What are the signs and symptoms of dehydration?
More than 1,000 care home patients have died suffering from malnutrition, dehydration and bedsores according to a report in The Guardian.
The figures were obtained by the Guardian from the Office for National Statistics (ONS), which completed an analysis of death certificates at the newspaper’s request.
The article quoted Age UK charity director Caroline Abrahams, who said:
The provision of adequate food and drink is one of the Care Quality Commission (CQC) fundamental standards of good care practice and as such we are sharing the following content from our online Fluids & Nutrition training course.
Why are fluids important?
We need fluid to enable the body to carry out its basic functions becuase it:
- aids in the digestion of food
- is the major constituent of blood
- is used to remove waste products from the body
- helps in the control of body temperature
- keeps the body cells hydrated and healthy.
It is recommended that we should have 1.5 to 2 litres of fluid each day or six to eight glasses.
Signs and symptoms of dehydration
Early signs and symptoms of dehydration include:
- being thirsty
- having a headache
- tiredness
- confusion
- low urine output
- dark concentrated urine
- constipation.
Continued dehydration can cause other conditions such as:
- chronic skin problems
- pressure sores
- infections, particularly urinary tract infections (UTI)
- kidney failure
- slow wound healing
- poor oral health, such as ulcers or thrush.
Dehydration in older people is particularly concerning as, in addition to the conditions already mentioned, a lack of fluid can cause disorientation and make them more prone to falls.
Their skin is also more fragile and has lost some of its elasticity, making them more vulnerable to developing skin problems and pressure sores.
Car staff should always ensure that drinks are available and if using jugs of water or squash, ensure that these are refreshed regularly.
What is a nutrition risk assessment?
All individuals should have a nutrition risk assessment carried out on admission. This should be reviewed monthly or more often as needed. The assessment should include questions such as:
- Do they require a particular type of diet?
- Do they have any intolerances or allergies?
- Do they have religious or cultural needs regarding food and drink?
- Do they need any support to eat and drink?
- What are their likes and dislikes regarding food and drink?
- How is their oral health?
If any issues are indicated, a specific person-centred care plan should be put in place to address these.
One assessment tool is the MUST score. This is often used in hospitals, care homes and the community to assess those who are malnourished, at risk of malnourishment or obesity. It stands for:
- Malnutrition
- Universal
- Screening
- Tool
Promoting nutrition and hydration
The Care Quality Commission informs service users that ‘you must have enough to eat and drink to keep you in good health while you receive care and treatment’.
Care staff are advised to always check the individual’s care plan which will have been developed to provide information on the individual’s specific needs and preferences. For example, this may indicate that they are on a special diet, have an allergy to certain foods or need food that has been pureed. There may also be cultural or religious beliefs which influence the provision of food and drink.
It is important to provide a choice of different foods and drinks at meal times, and as snacks should ensure there is something available for everyone.
Is there a particular reason why they are not eating?
Where an individual is not eating or drinking, the reasons should be investigated.
Below is a list of possible reasons.
- Do they like the food or drink?
- Does the food look appetising?
- Is their mouth sore?
- Do their dentures fit properly, have they got them in?
- Can they see the food?
- Are they struggling to use the cutlery?
- Can they lift a glass or cup?
- Are they in the environment they prefer?
- Is the portion size too large?
- Are they having difficulties swallowing the food or drink?
- Do they remember to eat?
- Are they depressed?
- Can they reach the food or drink?
- Is it at the right temperature?
Once the cause has been discovered, steps can be taken to address this.
Consider the following:
- Tastes can change; the individual may have asked on admission what foods they prefer but is this still the same?
- The appearance of food will have a big influence on whether an individual wants to eat it, particularly if they are feeling poorly. Use foods of different colours and place them neatly on the plate.
- The individual may need to be seen by a doctor or dentist for problems with their mouth or teeth.
- Placing food on a coloured plate can make a better contrast where there are sight difficulties. Blue is a good colour to use, as there aren’t really any blue foods.
- Where the individual has difficulty holding cutlery, providing them with adapted cutlery may help. Cutlery is available with thicker or angled handles. A non-slip mat placed under a plate will stop it moving around. Individuals with dementia may forget how to use cutlery, so provide finger foods instead which they can easily pick up.
