KEY INTERVIEW: Nutrition and Hydration in the Clinical Setting

21 Mar 2016 --- Following on from Nutrition and Hydration Week (March 14-20), Independent Consultant Dr Rekha Elaswarapu talks to NutritionInsight about the importance of such awareness campaigns for older people, and how the food and beverage industry can help provide suitable nutrition.

Unfortunately, older people are still more at risk of malnutrition – in particular dehydration – especially those that must be admitted to hospital: “Despite ample evidence that prevention of dehydration can significantly improve the chances of older people to have better health and well-being, there are still major concerns regarding hydration practices in hospitals,” says Dr Elaswarapu.

Dr Elaswarapu currently holds a wide array of roles, including acting as a senior policy advisor specializing in older people, as well as nutrition and hydration.

“Promoting good hydration is an important aspect of providing high quality safe and dignified care for patients. Dehydration can cause many avoidable conditions such as UTIs, pressure ulcers, dizziness and falls etc,” she says. 

Dr Elaswarapu also works and speaks on behalf of the Natural Hydration Council (NHC): “The NHC works with a number of experts on a range of hydration topics to ensure that the media and other stakeholders receive engaging science based communications on the benefits of drinking water. That is how I have been involved with the NHC to date.”

Dr Elaswarapu is also a Trustee at the UK National Dignity Council, which is made up of representatives from various bodies including Health and Social Care organizations: “The National Dignity Council has aimed at promoting the dignity aspect of ensuring good hydration by focusing on issues such as help with drinking, help with toileting to avoid undignified spoiling of clothes (which may prevent patients from drinking), and hydration and nutrition needs to meet cultural, clinical needs and personal preferences.” 

“Other barriers that are directly related to attitudes and practices in hospitals include: lack of choice; failure to provide water/drinks at the bedside; people not helped or encouraged with drinking; and water/drinks intake not monitored,” she adds.

“There are many reports in the media about poor quality of hydration care in hospitals, which has put the patients at risk of ill health and compromise dignity and safeguarding.”

Elaswarapu continues: “However, many initiatives have been promoted in recent years, such as developing resources for care professionals by Royal College of Nursing, NHC, European Hydration Institute and Social Care Institute for Excellence. These resources provide detailed guidance on improving hydration for patients with a variety of conditions such as kidney disease, difficulty with swallowing, Diabetes and incontinence etc.” 

“The all-party parliamentary Hydration forum, under the aegis of International Longevity Centre UK (an independent think tank on older people policy), produced a Hydration Action Plan which looked at issues such as screening, training, guidance and regulation to highlight the need for hydration with various key stakeholders,” says Elaswarapu.

The ILC-UK ‘Hydration Action Plan’ focuses on six key areas:

•    To raise awareness about the importance of hydration and prevention of dehydration to ensure good health.

•    To ensure that up to date good practice guidance is available across all sectors.

•    To promote screening for hydration for all people using health and social care services with special focus on people in vulnerable circumstances.

•    To incorporate in the training for front line managers and care providers the significance of hydration in care provision.

•    To ensure inclusion of hydration in inspections and regulation through essential standards of quality and safety.

•    To develop robust and high quality evidence by encouraging research into hydration in health and social care.

Food is also a focus of the National Dignity Council. Therefore, there is also a role for the food and nutrition industry:

“Being able to eat the food that is supplied and manage the drinks offered is what dignity and respect is all about.”

Elaswarapu explained: “The food and nutrition industry can get involved with care settings and promote/sponsor learning talks for staff and patients on good hydration and nutrition to prevent avoidable hospital admissions. They can also focus on developing products that encourage patients to drink. Some examples are Oranka Juice Solutions, ‘Hydration for Health’ (H4H, sponsored by Danone Waters) to name a few.”

“They could also fund research which develops evidence base to promote good hydration and nutrition,” she says.

“Finally, the National Dignity Council celebrates Dignity Action Day every year on 1 February, and this year Danone UK sponsored an event focusing on Hydration and Dignity for care staff.”  

“Of course, the industry could get involved in the Nutrition and Hydration Week too.”

by Kerina Tull