Qualitative analysis of a virtual research meeting summarises expert-based strategies to promote hydration in residential care during COVID-19 and beyond

Abstract

ObjectivesPoor fluid intake is a complex and long-standing issue in residential care, further exacerbated by COVID-19 infection control procedures. There is no consensus on how best to prevent dehydration in residents who vary in their primary reasons for insufficient fluid intake for a variety of reasons. The objectives of this research were to determine expert and provider perspectives on: (1) how COVID-19 procedures impacted hydration in residential care and potential solutions to mitigate these challenges and (2) strategies that could target five types of residents based on an oral hydration typology focused on root causes of low fluid intake.DesignQualitative study based on virtual group discussion. The discussion was audiorecorded with supplementary field notes. Qualitative content analysis was completed.SettingResidential care.Participants27 invited researcher and provider experts.ResultsChallenges that have potentially impacted hydration of residents because of COVID-19 procedures were categorised as resident (eg, apathy), staff (eg, new staff) and home-related (eg, physical distancing in dining rooms). Potential solutions were offered, such as fun opportunities (eg, popsicle) for distanced interactions; training new staff on how to approach specific residents and encourage drinking; and automatically providing water at meals. Several strategies were mapped to the typology of five types of residents with low intake (eg, sipper) and categorised as: supplies (eg, vessels with graduated markings), timing (eg, identify best time of day for drinking), facility context (eg, identify preferred beverages), socialisation (eg, promote drinking as a social activity) and education (eg, educate cognitively well on water consumption goals).ConclusionsCOVID-19 has necessitated new procedures and routines in residential care, some of which can be optimised to promote hydration. A variety of strategies to meet the hydration needs of different subgroups of residents can be compiled into multicomponent interventions for future research.

Wet Your Whistle with Water (W3) to Improve Water Intake in Seniors’ Care

“…Using this touch point to remind residents to drink or providing them with specialty drinks to pique interest could support hydration. Other work has suggested several ways to promote hydration during an outbreak (Keller et al, 2022), including creating physically distanced interactions (e.g., residents sitting in their doorways) to share fluids and offering fluid at every contact point when a staff member is in a resident's room.…”

“…Dehydration is associated with poor health outcomes that range from delirium, constipation, urinary tract infections, reduced quality of life, increased risk for falls, increased number of hospitalizations, morbidity, and mortality (Edmonds et al, 2021;Hart, Marsden & Paxman, 2020;Hooper et al, 2015;Lean et al, 2019). Due to a lack of a gold standard to determine dehydration in LTC and RH, fluid promotion is considered a reliable approach to prevent dehydration (Hooper et al, 2015;Keller et al, 2022). As there are differences in sources of funding and service offerings in LTC and RH, strategies to address dehydration and capacity to undertake these strategies may vary between these two settings (Roblin et al, 2019).…”

“…However, resident hydration is not always a priority, especially at times of a COVID-19 outbreak; providing sufficient fluids requires significant time and effort based on individual needs of residents (Cook et al, 2019a;Cook et al, 2019b). Team member education on the importance of hydration, barriers to fluid intake, and use of diverse strategies to address barriers may be necessary to promote fluid intake of residents (Bunn et al, 2015;Keller et al, 2022). Due to the multifactorial nature of how dehydration can occur in residents, individualized strategies within multicomponent interventions are needed to decrease the risk for dehydration (Bunn et al, 2015;Hodgkinson, Evans & Wood, 2003).…”

Dehydration in geriatrics: consequences and practical guidelines

“…An expert consensus meeting for promoting hydration in residential care published their findings in 2022 [28 ▪▪ ]. This group was convened because of challenges faced in residential aged care facilities during the coronavirus disease 2019 lockdowns.…”