Research at BioMed
Understanding the patient and healthcare professional perspectives for technological and service developments
Hydration: important for everyone
Older adults are particularly susceptible to dehydration because of age-related changes in kidney function and thirst sensation. Studies reporting fluid intake vary between suggesting older people drink less or enough to satisfy recommended amounts. However hydration of individuals in institutional or home care environments is frequently reported to be poor. Improving hydration amongst older people reduces the occurrence of acute or chronic health conditions. The benefits of adequate hydration are many and include fewer falls, lower rates of constipation, fewer deaths from coronary heart disease, and better rehabilitation outcomes in orthopaedic patients.
To test market interest in an improved fluid dispenser for older, disabled adults, a letter was published in the MediWales newsletter inviting companies to respond to the idea of producing a fluid dispenser designed with older people in mind. At the same time several universities and colleges with departments of 3D design were approached to gauge interest in having the project as a student competition. These resulted in expressions of interest from Richard Bedwell, MD of BiPlas Ltd and Roberto Fraquelli, Head of Design at Plymouth University. Thus three organisations provided the essential elements for a potentially fruitful partnership; the BioMed Centre would set the specification, the design students would create the ideas, and BiPlas Ltd would develop any promising concepts into a marketable product. As an additional incentive to the students the John James Bristol Foundation was approached and the Trustees agreed to provide £1000 in prize money.
The specification was demanding and interpretations varied. The results produced a fascinating range of original designs with evidence of considerable thought and ingenuity. Dispensers included those providing 2 litres of water or beverages in varying volumes, hot or cold, some armed with sensors and flashing lights to remind users and staff if the intake was inadequate. The fluid intake was delivered to bite-valve straws, cups or mugs with special handles or grips to suit the needs of older people.
The judges decided that the winner should be the student who had most closely met the specification and in the most innovative way and so the first prize was awarded to Rhys Thomas from Swansea Metropolitan University at BioMed’s Open Day in February 2008. This inevitably resulted in some excellent and highly imaginative designs being rejected for the purpose of the competition, but raised awareness of the opportunities for design and manufacture in this field.
Work in this area since the competition has focussed on developing a submission for a research grant to look in detail at current practice on offering drinks to people in care homes or hospital. This is the environment where any new device would be used and if a new device is to be successful then cultural as well as physiological issues need to be well understood.
Whilst there is some evidence on which to base changes in hydration practice and there are guidelines for hospitals and care homes there are still problems with older people’s fluid intake and their quality of experience around the consumption of beverages. Research is required which leads to real changes in practice so that older peoples’ fluid intake and experience of drinking is improved. The BioMed have recently been successful in obtaining funding from North Bristol NHS Trust’s Small Grants Scheme for a scoping study and also intend to apply for National Institute of Health Research funding to carry out more detailed research in collaboration with the University of the West of England, the National Patient Safety Agency and the Devices for Dignity Health Technology Cooperative.
Living with a long-term catheter
This study, which started in October 2006, is designed to find out from patients and carers what life is like with a long term indwelling catheter. The results of the study will be used to inform device design and health care service provision, and to develop specific tools for measuring issues associated with living with a long term catheter. The first phase of the project, funded by the Wright Bequest and led by the BioMed, is now complete. This phase involved interviewing patients who have long term catheters to identify issues that affect their daily lives in order to develop a new questionnaire to assess quality of life.
The project has follow-on funding through Action Medical Research to fully validate this questionnaire along with a questionnaire related to catheter function, and also to establish the costs of living with a long term catheter. We are conducting interviews with patients to ensure the questionnaires are acceptable and understandable. This will be followed by a postal questionnaire to further validate the tools.
Phases 2 and 3 of this study are led by the University of Southampton, in collaboration with the University of Surrey and the BioMed. To find out more go to www.action.org.uk/research_projects/grant/287/
If you have any comments or are interested in taking part in this study please contact Nikki Cotterill and Sarah Fowler
Some of the Action Medical Research Team