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Research reveals care staff may be rationing fluids

Recent research figures have provided stark evidence that some care homes are failing to ensure that residents consume enough fluids for their health.

The data, released by the University of Oxford, Barnet and Chase Farm Hospitals NHS Trust and the London School of Hygiene and Tropical Medicine, was drawn from 20,000 elderly and infirm patients aged 65 years and over. Focusing on individuals admitted to a London hospital trust for the first time between January 2011 and December 2013, the research showed that a significant number of admissions from care homes had high levels of sodium in their bloodstream.


Dehydration is one of the most common reasons for raised sodium levels, and in severe cases too much sodium can lead to coma, paralysis of the lung muscles and death. Researchers discovered that while 1% of patients admitted from their own homes were found to have high sodium levels, the figure rose to 12% in the case of patients admitted from care homes.

Even when factors that might explain lower fluid consumption - such as the patient's age and possible symptoms of dementia - were screened out, the figures were still over five times higher for patients admitted from care settings.

Dr Anthony Wolff, lead researcher on the project, says that when a patient is admitted with dehydration it can directly affect their chances of survival: "Our study shows that too many people admitted to hospital from a substantial number of care homes are dehydrated, leading to unnecessary loss of life."

Approximately 56% of an older man's body weight (not including fat) is water, and this reduces to 47% in older women. Fluids support most of the body's major processes, including taking nutrients to the cells and carrying waste away. They also perform tasks such as keeping the joints mobile, regulating temperature, maintaining eye health and lubricating digestive and mucous tracts.

It is particularly important to encourage older people to drink plenty of fluids, as they are less likely to experience feelings of thirst. On average a healthy adult can lose up to 2.5 litres of water a day – 50% through excretion of water and waste products and around 47% through the skin, although the amount lost through sweat can increase in hot weather. As the body sheds water, it also loses vital minerals known as electrolytes, leading to symptoms that may include headaches, constipation, confusion and irritability, tiredness and dizziness.

Professor Martin McKee of the London School of Hygiene and Tropical Medicine – a co-author of the research paper – has expressed "serious concerns" about the quality of care provided in some residential homes. He believes that when hospitals receive multiple admissions from a single care home it may be indicative of a systemic problem, and "the issue should be raised formally".

So why do care homes fail to ensure the individuals in their care are properly hydrated? Dr Wolff claims that he has "heard anecdotally" of care staff rationing drinks so residents are less likely to go to the toilet or suffer incontinence during the night. However he is keen not to apportion blame: "It may be these workers are thinking they are doing the right thing. Residents don't want to get up at night, they are at greater risk of falling and there is greater risk of being incontinent."

Norman Lamb, Minister for Care and Support, is less conciliatory, describing the apparent failings of care homes as "completely unacceptable" and "abhorrent". But care homes have hit back, insisting that residents are constantly monitored to ensure their fluid intake is sufficient.

Simone Jaacock, manager of Greys residential home says "..we work closely with our residents to ensure proper hydration, we even suggested juice or water instead of tea or coffee after 3pm which went down very well with all bar one choosing juice. We supply fresh fruit, juice and of course there is always a jug of fresh water in each of our residents rooms. When we have hot weather we work even harder to ensure the well-being of each and every one of our residents."

Those sentiments were echoed by a number of care homes we approached including Graceland carehome who told us " .. we would never ration fluids, we actively encourage residents to drink more water or juice, this can however prove a little tricky as some residents can become offended, with tea as their preference which can dehydrate the body, however we always make sure all residents have fresh water, juice and tea but you cannot force a resident to drink something that they do not wish to drink."

It is a complex issue but the government's view is unequivocal. "The law is very clear – care homes must make sure residents get enough to eat and drink and we are making it easier to prosecute homes that fail to do so."

So are care homes failing to deliver the necessary basic level of care as Norman Lamb accuses them of or is this another strategy by the government to move the blame for poor elderly care away from budget cuts and nursing shortages?

By: Robert Anderson

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