Socially constructing older people: examining discourses which can shape nurses’ understanding and practice

Toward a moral commitment: Exposing the covert mechanisms of racism in the nursing discipline

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.

Maintaining oral hydration in older adults in surgical wards: a best practice implementation project

INTRODUCTION AND AIM

Oral hydration is essential in older adults as poor hydration can complicate existing medical conditions and increase morbidity. Older adults in surgical wards are at risk of dehydration due to insufficient fluid consumption. The aim of this project is to ensure patients aged 65 years and above are adequately hydrated.

METHODS

The current project was conducted over 7 months from February to August 2019 and involved pre and postimplementation audits to ensure compliance with best practice. The Joanna Briggs Institute Practical Application of Clinical Evidence System and the Getting Research into Practice tools were used as a guide. Audits were conducted at four surgical wards with a sample of 42 patients at each audit. The measures implemented include educating nurses on the importance of oral hydration in older adult patients and labelling water jugs to encourage fluid intake among these patients.

RESULTS

Nurses' compliance in monitoring older adult patients' daily fluid intake increased from 5 to 76% at follow-up audit (P < 0.05). In addition, the average amount of fluid consumed over 3 days increased from 858.23 to 1037.50 ml.

CONCLUSION

This project demonstrated a significant increase in oral fluid intake among older adult patients during hospitalization and their understanding of adequate fluid intake. Nurses play an important role in ensuring adequate amounts of daily fluid intake by these patients.

Nursing Students' Attitudes Toward Older Adults After Their First Intentional Encounter: A Cross-Sectional, Correlational Study

AIM

This study examined how intentional first encounters as a nursing student, as well as prior relationships with older adults, influenced baccalaureate prelicensure nursing students' attitudes toward this population.

BACKGROUND

There is a growing demand for knowledgeable and skilled nurses to provide person-centered care to an aging population. An ongoing challenge is lack of interest in practicing within gerontological settings following graduation.

METHOD

A cross-sectional, correlational, comparison research design was used. Ninety-nine nursing students in five groups were recruited from six baccalaureate prelicensure nursing schools.

RESULTS

A one-way analysis of variance revealed a significant difference among groups, F(4, 94) = 4.873, p = .001. Students completing clinical in half-semester acute care and long-term care (M = 64.03, SD = 16.9) had better attitudes than students in other clinical experiences.

CONCLUSION

Addressing the development of positive attitudes in nursing students remains imperative to promote person-centered care to the aging population.

Nursing practice with hospitalised older people: Safety and harm

BACKGROUND

Nursing teams work with hospitalised older people in institutions, which prioritise a biomedical model of care. This model does not fit the needs of older people because it emphasises efficacy and a narrow definition of patient safety, but does not prioritise functional needs. Nursing care is provided around the clock within the context of fiscal restraints as well as negative societal and nursing perspectives about ageing and old people. Yet, nursing perceptions of managing safety and potential harms to older patients within these hospital institutions are not well understood.

METHODS

An integrative review was conducted to examine nursing perspectives of safety and harm related to hospitalised older people.

RESULTS

The majority of included papers focused on restraint use. Findings reveal that nurses are using restraints and limiting mobility as strategies to manage their key priority of keeping older patients safe, reflecting a narrow conceptualisation of safety. Policy, administrative support and individual nurse characteristics influence restraint use. Safety policies that nurses interpret as preventing falls can encourage the use of restraints and limiting mobility, both of which result in functional losses to older people.

CONCLUSIONS

This complex issue requires attention from clinical nurses, leaders, policy makers and researchers to shift the focus of care to preservation and restoration of function for older people in hospital as a safety priority.

IMPLICATIONS FOR PRACTICE

Clinical leaders and nursing teams should engage in developing processes of care that incorporate maintaining and restoring older people's function.