- Mugs with two handles may help those who have difficulty lifting a cup with one hand. Using straws may also help but do not use these for hot drinks.
- The environment provided for eating and drinking is important. Generally, meal times are social occasions, where individuals sit together and chat. However, this might not suit everyone because some people prefer to eat on their own. Is the dining area welcoming and relaxing; are the chairs comfortable and the lighting sufficient?
- Portion size is important. Some people can be put off eating if they are presented with big plates of food, but you can always offer second helpings to ensure they are having enough.
- Individuals with certain conditions can develop problems with swallowing; this is called dysphagia. They may need foods that are softer in texture.
- Sometimes people with more advanced dementia may forget to eat and need gentle reminders at each meal time; sitting and eating with them may also help.
- Individuals who are depressed often don’t feel hungry; they may need to be referred to the GP.
- Make sure the individual can reach the food and drink you are giving them; you may be working with individuals with limited mobility.
- The individual may prefer cold to hot drinks or vice versa. Some individuals take a while to finish eating so the provision of a specialist plate to keep the food warm will help.
Assisting with the intake of food and drink
Some people may need assistance to help them to eat and drink. The advice when supporting any person to eat is to always keep in mind their dignity and show respect.
Tips to help:
- Make sure they are comfortable and in a position where they can easily take food and drink. This is usually sitting upright but it will vary according to each individual’s needs.
- Make yourself comfortable too. Position your chair so that you do not have to keep turning or twisting.
- Provide protection for their clothing if necessary.
- Talk to the person; tell them what they are about to eat.
- Offer small portions of the food, giving them time to swallow before offering more.
- Periodically offer a drink.
- Be patient and allow them to take their time.
- Following the meal or drink, make sure the individual is clean, tidy and comfortable.
Reporting concerns
Any concerns that an individual is not eating and drinking sufficiently must be reported. Staff should tell their line manager and record any concerns in the person’s care plan. When working in domiciliary care, it might be appropriate to also inform the family.
Care managers should investigate the reasons why a person is not eating and/or drinking enough and may refer them to a professional who can help; for example, a dentist, doctor, dietician or speech and language therapist.
Diet and fluid monitoring
Where there are concerns that an individual is not taking enough food or fluids, their intake may be monitored. A record is made of the amount of food the individual has eaten and how much fluid they have taken daily.
Supplementary foods and drinks
Some people may be given supplementary food or drinks to boost their intake of nutrients; for example, smoothies and milk drinks. Occasionally they may be prescribed supplementary drinks by the doctor. These are available as soups and milk or fruit-based drinks.
Food safety
It is essential that the food and drink that is provided is safe and free from any hazards. The food and drink provided must be free of:
- harmful bacteria or viruses (for example, salmonella or norovirus)
- chemicals (for example, pesticides or cleaning products)
- foreign bodies (for example, small bones or pieces of packaging)
Some people may be more vulnerable to foodborne illness because of their age (babies, young children or older people), lowered immunity, or they may already be ill. It is, therefore, essential that good hygiene is applied when preparing and serving food and drink.
4 C's of Food Hygiene
Good food hygiene can be achieved by following the 4 C’s.
- Cross-contamination – prevent hazards from being deposited on food from people, utensils and other foods. The most important step is to wash your hands thoroughly. Store and prepare raw and cooked foods separately.
- Clean – Keep the preparation area and all utensils clean.
- Chill – Keep high-risk foods in the fridge at a temperature of 5 degrees.
- Cook – Make sure food is cooked until it is ‘steaming hot’.
The advice is to remember before preparing or serving food or drink, is to always read the individual's ‘Plan of Care’ and be familiar with their particular requirements. Carers need to know if the person has a specific diet or if there are foods they should not eat because of an allergy or the medication they are taking. If the wrong foods are provided, they may become seriously ill or go into anaphylactic shock (a severe allergic reaction).
Some individuals may have difficulties swallowing and need food that has been pureed or mashed, giving them food that is not the right texture could result in them choking.
Fluids and nutrition online training course
The above information has been taken from our Fluids & Nutrition online training course which maps to standard 8 of the Care Certificate.
The course costs £10.50 to buy online and is also included in EduCare for Health and Social Care - our complete online training package that contains 30 essential safeguarding and duty of care courses and starts at £350 for up to ten learners, making each course just £1.17 each.
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