Nutrition & Hydration Week 2026 – The Link Between Nutrition and Hydration in Care Homes

 

By Rachel Sipaul, Senior Dietitian at apetito

As we celebrate ‘Nutrition and Hydration Week’ 2026, it is an opportunity to focus on two aspects of care that are often seen as distinct. Yet for older adults living in care homes, they are inseparable. Nutrition and hydration profoundly influence each other, hydration is not simply a comfort measure, it is a clinical and nutritional foundation. When nutrition declines, hydration becomes harder to maintain. Recognising this relationship and supporting residents with both aspects of care promotes good health and wellbeing and ensures care homes are delivering a person‑centred approach to care.

Hydration & Nutrition

A resident’s hydration status can significantly affect their ability to eat well. Even mild dehydration can impair alertness, mood, appetite and motivation to engage with food. Evidence shows that dehydration of 1–2% body mass can lead to confusion, lack of concentration and tiredness, all of which can directly influence mealtime engagement^1,2.

The Malnutrition Task Force highlights that loss of appetite is common in older people, and hydration is a key modifiable factor underpinning appetite regulation and eating behaviour^3,4. When a resident is “not eating well”, their hydration status should always be part of the clinical review.

Hydration can also affect the mechanics of eating, as an adequate fluid intake supports:

• Saliva production — essential for chewing and swallowing
• Bolus formation
• Gastric emptying
• Comfort during meals

Without sufficient hydration, residents may associate eating with discomfort, reflux, dry mouth or fatigue, all of which reduce food intake. Mouth dryness and constipation have both been linked to mealtime decline, both of which can be linked to poor hydration ^5,6.

In terms of an adequate fluid intake, older adults are advised to drink ⁷:

-Women at least 1600ml/day

-Men at least 2000ml/day

All fluids count, water, tea, coffee, juice, squash, fizzy drinks, milk drinks⁷.

Many care home residents have increased needs, such as if they have a fever, diarrhoea, excessive sweating, high‑output stomas, or use of certain medications. Care plans must therefore adjust these targets and include clinical oversight.

Nutrition & Hydration

Nutritional intake can also significantly contribute to overall hydration. Fluid‑rich foods such as soups, yoghurts, ice-lollies, jelly, ice cream and fruits can help meet hydration needs, especially for residents who struggle to drink enough ².

Malnutrition can also influence hydration. A loss of muscle mass reduces the body’s total water reserves, meaning that older adults with low muscle mass are more vulnerable to fluid depletion. Malnutrition risk assessment can also be dependent on hydration status as body weight, functional status and clinical observations can all be distorted by dehydration¹.

It is therefore important for care home staff to consider nutritional and hydration status together and not in isolation. If a resident is at risk of malnutrition, fortified drinks such as milkshakes or milky tea/coffee can help to hydrate while also providing energy and protein ^2,7.

Shared Barriers

Nutrition and hydration share many of the same barriers ^{2,5, 6,8-10}. Recognising the joint impact and addressing nutrition and hydration together will improve the resident’s overall wellbeing.

Shared Barrier	Impact on Hydration	Impact on Nutrition
Cognitive impairment (dementia)	Forgets to drink; unable to recognise thirst	Forgets meals; reduced hunger cues
Frailty & poor mobility	Unable to access drinks	Cannot access or engage in mealtimes
Poor dentition	Avoids some drinks	Avoids certain foods
Fear of incontinence	Deliberately restricts fluids	May skip meals to reduce toileting
Low mood/social withdrawal	Reduced drinking	Reduced eating
Pain or acute illness	Reduced thirst	Loss of appetite
Poor mealtime environment	Drinks less	Eats less
Swallowing difficulties	Unsafe or difficult drinking	Unsafe or difficult eating

 

Practical Strategies to address Nutrition and Hydration

The Care Quality Commission (CQC) Regulations 9 and 14 instruct providers to integrate preferences, needs, risks and cultural considerations across hydration and nutrition planning ¹¹. Some practical suggestions that can help with this include:

• Document food and drink preferences together, highlighting specific dietary requirements that can impact on drinks also (e.g. milk allergy and need to avoid milk-based drinks)
• Use foods that hydrate and nourish such as custard; yoghurts; milk shakes; milky drinks; smoothies; nourishing / fortified soups
• Creating enjoyable and social opportunities such as hydration cafés, mocktail clubs and “drink of the day” to encourage both drinking and social eating.
• Ensure residents with impaired mobility or co-ordination can access their meal and drink, if required adaptive equipment (handled mugs, cups with lids) can aid independence and intake.
• Mealtimes provide built‑in structure and familiarity, making them ideal for hydration support, offering drinks before, with and after meals. Drinking during mealtimes, can improve hydration and digestion and importantly make the meal much more enjoyable.

Dysphagia

For residents with swallowing difficulties, the hydration and nutrition relationship needs to be managed with care. Expert input is often required from healthcare professionals such as a Speech & Language Therapist and Dietitian.

Modified diets and thickened fluids should be prepared in line with standardised dysphagia guidance and testing methods (IDDSI, www.iddsi.org).  As thickened drinks can be less appealing and take more effort to consume, residents with dysphagia can be at a higher risk of dehydration ^2,12. Effective dysphagia management should consider:

1. Ensure the correct consistency to keep residents safe
2. Increase the frequency of offering fluids
3. Monitor hydration and nutrition closely, using tools such as food and fluid charts

 

Recognising the link between nutrition and hydration can transform care home practice. It ensures these two essential aspects of care are prioritised together, providing an environment where residents health and wellbeing can thrive, and mealtimes can be enjoyed.

For further information and support contact apetito at: https://www.apetito.co.uk/

 

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References

12. Liska D, Mah E, Brisbois T, Barrios PL, Baker LB, Spriet LL. Narrative review of hydration and selected health outcomes in the general population. Nutrients. 2019;11(1):70.
13. British Dietetic Association. BDA Care Home Digest: Nutrition & Hydration in Care Homes. BDA; 2024.
14. Malnutrition Task Force. Eating Well in Later Life: Practical Guide. Malnutrition Task Force; 2017.
15. Malnutrition Task Force. State of the Nation 2025: Older People and Malnutrition in the UK. Malnutrition Task Force; 2025.
16. Wessex Academic Health Science Network. Hydration in Older People: Practical Guide. Wessex AHSN; 2019.
17. NEL NHS. Hydration Guidance for Care Homes. Northeast London Health and Care Partnership; 2020.
18. British Dietetic Association Older People’s Specialist Group. Eating, Drinking & Ageing Well. BDA; 2023.
19. Welsh Government. Food and Nutrition for Older People in Care Homes – Section 3: Drinking. Welsh Government; 2011.
20. MM‑ELHCP (East London Health & Care Partnership). Hydration Guidance for Care Homes. MM‑ELHCP; 2022.
21. Malnutrition Task Force. Eating Well in Later Life: Malnutrition Prevention. Malnutrition Task Force; 2017.
22. Integrated Care Board. Nutrition in Care Homes: Guidance for Providers. ICB; 2023.
23. Lee Martin. Practical nutrition and hydration for dementia-friendly mealtimes. 2019. ISBN 978 1 84905 700 4.