Attitudes toward guardianship, social work goals, and perspectives of disability among social work students

Purpose: Guardianship of people with disabilities has been under growing scrutiny, leading some welfare states to offer supported decision-making as a legal alternative. This study examined the attitudes of Israeli social work students toward guardianship and supported decision-making and the relationship between these attitudes and the perceived importance of social work goals, as mediated by perceptions of disability.Materials and methods: Participants were 414 undergraduate and graduate level social work students from Israel. Participants completed a structured questionnaire that measured: attitudes toward guardianship and supported decision-making, importance of social work goals, and perception of disability.Results: Although social work students tended to support limiting the scope of guardianship, they did not clearly oppose it. Individual model perspective of disability mediated the association between the social work goal of social control and attitudes toward guardianship. Social model perspective of disability mediated the association between the social work goal of social justice and attitudes toward guardianship.Conclusion: To reduce guardianship appointments, social work educators should educate students better regarding current supported decision-making trends, emphasize the importance of social justice goals, and discuss critically the necessity of social control. Further, educators need to embrace the social model of disability, in particular its view of autonomy and interdependence.Implications for rehabilitationThe UN Convention on the Rights of Persons with Disabilities has urged limiting guardianship practices, and developing instead less restrictive alternatives, especially supported decision making.In order to fully implement the Convention's vision, efforts must be placed in social work training programs on discussing the limitations of guardianship, the dilemmas it raises and the advantages of other less restrictive alternatives, including that of supported decision-making.Social work educators should also emphasize the importance of social justice goals and discuss critically the necessity of social control.Similar emphasis should be placed on exposing students to the social model of disability, including its view of autonomy and interdependence.

A qualitative study exploring staff attitudes to maintaining hydration in neurosurgery patients

AIMS

To explore staff perceptions of the processes and influences on maintaining patients' hydration on a busy neurosurgery ward.

BACKGROUND

Dehydration continues to be a major concern in the NHS where its avoidance is hindered by complications arising from clinical conditions, poor assessment and documentation of hydration and a lack of staff time to monitor fluid intake. Recent work has explored patient perceptions of hydration care but there has been little conducted recently that has explored those of staff.

METHODS

Semi-structured interviews were conducted with staff working on a neurosurgery ward during 2016. We used open-ended questions to elicit experiences of hydration care and explore factors that influenced the maintenance of hydration in patients.

RESULTS

We found that staff were aware of the importance of hydration and saw it as a central aspect of the care they provided. A range of staff are involved in the assessment of patients' hydration requirements and their ability to meet them. Similarly all staff were expected to provide oral fluids for patients able to drink independently. Competing priorities inhibited the time staff could spend providing hydration care which had an impact on the timely and accurate completion of fluid balance charts and meant that relatives were relied on to support patients requiring assistance in drinking.

Delivering dignified care: A realist synthesis of evidence that promotes effective listening to and learning from older people's feedback in acute care settings

AIMS AND OBJECTIVES

To explore effective mechanisms for listening to and learning from feedback from older people in the context of acute care.

BACKGROUND

Maintaining the dignity of older people in acute care has become an issue of international concern. In the United Kingdom, recommendations for care improvement have led to the formation of an implementation group, the "Listening and Learning Hospitals Pilot Project." This literature review forms phase 1 of the project.

DESIGN

Realist synthesis was used to explore and synthesise wide-ranging evidence.

METHODS

Using 12 databases, literature was scoped to propose four principles that underpin the context, mechanism and outcomes (CMO) of effective relation-based interventions with older people and their care partners in the acute care setting. A search was carried out in order to synthesise data to refute or support each principle. A total of 137 studies and 11 sources of grey literature were appraised and included. A final synthesis of evidence across all principles identified key mechanisms for effective relation-based interventions.

RESULTS

Eight essential mechanisms support effective care interventions.

CONCLUSIONS

This review adds depth and breadth to current nursing knowledge in this field through the process of realist synthesis. Acute care organisations need to make a commitment to supporting relational care at organisation and unit levels. Additionally, they need to value and support the well-being of the nurses delivering it so that interventions to improve care for older people can succeed.

RELEVANCE TO CLINICAL PRACTICE

Essential mechanisms synthesised from the review, together with other suggested interventions for improving dignified care of older people in acute care by listening to them and learning from their feedback, may contribute towards practice development in acute care.

The meaning of patient-nurse interaction for older women in healthcare settings: A Qualitative Descriptive Study

AIMS AND OBJECTIVES

The purpose of this study was to explore the meaning of patient-nurse interaction for older women receiving care in healthcare settings.

