Hydration care for older adults, including those living with dementia: mixed methods design combining systematic review, ethnography and online forum analysis

Parkinson, Ellice Gayle (2025) Hydration care for older adults, including those living with dementia: mixed methods design combining systematic review, ethnography and online forum analysis. Doctoral thesis, University of East Anglia.

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Abstract

Background
Low-intake dehydration (serum/plasma osmolality>300mOsm/kg), following insufficient drinking, is associated with adverse health outcomes in older people. There is mixed evidence relating to numbers affected and which groups may be at higher risk. Care home staff supporting older adults living with dementia to drink frequently report challenges in doing so. This thesis aimed to establish the prevalence of low-intake dehydration in older adults, identify groups at greater risk, examine caregivers’ discourses, actions and interactions for how people living with dementia drink in care homes, and explore interactive negotiations between care home staff and residents when supporting residents to drink.

Methods
This mixed-methods thesis used a convergent parallel design encompassing three studies. The systematic review assessed low-intake dehydration prevalence in non-hospitalised older adults. An ethnographic case study observing staff and residents, explored ways in which care home residents living with dementia were supported to drink. Thematic discourse analysis of caregivers’ online forum posts assessed the importance allotted to drinking in caring for long-term care residents living with dementia.

Findings
Meta-analysis of 44 studies found that 24% of non-hospitalised adults were dehydrated (95%CI:0.07,0.46), including 34% of long-term care residents and 19% of community-dwellers. Subgroup analyses did not suggest that people with cognitive impairment were at more risk than those with no cognitive impairment. The ethnography found that staff discourse and actions de-prioritised drinking activities compared to other care needs. Forum users also de-prioritised drinking in their discourses compared to food and eating.

Discussion
These empirical studies demonstrate that whilst low-intake dehydration is highly prevalent in community and long-term care settings, providing hydration care to those living with dementia in care homes is often de-prioritised compared to other care needs.

These findings indicate the value of care settings reviewing how they prioritise making drinks available and accessible to promote residents’ health and wellbeing.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User:	Chris White
Date Deposited:	20 May 2025 13:47
Last Modified:	20 May 2025 13:47
URI:	https://ueaeprints.uea.ac.uk/id/eprint/99311
DOI:

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