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Care homes - questions and answers

Here we answer some commonly asked questions.

Q – How can staff help with sundowning/afternoon restlessness?

A – reduce the use of caffeinated drinks or replace with caffeine free, try to encourage residents to have an afternoon nap, after lunch. This helps to destimulate residents which enables them to feel calmer during the evenings. Reduce noise levels and light levels during this time. in the evening try to establish a dimmer, calm environment for the evenings to help residents wind down for bed.

Q. Why is Vitamin D important for care home residents? 
A. Our housebound elderly will be unable to get enough Vitamin D unless they are actively encouraged and enabled to get into the sunshine every day between March and October. 

Whilst we know Vitamin D helps the absorption of calcium from the bowel and so is vital for bone health, it also helps to prevent muscle weakness and in turn prevent falls. 

Ideas to introduce Vitamin D into the daily routine for your residents are: ‘walk and talk’, tea on the patio, exploring the garden and bird watching. This approach combined with a good dietary calcium intake will help to reduce falls and fractures. (Supplements may be necessary for those unable to get into the sunshine).

Combining bone health with falls prevention strategies such as regular exercise including balance and strength work, well-fitting footwear, regular medication reviews, appropriate use of equipment and regular eye tests will all help maintain your residents’ health.

Q. How can I improve hydration within the care home?

A. Dehydration is one of the most common indicators of someone moving from a
care home to hospital. Adequate fluid consumption in older adults has been found to be associated with fewer falls, lower rates of constipation and lower rates of laxative use.
The first indication of dehydration in most people is feeling thirsty. Other symptoms include confusion and sluggishness, light headedness/feeling faint when standing, or dark strong-smelling urine.

But how much should we drink? For people under 60 years of age, daily fluid intake is calculated by multiplying weight (kg) x 35ml. For people over 60 years of age it reduces to 30ml/kg. If the environment is hot more fluids may be required; this is also the case if residents are vomiting or have diarrhoea. Conversely, residents with cardiac or renal failure may be advised to restrict fluids.

Remember to record food and fluid intake. Sources of fluid are:
Cold drinks including water, diluted squash, fruit juices; hot drinks including tea and coffee; prescribed sip feeds and thickened fluids for residents with dysphagia. Alcohol does not count as it has a diuretic effect. Some foods have good fluid content such as jelly, ice cream, custard, yoghurt, soup, tomatoes and cucumber. In hot weather, ice-lollies are a great way of keep cool and count towards fluid intake.
Remember if you’re feeling thirsty – you’re already dehydrated.

Q; I am concerned about one of my residents, who do I call and when?  

Q; I have a resident that is losing weight and eating very little. What can I do?

Refer to ‘MUST’ guidelines. See below for suggestions on fortifying food intake: