Hydration watchfullness for the elderly- Nederlands

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Main result 

Better hydration of older people

Title

Hydration watchfulness for the elderly

Date 2019

Objectives

Preventing heat-related illness due to dehydration

Location  /geographical coverage           

Nursing homes near the city of Dordrecht, the Netherlands

Organisation  responsible  for good  practice     

Municipal health service of the region South-Holland South

Short  summary 

The elderly benefit from adequate hydration. Dehydration is one of the main direct effects of prolonged heat exposure and can be prevented by drinking enough fluids. Keeping an eye on whether someone or yourself drinks enough can be more difficult than expected. Especially for those residing in nursing homes who are possibly unable to monitor this themselves A simple system was developed that consists of a card where the number of required drinks per day can be crossed off. This is a good way to make sure that people drink the required amount each day. Alternatively, a jug can be filled with the amount of water that should be drunk for that day. Another feature is to monitor the frequency and mostly the color of the urine produced. When people urinate less frequent and/or their urine is very dark in color this is a signal that the body is preserving water. Preserving water is a sign that someone needs to drink more fluids. A person can use this feature to notice when to drink more. Nursing staff can use it to stimulate someone to drink more.

Impact 

Preventing dehydration is of utmost concern. Dehydration can lead to serious

health problems and even death when untreated. For those aware that they need to watch their hydration status it can prevent hospital admission.

Incontinence problems amongst the elderly also seem to play a role. Elderly people sometimes have incontinence problems and they sometimes (whether or not mistakenly) associate this with admission to a nursing home. Nursing homes are often associated with the last stage of life where one goes to eventually die. In seeking to avoid admission to a nursing home, elderly people might not drink

enough fluids to avoid their incontinence. This seems to be a reason why the elderly sometimes hydrate insufficiently.

Innovation

There is a considerable amount of scientific evidence for these interventions that

indicate their effectiveness. This provides a measure of certainty for specific

interventions and guides whether or not to implent these interventions.

Drinking fluids in general is a proven and intuitive way to hydrate during heat. For example, when one is used to drinking coffee at a set time each day, it is best to keep doing this during a heat wave, even though coffee has a small diuretic effect (it stimulates the production of urine). Because when someone is used to drinking something as a habit, it is better to keep this habit than to advise against drinking coffee.

The thirst stimulus provides an adequate way to regulate one’s hydration. This

works better than a set amount of fluid each day. However, for elderly people, the thirst stimulus is less effective. Keeping tabs on how much someone drinks via a chart that registers the amount of drinks is better than an elderly person’s own thirst stimulus, on average. These interventions need to be evaluated and adjusted per person.

Similar to coffee, alcohol has a diuretic effect. The net result is that the amount of

fluid drunk is usually (for beer) enough to compensate the diuretic effect of the

alcohol contained within the drink. This effect diminishes considerably when the

amount of alcohol per drink increases. The main reason to avoid alcohol during

heat waves is because it makes the person less able to regulate their body

temperature through behavioral changes.

The temperature of the drinks is also significant. Hot drinks cause the body to

sweat which ultimately leads to a net decrease in body heat despite the extra heat added from the hot drink. Cold (chilled) drinks are more effective however.

Lessons learned

It is difficult to measure the impact of this practice. The amount of hospital

admissions due to dehydration could be a criterion. Due to the covid-19 pandemic the amount of hospital admissions was disturbed from the time since

implementation of the practice until now. The national heat plan for the Netherlands is currently under review after which an evaluation of the practice of the drink card is planned.

Sustainability    

The municipal health service must deliver the required information to all relevant

stakeholders. The stakeholders must also first be identified. Community centers

and nursing homes are good candidates for identifying the target audience of

elderly people and others at risk for dehydration during heat waves. Folders/cards can be printed and handed out at general practitioners, community centers, etc. The costs involved are low.

 Replicability  and/or  up-scaling

Replicability should be fairly easy. Cards that keep score of the number of drinks

people have consumed can be printed easily and instructions for the nursing staff can be updated.

The main hurdle would be to update protocols/guidelines and then take the time to instruct everyone on their usage.

Contact  details

Municipal health service of the south area of the Province of South-Holland (GGD

Zuid-Holland Zuid)

Karel Lotsyweg 40

3318 AL Dordrecht, The Netherlands

+31 78 7708500

info@dgjzhz.nl

Henk Saak

+31 78 7703369

h.saak@ggdzhz.nl

Related Web site(s)

https://www.ggdzhz.nl/gezondheid-en-milieu/hitte-en-gezondheidsadviezen

https://awgl.nl/projecten/hittestress-voorkomen

https://www.nhg.org/thema/farmacotherapie/medicatiegebruik-en-dreigende-

Related  resources  that have been  developed