BACKGROUND

Older women are often overlooked or misunderstood by the nurses caring for them. Some research exists on nurses' perception of their interaction with patients, yet few studies have described the meaning of such interaction from the patients' perspective.

METHODS

This was a pilot study using qualitative description as a methodology. Data were filtered through a lens of critical feminist theory to interpret interactions taking place in healthcare settings that are often characterised by paternalism. Seven women between the ages of 66 and 81 were interviewed using a semi-structured guide.

RESULTS

Participants had a distinctive perspective on the experience of caring. Their expressions include stories of being cared for themselves by nurses as well as historical recalls of being the one-caring for family members. In these combined stories, the contrast between the nurses who held caring in primacy and those who were distinctly uncaring sheds light on the importance of cultivating a moral ideal of caring and respect for personhood.

CONCLUSION

A population of older women who potentially face disabling conditions must rely on direct, meaningful, interaction with nurses to successfully navigate the healthcare system. The findings suggest that these women did not have consistent access to such interaction.

IMPLICATIONS FOR PRACTICE

The gathering and interpretation of new narratives about patient-nurse interaction for older women could lead to a deeper understanding of power and civility as it impacts a caring relationship. Further research using a theoretical lens of critical feminism has implications for improving healthcare delivery for older women worldwide.

A hermeneutic phenomenological explorations of living in old age

Although there have been some studies that explore the meaning of aging and give voice to older people, the impact that the aging experience can have on them justifies continued research in this area. In this study, with a hermeneutic phenomenological design and an interpretation method inspired by the philosophy of Ricoeur, we conducted in-depth interviews with 14 elderly people at a social day center in Rome (Italy). The analysis revealed three central themes associated with the experience of being old: changes and limitations related with being aged, the experience that comes from having lived a long life, and an awareness of death. The findings could help health professionals, families and caregivers to achieve a deeper understanding of what old age entails, and may also serve as a platform for interventions that seek to enable older people to experience aging as a meaningful and positive process.

Normalization of Neglect: A Grounded Theory of RNs' Experiences as Family Caregivers of Hospitalized Seniors

Often older people, while maintaining a level of independence, rely on family members to provide care and assistance. Caregivers who are also registered nurses (RNs) may provide a different perspective around the experience when their older relative is admitted to acute care. The aim of our research was to investigate and develop theory regarding nursing care provision as described by RNs, who were family caregivers to older adults, when that older adult was admitted to acute care. Over a six-month period in 2011, RNs meeting this criterion (n = 12) were interviewed individually. We identified two central categories: "Culture of Neglect" and "Vigil by the Bedside". The core category "Normalization of Neglect" was identified as the theory, grounded in the data the participants provided which described a culture of neglect that had normalized poor nursing care. These findings highlight the issue of neglect and abuse, and further investigation is warranted.

Fragmentation in Australian Commonwealth and South Australian State policy on mental health and older people: A governmentality analysis

Mental health care for older people is a significant and growing issue in Australia and internationally. This article describes how older people's mental health is governed through policy discourse by examining Australian Commonwealth and South Australian State government policy documents, and commentaries from professional groups, advocacy groups and non-governmental organisations. Documents published between 2009 and 2014 were analysed using a governmentality approach, informed by Foucault. Discourses of 'risk', 'ageing as decline/dependence' and 'healthy ageing' were identified. Through these discourses, different neo-liberal governmental strategies are applied to 'target' groups according to varying risk judgements. Three policy approaches were identified where older people are (1) absent from policy, (2) governed as responsible, active citizens or (3) governed as passive recipients of health care. This fragmented policy response to older people's mental health reflects fragmentation in the Australian policy environment. It constructs an ambiguous place for older people within neo-liberal governmental rationality, with significant effects on the health system, older people and their carers.

Representation of age and ageing identities in popular music texts

AIMS

To critically examine the representation of ageing identities in popular music texts.

BACKGROUND

Having a positive outlook provides both short-term benefits and has been proven to help people live longer. Music is capable of conveying positive and negative emotion towards ageing, however, only a limited number of unpublished studies exist on how age and ageing is represented in popular music.

DESIGN

Qualitative discourse analysis.

METHODS

In July 2014, a search without time limits was completed of the music lyrics databases, The Music Lyric Database, Songfacts, The Macronium and Absolute lyrics for English language music texts relating to age and ageing.

RESULTS

Findings revealed (N = 76) relevant music texts offering up negative and positive discourses of age and ageing, with negative predominating. Identities of age and ageing were categorized as 'contented and celebrated aged', 'pitiful and petulant pensioners' and 'frail and flagging old folks'.

CONCLUSION

From this study, it is evident that mainly negative representations of age and ageing are available in popular music texts. It is imagined that the negative representations of age and ageing can be dispiriting, confidence and esteem lowering for older people and their potential impact might be considered carefully by artists. However, while evidence exists that negative and positive emotions can influence health and well-being, further qualitative research is needed to explore what impact precisely the negative texts have on those experiencing ageing.

Who wants to work with older people? Swedish student nurses' willingness to work in elderly care--a questionnaire study

BACKGROUND

The aging population is a globally recognized challenge for the health care service. The growing number of older people will probably lead to increased demands for nurses working in elderly care. Clinical practice has been shown to have an impact on how student nurses perceive a particular field of nursing.

OBJECTIVES

To compare perceptions of the clinical learning environment in nursing homes among students considering a career in aged care or not, and to examine the difference in age, gender and previous working experience as health care assistants in elderly care between the two groups.

DESIGN

This was a cross-sectional study using the Swedish version of the Clinical Learning Environment and Nurse Teacher evaluation scale.

METHODS

Consecutive sampling was performed over three semesters from September 2011 to December 2012. The survey was conducted with 183 student nurses. Mann-Whitney U-test was used to examine differences in relation to two groups namely student nurses who did or did not consider to work in elderly care. A chi-square test of independence was performed to examine the difference in age, gender and previous working experience between the two groups.

RESULTS

The analysis leaned towards an overall positive evaluation of the clinical learning environment with more positive values for students considering a career. There were no significant differences between younger students (18-23) and older students (24-50) regarding willingness to work in elderly care or not. Neither was any significant difference displayed between students, based on gender nor for previous work experience.

CONCLUSION

Age, gender and previous work experiences as health care assistants did not impact on students' willingness to work in elderly care. Future studies need to acknowledge the complexity of why student nurses choose a particular pathway in nursing by longitudinal studies following cohorts of students during the course of the nursing programme.

Ageism, negative attitudes, and competing co-morbidities--why older adults may not seek care for restricting back pain: a qualitative study

Background

Back pain, the most common type of pain reported by older adults, is often undertreated for reasons that are poorly understood, especially in minority populations. The objective of this study was to understand older adults’ beliefs and perspectives regarding care-seeking for restricting back pain (back pain that restricts activity).

Methods

We used data from a diverse sample of 93 older adults (median age 83) who reported restricting back pain during the past 3 months. A semi-structured discussion guide was used in 23 individual interviews and 16 focus groups to prompt participants to share experiences, beliefs, and attitudes about managing restricting back pain. Transcripts were analyzed in an iterative process to develop thematic categories.

Results

Three themes for why older adults may not seek care for restricting back pain were identified: (1) beliefs about the age-related inevitability of restricting back pain, (2) negative attitudes toward medication and/or surgery, and (3) perceived importance of restricting back pain relative to other comorbidities. No new themes emerged in the more diverse focus groups.

Conclusions

Illness perceptions (including pain-related beliefs), and interactions with providers may influence older adults’ willingness to seek care for restricting back pain. These results highlight opportunities to improve the care for older adults with restricting back pain.

Media portrayal of older people as illustrated in Finnish newspapers

Media portrayals of older people, such as those in newspapers, both inform and reflect public attitudes. By becoming aware of culturally influenced attitudes about older people, and how these attitudes are reflected in the ways older people are viewed, treated, and cared for in society, the healthcare profession can better understand how to provide high-quality care. By applying an ethnographic approach in textual reality, this paper explores how newspaper articles focusing on health portray older people in society, using Finland as an example. The data consist of articles selected from three of the main Finnish daily newspapers during a 3-month period in the spring of 2012. The findings show that, overall, the society regards older people and their care as important. However, there were suggestions of paternalistic attitudes towards older people. Furthermore, the perceptions regarding different groups of older people could lead to the possibility of inequality. The media portrayals of older people worldwide seem to share similarities, although the findings of this study are particularly in accordance with the cultural attributes of the Nordic countries and societies.

