An exploration of hydration practices in Maltese residential care homes for older people

Background: The integral relationship between adequate hydration and good health is widely recognised. Older people with complex needs and frailty can struggle to maintain adequate hydration, with residents in care home settings being at an increased risk of dehydration.
Aims: To explore current hydration practices in residential care homes in Malta.
Methods: An exploratory qualitative approach was adopted to explore staff’s views and approaches in supporting resident’s hydration. Data was collected via semi-structured, individual and small group interviews with 2 care homes from the central and southern region of Malta. A process of open coding, followed by axial coding were used to analyse the data. Peer debriefing was performed throughout, until agreement was reached amongst the research team about the final themes and sub-themes.
Findings: Three themes emerged from the data: culture of promoting fluid intake; challenges in supporting older people to achieve optimum hydration; hydration practices and approaches.
Conclusion: A hydration promotion culture was demonstrated through various practices adopted in the care homes. The strong focus on water intake, in response to concerns about consuming sugary beverages, has implications on the promotion of a person-centred approach to hydration care. Inconsistencies in monitoring of fluids and daily recommended targets, highlights the importance of policies or guidelines to guide hydration practice. Challenges related to refusal of fluids and language barriers amongst non-native staff were evident and justifies further research is this area.