Supporting Optimal Hydration With Those Living With Dementia in Care Homes

Previous literature has shown that maintaining adequate hydration levels for residents with dementia can be challenging. This is due to difficulties with swallowing, remembering to get drinks or refusal to drink. Dehydration in people with dementia is a major problem and significant cause of admission to hospital (Bourdel-Marchasson, 2004; Hodgkinson, Evans and Woods, 2003). Despite this, there is limited research into hydration interventions for this population, despite preliminary evidence suggesting the potential benefits of using multi-component interventions (Bunn et al. 2015).

The primary aim of this feasibility study was to establish the feasibility and acceptability of conducting a definitive RCT to evaluate the effectiveness of a multi-component hydration intervention for people living with dementia in nursing care homes compared to usual care.

Secondary aims were to establish:

• Whether the Think Drink intervention can be delivered as planned within nursing care homes for people living with dementia
• If the intervention is acceptable to care home staff
• If it is feasible to recruit and randomise care home sites and participants
• Barriers to the delivery of the Think Drink guide intervention.
• If the outcome measures are feasible to use within a care home setting
• If reliable data can be collected
• A sample size calculation for an RCT. This study was a three-phase multi-method design consisting of analysis of the empirical grounds for the hydration intervention, development of a multi-component hydration intervention and a feasibility cluster trial of the intervention. The first phase constituted of a survey of care homes, a systematic review-informed review of previous literature and collection of professional perspectives. Second phase was the development the intervention through five workshop events. Finally, the feasibility phase compared 6 intervention homes and 5 control homes in North East England, over a 3-month period.

The literature review revealed three articles of limited quality and indicates that there has been limited multi-component interventions promoting hydration care following Bunn et al. (2015)'s original systematic review. Evidence available suggests the importance of combining functional and awareness-raising approaches within multi-component interventions. Professional perspectives also reinforced these findings. This was reflected in the development of the Think Drink Guide that had three interacting components. The 'policy' component was directed at the governance of the care home, whereas 'practice' components were directed at hydration procedures and processes, and 'educational' components that provided learning resources for care home staff to develop knowledge and understanding of hydration care. Think Drink was implemented through a short awareness-raising educational programme and accompanying information booklet detailing a range of practices (including organisational, system and individual practice) designed to encourage hydration.