Role modeling clinical judgment for an unfolding older adult simulation

Nurse educators must foster development of clinical judgment in students to help them provide the best care for the increasing population of older adult patients. This article reports qualitative findings from a mixed-methods study that focused on clinical judgment in the simulated perioperative care of an older adult. The sample was composed of treatment and control groups of prelicensure students (N = 275) at five sites. The treatment group watched a video of an expert nurse role model caring for a patient similar to the simulation patient, whereas the control group did not watch the video. Four weeks after simulation, participants cared for real-life, older adult perioperative patients. After the simulated and real-life care experiences, participants completed questionnaires related to clinical judgment dimensions. These two data sets revealed rich findings about the students' simulation learning, affirming the value of expert role models. Transferability of simulation learning to practice was also explored.

The care of older adults in hospital: if it's common sense why isn't it common practice?

AIMS AND OBJECTIVES

To present three converging myths that underlie the perception that nursing care for older persons in hospital is simple in comparison with its actual complexity.

BACKGROUND

Literature provides strong evidence indicating that the myths we discuss inherently arise from ageism, the social value of older patients and the economic burden of being an older patient in hospital. These powerful social discourses promote harm to older patients. Harm emerges from both the omission of gerontological nursing knowledge and skill and the commission of acts that unintentionally harm. A corresponding ethical challenge results for acute care nurses.

DESIGN

A discursive paper.

METHODS

We illuminate gerontological issues by discussing three myths. In myth one, we detail four clusters of distinguishing characteristics in older hospitalised people. In the second myth, we challenge the idea that the role of the acute care hospital is to attend only to acute medical concerns. Finally, in the third myth, we address the issue of incorporating functional assessment into the acute care nursing assessment. We argue that functional assessment is poorly integrated and becomes acceptable only as long as the medical regimen is managed appropriately.

CONCLUSION

Safe quality care in hospital for older adults requires a hybrid practice that integrates acute care specialty knowledge with gerontological nursing knowledge and skill. Clinical reasoning that integrates this type of nursing knowledge can prevent harm.

RELEVANCE TO CLINICAL PRACTICE

Integrating key elements of acute care nursing specialty knowledge with gerontological nursing principles aids to prevent the omission of care that is known to be harmful to older people. Conversely, the commission of gerontologically sensitive acute care can enhance safety and promote quality care in hospital.

Canadian Nursing Students and the Care of Older Patients: How Is Geriatric Nursing Perceived?

The aim of this research was to contribute to an understanding about the professionalization of gerontological nursing. The specific objective was to explore attitudes about older people among undergraduate nursing students. Three focus groups were carried out with 3rd-year nursing students in a generalist program in a small Canadian city and discussions focused on experiences and attitudes surrounding the care of older patients. A qualitative descriptive approach was used to analyze the verbatim transcripts. Results indicated that students had positive reactions to caring for older patients, at least when dementia is not present, but they received a strong message from their mentors that this type of nursing is neither prestigious nor valued. Discussions surrounding the care of older adults highlighted students' perceptions of conflicts between the art and science of nursing, and their concerns regarding the divisions of tasks between nursing students, registered nurses, and licensed practical nurses.

Macro- and micro-level predictors of age categorization: results from the European Social Survey

This study evaluated macro- and micro-level variables associated with individuals' perception of the ending of youth, the beginning of old age, and the length of the middle age period. The European Social Survey is a biennial multi-country, cross-sectional survey. Our analysis is based on the fourth wave, which included a rotating module on ageism. The source sample consisted of 28 countries and a total of 54,988 respondents. Whereas macro-level variability accounted for 14 % of the variance associated with the perception of the ending of youth, only 5.7 % of the variance associated with the perception of the beginning of old age was accounted for by macro-level variability. Almost 10 % of the variance associated with the perception of the middle age period was associated with macro-level variability. Different patterns of macro- and micro-level correlates emerged for the ending of youth, beginning of old age, and the period of middle age. Overall, results demonstrate that individual differences in the perception of the ending of youth, the beginning of old age, and the length of the middle age period are more pronounced than contextual differences. Results also suggest that individuals' mental maps regarding the timing of these events are not necessarily concordant.

