Mealtime Partners, Inc.


We Specialize in Assistive Dining Equipment and Accessories

Mealtime Partners, Inc. (MtP) November 2009 Newsletter

Independent Eating...   is a Wonderful Thing 

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The Importance of Hydration

Over the past few months many aspects of independent eating have been discussed in our Newsletters because assistive dining equipment is our primary product. Some of the information pertaining to dining, particularly that information relating to positioning, is equally applicable to drinking. However, because of the importance of adequate hydration to all of us, this article will specifically discuss hydration and how independent drinking systems are important to those who are unable to lift, hold, or tip a cup.

A little background might be helpful. The majority of our body weight is comprised of water (approximately 70%). The water is contained in our cells, our blood vessels, and the space between cells. We constantly lose water from our body. It is lost when we breathe, perspire, urinate or have a bowel movement. However, most of the time, we replace the water that is routinely lost as we lose it, through drinking. Yet, it is estimated that up to 75% of Americans do not drink enough water.

This problem is far greater for the frail elderly. Data from the 1996 National Hospital Discharge Survey1 revealed that 208,000 patients 65 years of age and older were discharged from short-stay hospitals with a primary diagnosis of dehydration. Since the average length of stay for people 65 and older was 6.5 days in 1996, and the average cost of care per day was $1,006, the cost of hospitalization for dehydration in that year alone was $1.36 billion. The problem of dehydration in the elderly continues to exist today at epidemic proportions.2

Dehydration occurs when we do not take in adequate liquid to replace what is lost from our bodies. However, thirst is not the first symptom experienced by an individual who is becoming dehydrated. The signs and symptoms of mild dehydration are: headache, dry mouth, fatigue, cramps, weakness, dry flushed skin, and, lightheadedness. However, for those people who live in a constant state of mild dehydration, they are unaware of it because the symptoms of dehydration have become “normal” for them.

If dehydration becomes moderate, the symptoms worsen and will include: dark yellow urine, eyes that do not tear, lack of sweating, nausea, vomiting, sleepiness, changes in mental status, increasing weakness, and, skin that does not “return to normal” rapidly when pressed. Ongoing dehydration will cause people to be weak, fatigued, apathetic, and depressed. Dehydration, if not addressed, can become life threatening.

For most individuals, dehydration is 100% preventable and yet many people with disabilities suffer from some level of dehydration almost constantly. The daily routine for many people who are dependent upon another person to provide them with fluids and nutrition, commonly associates drinking with food. That is, drinks are only provided at mealtimes. This practice leads to an inadequate amount of liquid being consumed by the individual. Also, it is a difficult challenge for a care provider to remember, and/or to have the time, to offer a drink to someone at regular intervals. The result is that when liquid is offered, the person providing the drink encourages the consumption of large quantities of liquid, in a hurry. The consumer is then obliged to repeatedly swallow, without a break to breath or reorganize their mouth. The more swallows taken without a break, the greater the risk of choking or aspiration.

Due to the great importance of proper hydration, Mealtime Partners recommends that everyone be provided the means to drink at any time they wish, and that drinking not just be made available at mealtimes.


The Mealtime Partner Assistive Dining Device is the only powered dining device ever built that reliably picks up food! It can serve most ordinary table foods without special preparation and can also serve textured foods and liquids (soup, cereal, pureed foods, etc.). It serves a controlled amount of food and wipes the bottom of the spoon to minimize dripping. The versatile mounting systems that are available, enable the Mealtime Partner to be used by the majority of people who cannot self-feed. If you need help with selecting a mounting system, please call us at 800-996-8607. We will be pleased to assist you.


Independent Drinking

There are several different methods of providing a drink: a cup can be placed at the user’s lips and tipped; a bottle can be used in the same way; or, a container with a straw can be offered. However, great caution should be used when offering someone a drink from a bottle. The inclination when drinking from a bottle, particularly a bottle with a spout top, is to lift or tip the head up and backwards. This head position poses a risk to the drinker because it exposes the airway to a possibility of the liquid “going down the wrong way”. Additionally, while the bottle is to their lips, the user is required to swallow the liquid continuously, rather than one swallow at a time. As mentioned earlier, repeated swallows without a break between each swallow, significantly increases the risk of choking. Even though providing a drink from a bottle results in less spillage than a cup, it is recommended that bottles not be used, because of the increased risk of choking.

Drinking from a cup is a safe way of receiving a drink as long as the person’s head is maintained in a chin tuck. (If you are unfamiliar with promoting a chin tuck, that topic was covered in our June 2009 Newsletter article: Promoting a Chin Tuck for Safer Eating. This article applies well to drinking, also.) It is difficult to reliably provide a drink from a cup without occasional spillage. However, with practice a partner and drink recipient usually become skilled at this task and spillage is minimal.

