The Memory Unit OT

Hydration is always important, in all seasons and all phases of life. But as we approach the warmer weather, promoting hydration becomes all-the-more important.

Here are some tips and tricks that I personally have found useful.

Decorate a Water Bottle or Tumbler

Generally speaking, things that have personal meaning remain more of a focal point in an individual’s life. This is especially true in instances of dementia. Adding decorative stickers is a simple and cost-effective way way to add personal meaning to a very basic water bottle or tumbler. Stickers of favorite sports teams, favorite animals, or favorite vacation spots are easy to find and will add personal identifiers to a water bottle in a way that is also infection-control compliant.

Use Drink Mixes or Other Flavorings

As dementia progresses, sense of taste can diminish. Individuals living with dementia may be less inclined to continue to drink a glass of water after the first sip because of it’s boring taste. Enter: drink mixes. Because we almost always encounter comorbidities, I tend not to chose sugary juice/fruit punch mixes (because that may not be helpful to individuals who also have diabetes). My favorites are Tru Lemon lemonades and Stur water enhancers.

Offer ‘Happy Hour’ Every Hour

It can be 5 o’clock all day long on The Memory Unit. I like to offer what I refer to as ‘spritzers’: it’s equal parts fizzy beverage and favorite juice. Ginger ale mixed with apple juice. Sprite mixed with cranberry juice. Served up in a fancy party cup with a colorful straw and you’ve got the makings of a Memory Unit happy hour (even if it’s 9am!). I also recommend encouraging a unit to keep disposable party glasses on hand. Sometimes the simple switch from a standard cup to a party cup can make a big difference.

Be Present and Patient in the Process

Especially in instances of moderate to advanced dementia, it is unrealistic to expect an individual to finish a full drink independently after just a setup and initiation cue. Often, they require close supervision with repetitive multisensory cues and our demonstration of the task to maintain appropriate engagement and finish a full glass. It is not only good practice but an indicated clinical intervention to sit with someone for multiple 1-2 units of treatment to maximize engagement in the task and effective overall health.

Always Choose a Cup that’s Easy to Hold

As OTs, we’re always thinking about adaptive strategies and equipment. This could mean prescribing a traditional Kennedy or Nosey cup. But it can also mean collaborating with the interdisciplinary team to find a water bottle or tumbler with a firm handle and easy mouth piece that won’t be too hard or heavy to hold. It may just take some trial and error. And don’t knock those classic hospital cups; most facilities have them readily on hand, and sometimes they are the perfect size and handle shape for Residents.

Now, let’s talk about making this skilled.

As with any intervention, you have to use your Activity Analysis skills. So the key questions you need to ask yourself are:

1. Why am I doing this with my Resident?
2. What deficits or needs dose this Resident continue to show?
3. What goals have I (or the OTR) written in the care plan?
4. How can this activity address those needs and goals?

It’s Totally Appropriate to Write a Goal for Hydration/Cup Use in the Care Plan.

We write goals all of the time for meal engagement, adaptive equipment, and eating skills. Drinking skills go hand-in-hand. Your goal could look something like:

Resident will successfully drink 8 or more ounces using single-handle cup with straw with supervision and mod multisensory cues on 4/4 occasions for maximized independence with all meals and improved overall health.

Within this goal, your treatments can then focus on trialing various cups, cues, times of day, and even different flavors of drinks until you find a consistent and effective intervention.

Skilled OT services were utilized this day to address Resident’s independence and consistency with hydration. Trialed multiple single-handled cups of varying sizes with Resident over the course of 3 treatment encounters today. Resident noted to prefer cranberry mixed with ginger ale. Demonstrated greatest success with 12oz cup with lid and brightly colored straw. Required moderate visual and verbal cues to execute repetitive drinking/sipping. Demonstrated good grasp pattern around cup, managing cup to and from mouth with supervision. Recommend re-trial of this cup and beverage at next session to assess long-term effectiveness of this strategy.

You are a strong clinician. And unlike other staff in the building, you have the advantage of being able to take the time to sit and work with a Resident for a prolonged period of time. Use this to thoroughly trial different hydration options, all the while using your clinical assessment skills to determine best types of equipment, cues, and setup supports to maximize your Resident’s success.

You’ve got this!

If you’ve found a tried and true strategy, share with us in the comments!

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