Developing positive attitudes toward geriatric nursing among Millennials and Generation Xers

Despite the increase of the older adult population, there exists a shortage of health care professionals trained to help this population remain independent as long as possible. Ageism, common among younger adults, affects the capacity building of health care for older adults. Research has indicated that increased knowledge about older adults, as well as exposure to the elderly, may alter nursing students' attitudes regarding careers in gerontological nursing. However, questions remain as to what are the most effective ways to provide gerontological content in nursing programs and enhance attitudes toward older adults.With the understanding that younger adults see a need to balance work and play, a baccalaureate nursing program provides examples of ways to accomplish this through integration of courses, simulations, positive images of aging, and learning activities that enhance empathy for both frail and healthy older adults.

Elder care as "frustrating" and "boring": understanding the persistence of negative attitudes toward older patients among physicians-in-training

OBJECTIVES

This study explores the attitudes of physicians-in-training toward older patients. Specifically, we examine why, despite increasing exposure to geriatrics in medical school curricula, medical students and residents continue to have negative attitudes toward caring for older patients.

METHODS

This study used ethnography, a technique used by anthropologists that includes participant-observation, semi-structured interviews, and facilitated group discussions. Research was conducted at two tertiary-care academic hospitals in urban Northern California, and focused on eliciting the opinions, beliefs, and practices of physicians-in-training toward geriatrics.

RESULTS

We found that the majority of physicians-in-training in this study expressed a mix of positive and negative views about caring for older patients. We argue that physicians-in-trainings' attitudes toward older patients are shaped by a number of heterogeneous and frequently conflicting factors, including both the formal and so-called "hidden" curricula in medical education, institutional demands on physicians to encourage speed and efficiency of care, and portrayals of the process of aging as simultaneously as a "problem" of inevitable biological decay and an opportunity for medical intervention.

DISCUSSION

Efforts to educate medical students and residents about appropriate geriatric care tend to reproduce the paradoxes and uncertainties surrounding aging in biomedicine. These ambiguities contribute to the tendency of physicians-in-training to develop moralizing attitudes about older patients and other patient groups labeled "frustrating" or "boring".

An exploration of the hydration care of older people: a qualitative study

BACKGROUND

Older adults are more susceptible to water imbalance and ensuring they drink sufficiently is a complex and challenging issue for nurses. The factors that promote adequate hydration and the barriers which prevent older people from drinking are not well understood.

OBJECTIVE

This study aimed to understand the complexity of issues associated with the hydration and hydration care of older people.

DESIGN

A qualitative study using multiple methods.

SETTINGS

Two healthcare sites providing care for older people in the South West of England: a hospital ward in a major hospital and a care home providing personal and nursing care.

PARTICIPANTS

Twenty-one older people aged 68-96 years, were recruited to the study from the hospital ward and care home. The inclusion criteria for older people to participate were men or women aged 65 years and over and the exclusion criteria were being unable to provide informed consent, or being too ill or distressed to take part in the study. The staff participants of nurses and health care assistants totalled 21. The inclusion criterion for staff was any nurse or health care assistant providing hydration care. Seven friends or relatives participated by making anonymous comments via a suggestion box available to all friends and relatives.

METHODS

Data were collected via interviews with older people, focus group discussions involving staff, suggestion box comments made by friends and relatives and twelve hours observation of hydration practice. The data were analysed using thematic analysis.

RESULTS

Health professionals successfully employed several strategies to promote drinking including verbal prompting, offering choice, placing drinks in older people's hands and assisting with drinking. Older people revealed their experience of drinking was diminished by a variety of factors including a limited aesthetic experience and a focus on fluid consumption rather than on drinking as a pleasurable and social experience.

CONCLUSION

The rich and varied dimensions usually associated with drinking were lacking and the role of drinking beverages to promote social interaction was underplayed in both settings. Hydration practice which supports the individual needs of older people is complex and goes beyond simply ensuring the consumption of adequate fluids.