For a person who cannot lift a cup to their mouth, using a straw or tube that is linked to a source of liquid is the preferred method for their access to hydration. They will then to be able to drink at any time they wish. (Because a straw is a type of drinking tube, to avoid redundancy, we will use the term "straw" in the following discussion to mean any type and length of drinking tube.) Using a straw makes providing a drink much simpler and safer, and is essential for independent drinking. However, to be able to use a straw, the user must be able to form their lips around the straw to create the necessary vacuum. The user's lip closure capability requirements depend a lot upon the softness or rigidity of the straw. When selecting a straw, how much the tube will shape to the user's lips, and how much lip control the user will require to seal their lips around the straw (so that a vacuum can be developed), must be considered. (There are many varieties of straws and choosing the correct one for the individual is very important. The upcoming Mealtime Partners December Newsletter will cover the topic of straws, both reusable and disposable, and will provide additional insight into selecting the correct straw.)

Another important consideration when choosing a drinking system is the user’s ability to suck. If they have good strong suction, a drinking system can be mounted on the back of a wheelchair or a bed head. Alternately, a drink holder can be mounted in front of a wheelchair arm-rest and a long straw can be utilized by the user to take a drink without using their hands or having assistance. Unfortunately, many people who are unable to pick up a drink with their hands, also have a limited ability to suck and require a short straw. This reduces the mounting possibilities for a drinking system to being near the user's mouth, which is usually in front of the user, whether they are sitting in a chair at a table, are in bed, or sit in a wheelchair, with or without a laptray.

One of the simplest and inexpensive drinking systems is to use a sturdy cup or bottle (with a lid and a straw) placed on a table or laptray on a sheet of Dycem®3. However, this only works for individuals who have good coordination and understand that they might tip the cup over if they are not careful. Alternately, cup holders are available that have sticky bottoms that hold them in place once they are positioned on a Front Mounted Drinking Systemflat surface. They can accommodate a variety of different sizes and shapes of cups.

Another example of an independent drinking system is the Mealtime Partners Front Mounted Drinking System, shown to the right. It is one of the easiest drinking systems to use because it brings the drink very near the user's mouth, thus reducing the suction required for it's use. It has an advantage over the table or laptray mounting mentioned above, because it is held firmly in place and cannot be knocked over. The Front Mounted Drinking System was developed by Mealtime Partners to provide access to fluids to our customers who use wheelchairs but who have a very limited range of head and trunk movement, and, who additionally, have weak suction. The system consists of a heavy-duty gooseneck that has a clamp on one end and a cup holder on the other. Several lengths of goosenecks are available so that this drinking system can accommodate many different individual sizes. It is basically a moveable cup holder that will hold it's position. The picture shows the Front Mounted Drinking System holding a purple koozie with a green cup and straw in it. (These do not come with the drinking system).

Other drinking systems are available that locate the liquid on the back of the wheelchair, which may be preferred because it locates the liquid container out of the way. However, the user must be able to create more suction.

In conclusion, it is recommended that everyone who needs assistance with drinking, be provided an independent drinking system. Systems that use a straw are simple and safe and with the straw positioned near the user's mouth, permits independent drinking for almost everyone. Just be sure to select a drinking system meeting the user's physical capability for suction and that the straw is compatible with their lip closure/pucker capability to permit sealing the lips around it.

 

Because many of our dining customers need help getting a drink, Mealtime Partners, Inc. provides a variety of drinking systems that can meet the differing needs of individuals. Most of these systems can be mounted on a wheelchair or bed. To learn about the Mealtime Partners drinking systems, click here. Information is available to help you select the right drinking system. And, if you still have questions about selecting a drinking system, please call please call us at 800-996-8607. We will be pleased to assist you.



November 2009 Newsletter References:

1. Graves, E.J., Owings, M.F., 1995 Summary: National Hospital Discharge Survey. Advance Data from Vital and Health Statistics, No. 291. Hyattsville, Maryland: National Center for Health Statistics, 1997.

2. Burger, Sarah Greene, Kayser-Jones, Jeanie, Prince, Paula, Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment, National Citizens' Coalition for Nursing Home Reform, The Commonwealth Fund, July 2000.

3. Dycem® - manufactured by Dycem Limited in the United Kingdom. This unique material prevents slipping without the need for permanent fixing. Dycem is non-toxic and is easily washed, with a multitude of uses in clinical, home and work settings. Commonly used under plates and glasses, while eating, also great for holding desk top activities in place.

 


 

 

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