Water – A Primary Nutrient for Healthy Ageing Nick Ellins – Water UK

1. Water – A Primary Nutrient for Healthy Ageing Nick Ellins – Water UK ‘Malnutrition of older people in care’

2. Water in nutrition The Theory: “Drinking water is now clearly recognised by the World Health Organization as a basic nutrient of the human body, critical to human life, and is seen by many dieticians as the primary nutrient” The Facts: • Water is rarely considered or even offered in either nutrition or in care. It is a vital, but overlooked component of nutrition and wellbeing. The adverse effects of poor hydration include: • Kidney damage • Dizzy spells • Falls • Constipation • Urinary tract infections • Cognitive impairment • Certain cancers • Pressure sores • Poor Oral Health Source: H Forester – BMA Researcher A draft report of the published scientific literature on the impacts of water on health.  Commissioned by Water UK 2002

3. Existing Care Standards • The theory - "National Minimum Standards for Care Homes contains clear guidance on the provision of water to residents, and care homes must also ensure safe practice under the Food Safety Act 1990". • The facts – “Hot and cold drinks and snacks shall be freely available and offered regularly”. Care Standard 15 (Care Standards Act 2000 March 2001) • Conclusion - No where else in public health guidance would you find tea, coffee, high sugar soft drinks, alcohol and fizzy drinks ever recommended. We learn every day how damaging these are. Yet in Care Homes for older people, it is standard practice.

4. Existing Research • One pilot study suggests that good hydration can reduce the risk of breast cancer by 33% for premenopausal women and 79 per cent for postmenopausal women. • Consumption of 2.5 litres of water a day was associated with a 51 per cent reduction in bladder cancer risk compared to a 37 per cent reduction with other fluids. • In one study, the risk of Colon Cancer was reduced by 45 per cent in women and 32 per cent in men who drunk four or five glasses of water, a day compared to those who drank only two or less. • ‘Wise up on Water’ – A review of available medical evidence by Hilary J Forrester, Independent Researcher and Senior Policy Executive, Science and Education, BMA

5. “The composition of the whole body changes during ageing. There is a decline in the amount of lean body tissue, an increase in body fat and a decrease in the percentage of body water. This means that older people can have impaired temperature regulation, starting to shiver later in response to cold. They are thus more vulnerable to hypothermia. The reduced renal function (meaning that urine cannot be as concentrated) and the decline in the thirst mechanism puts an older person at greater risk of dehydration. Older people thus need to drink plenty of fluids even if they do not feel thirsty”. Age Concern Quote from Age concern Nutritional Care for older people – A guide to good practice by June Copeman page 4.

6. “Elderly people are at greatest risk for dehydration and its potentially life-threatening consequences. Elders aged 85–99 are six times more likely to be hospitalised for dehydration than those aged 65–69. More than 18% of those hospitalised for dehydration will die within 30 days, and associated mortality increases with age”. American Society of Consultant Pharmacists Quote from ‘Prevention and Management of Dehydration’ by Jeannette Wick RPh, MBA Chief Pharmacist, District of Columbia Department of Human Services, Washington, D.C.

7. The Water for Health Alliance