depression [the main effect of which was that 'life contained no enjoyment of anything'] affect this' complicate the issue.

I've always wondered how many of my five-a-day a pint of strong cider counts as.

Dehydration is a major concern to everyone at some point in their lives although most afforded to the elderly person. Yes we do all have differing levels of requirement re fluid input/output as each human body may have the same basic organs but function uniquely to the person.
We are informed as to what recommended levels should be, but again it is tempered by our daily lives.what we do, are we very active or inactive.
Dehydration is seen in many age groups, how many of us really try to ensure that our children take enough fluid onboard and i dont mean coca/cola. I have seen the effects of dehydration on a client during my years of working in elderly care, confusion, infection,
We can address this issue positively by providing direct access to fluids at all times and different types of drinks especially for the elder person why should they be constantly told drink more water, better 8 cups of tea than nothing. I think in care we have forgotten the basic principles of daily needs, how many times do you see in care facilities/hospitals drinks either absent or out of reach of the individual, one should not have to ask for a drink it should be readily available.
Re input/output charts these have been around decades and if used appropriately can be good indicators but again accurate recording is required. Lastly dehydration should not exist in care facilities at all if the care provided is of substance, nutrition and fluid are two areas paramount to negating health issues and should be embedded in any cares training.

This device you are looking at making sounds really interesting and would be a great help to carers who need to monitor fluid intake.I look forward to updates on your progress.

Neil - thanks for clarifying the fluid charts. These are surely difficult to accurate maintain for those elderly living in their own homes. It must also be very difficult as from what I've read online it's based on visual estimates. It sounds like there's definitely room for a product that provides constant monitoring! Thanks again.

Mike - thanks for your thoughts. I don't know if you're currently on any medication with respect to your depression but if you are I imagine that would affect the thirst sensations too. I'm sure that a pint of strong cider = 2.5 of your 5 a day ;)

Kevin - your insight is much appreciated and brings home again the importance of accurate measuring to the current systems in place to prevent dehydration. Thanks so much for your input.

David - thanks so much for your encouragement. It seems that there is a strong need out there for a device that can constantly monitor hydration levels.

Now a little more detail and I'd appreciate everyone's thoughts if anything springs to mind.

The idea with this device is that it is worn on the wrist and uses technology similar to the wearable fitness trackers that are becoming so popular. The device would resemble a classic wrist watch to encourage familiarity. The device itself would give an alert if the wearer's hydration levels dipped below a set point - alerts would be audible (perhaps a recorded message in a familiar voice encouraging the wearer to have a drink), visual (the watch face might glow and display a reminder to have a drink) and incorporate a gentle vibrate. If the wearer (or someone with them) does not respond and hydration levels continue to fall the device would alert a relative or carer via a Smartphone app. Depending on how 'with it' the elderly person was - a quick phone call from the relative or carer might be enough at this stage.

Any thoughts, improvements or concerns would be greatly appreciated!

Hi Sam this idea really sounds great I will talk to carer' I work with and pass any ideas they may have on to you good luck.

Sam

I'm really keen to include this conversation flow in our spring newsletter, which should give you a much wider audience. Are you happy for me to do a synopsis of the conversation and post it in the newsletter, with or without your address. If you want to summarise it yourself so that you get your key message across that would be great, but I know how busy people are.
Let me know what you think

Liz

David - that would be great, thanks for offering. It would be useful to have a few quotes for my report.

Liz - please feel free - it would be wonderful to hear from anyone with any opinions on this. If you could possibly remove my email address that would be good though. Thanks so much.

have you seen this? its the NHS advice.
Most of us welcome hot weather, but when it's too hot for too long there are health risks. If a heatwave hits this summer, make sure the hot weather doesn't harm you or anyone you know.
The very young, the elderly and the seriously ill are the groups who are particularly at risk of health problems when the weather is very hot. In particular, very hot weather can make heart and breathing problems worse.
"There is considerable evidence that heatwaves are dangerous and can kill," says Graham Bickler of Public Health England. In August 2003, temperatures hit 38ºC (101ºF) during a nine-day heatwave, the highest recorded in the UK.
"In the 2003 heatwave, there were 2,000 to 3,000 excess deaths [more than usual] in England. Across Europe, there were around 30,000 excess deaths."
Public Health England's heatwave plan (PDF, 1.19Mb) has advice on how to cope during a heatwave. Knowing how to keep cool during long periods of hot weather can help save lives.
"Most of the information is common sense," says Bickler. "It's not rocket science, but it can have a dramatic effect."
When heat becomes a problem
An average temperature of 30°C by day and 15°C overnight would trigger a health alert (this figure varies slightly around the UK). These temperatures can have a significant effect on people's health if they last for at least two days and the night in between.
The Meteorological Office has a warning system that issues alerts if a heatwave is likely. Level one is the minimum alert and is in place from June 1 until September 15 (which is the period that heatwave alerts are likely to be raised).
•minimum alert - people should be aware of what to do if the alert level is raised
•level two alert - there is a high chance that a heatwave will occur within the next few days
•level three alert - when a heatwave is happening
•level four alert - when a heatwave is severe
Why is a heatwave a problem?
The main risks posed by a heatwave are:

Sam,

I'm interested: when you say 'in the process of designing' do you mean you are sure you've got technology which works, and which can be put into production at a low-enough cost to be purchased by individuals, care homes, 'the NHS' ?

This sounds exciting, but there are a couple of points you must bear in mind:
1. The elderly (or some of them), don't hear the fire alarm, let alone a wrist band that will tell them to drink.
2. Families leave them in Care for reasons like travelling distances, respite etc, so to get a phone call to tell them that Mom needs a drink will annoy families.
3. Some elderly do have cellphones, but really couldn't be bothered about them. My own mother still doesn't know how Goggle works, or what Wi-Fi is, and couldn't care less. Now we expect the generation even older than her to understand...............
4. WE will ALWAYS have drinking and eating issues. Dementia and Alzheimers plays a big factor, and this is mood swings, not just remembrance.
5. Some carers work around rotas that are draughted around contracted and paid hours, so they cant just run when an alarm sounds.

Sorry to flatten your idea, but there are people monitoring this problem. The older you get (I think Mike will tell you), the more stubborn you become. you don't WANT to eat and drink, and the law cannot force the issue either.
Only loads of encouragement, gentle persuasion, reminders all over the apartments/rooms, and giving the GP's continuous updates can have an altering affect.

Are you 'having a dig' at me, Sally-Ann!

I'm often described as opinionated, and persistent crops up as well: can't actually recall stubborn. Idiot used to pop up a bit.

Sally-Ann is right to point out that there is a legal issue with this: in essence, in theory any mentally-capable person who doesn't want to eat or drink, can't be made to. And if someone is not mentally capable, although the person lacks the legal 'destructive self-determination' potentially exhibited by capacitous people, it all becomes enormously complex, and very 'fraught and challenging'. I've never really investigated the 'can a mentally-incapable person be made to eat and drink against their wish' - I find the 'a capacitous person at risk of choking or aspiration while eating and drinking, must be allowed to eat and drink if the person wants to, provided the person understands the risks' more helpful in my analyses.

I suspect that in theory, you could have a best-interests decision 'forcing nutrition and hydration onto a mentally-incapable person' - but even then, Sally-Ann's 'loads of encouragement, gentle persuasion' is the first route to try.

Sally-Ann - thanks so much for your message. Don't worry - I'm not flattened, this is exactly what I was hoping would happen, and gives me a chance to review my design and rationale :)

1. The watch will 'speak', glow and vibrate to prompt the wearer - but obviously there are always going to be a proportion of elderly users that won't react to any of the 3. I just wanted the more independently-minded and motivated wearers to be able to help themselves rather than by-pass them and go straight to relatives/carers/nurses.
2. The app alert would be set up to be sent to the most useful party, whether that be a relative, domiciliary care service, private carer or a computer/shift staff on a hospital ward.
3. The elderly wearer won't need a mobile phone themselves. They just wear the monitor which will share the data with those set up with the app. i.e the relatives/carers/nursing professionals would be the ones that would need a smartphone for this to work.
4. I absolutely agree - I know there are many many reasons why it's difficult to keep elderly folk hydrated. It must be incredibly frustrating to see it as part of the everyday job. My thought process was that whilst some wearer's might respond to the monitor's prompt, for many this will act as an early warning system to whomever is available to help them.
5. I understand - I've had a few chats with my relative's carers and they are all over the place and on incredibly tight time-frames. The app could be monitored by a manager/someone office-based that could then co-ordinate help if it was needed.

The overall aim of this product is to minimise occurrences of dehydration in older people whether in domestic, care home, or hospital environments. I know it only deals with half the issue and encouraging them to take more fluid is the other element, but if it could prevent some falls or infections that result in hospital admissions then it's surely got to be an improvement on what we have. I'll take onboard the legal issue regarding forcing food/drink. I imagine that if this product came to market it would result in care companies etc having to make policy decisions around that situation.

Thanks again - please feel free to add more points if anything comes to you. It's really valuable to have your insights.

Mike - with regards your question from yesterday. This is just a design project. I'm expected to identify a problem (in my case dehydration in the elderly) and 'design' a possible solution, showing the markers my thought processes and including mock-ups, sketches and justification for my design decisions. However, this is a subject close to my heart (3 grandparent's at home and in their 90's) and my research shows that all the technology that we need to make this already exists so I'm looking to take it forward after graduation. I have some excellent contacts in fields related to this type of technology so once I've got the degree 'out of the way' this summer I want to look to make it a reality if it's viable.

Thanks Sam - it is always a challenge to get these things done.

'Progress is typically awfully slow'

Usually fairly easy to identify a problem: much more difficult to come up with a sensible and potentially-effective solution; and more difficult still, to get the solution implemented.

Hope your degree goes well.

Hi Mike,

Yes - it's a bit of a challenge but well worth a go I think. I'm knuckling down now to write up my final report and pull together everything for the end of this month but I'll pop an update to this thread if anything comes up or there is anything to report.

Thanks so much to yourself and everyone else that has contributed to this discussion - it really has been incredibly useful,

Best wishes for now,

Sam