Giving patients decaf drinks reduces falls risk and improves care

Health and care organisations have been urged to make a “simple switch” and serve decaffeinated drinks to patients as standard, following new nurse-led research that has revealed the positive impact it can have on patient health.

Several hospital trusts and care home providers have been piloting serving decaffeinated drinks to patients and have found the potential benefits of doing so to be significant, particularly around reducing falls related to rushing to the toilet and lower continence pad usage.

Caffeine is a stimulant, an irritant and mild diuretic, meaning that it can result in increased frequency and urgency of urination.

“Just a simple switch to decaf could make a big difference – I think everywhere should do it”

Sarah Coombes

Research has previously suggested that there is a high correlation between falls and lower urinary tract symptoms in hospitals.

Continence nurse specialist Sarah Coombes made the link between caffeine, continence and falls at her own organisation, University Hospitals of Leicester NHS Trust (UHL).

She noticed an increase in the number of patients falling because of rushing to the toilet. As a result, she began to think about how the trust could try and reduce falls related to incontinence and urinary urgency.

Ms Coombes visited wards with the highest prevalence of falls relating to toileting and undertook some observational work to try and find out what could be causing the increase in incidents.

She told Nursing Times: “From a continence perspective, I could see that when drinks were being offered, decaffeinated drinks were never being offered.

"As a continence nurse, offering decaffeinated drinks or switching to decaf is the first line of treatment that we would recommend for an overactive bladder.”

Ms Coombes said she “put two and two together” and made the link that caffeinated teas and coffees could be contributing the number of patients that were falling on their way to the toilet.

During World Continence Week in 2021, Ms Coombes and the continence team at UHL launched a ‘taste the difference challenge’, where patients were offered decaffeinated hot drinks as the default option.

During the week, both patients and staff were invited to see if they could taste the difference between caffeinated and decaffeinated tea and coffee, and were informed about the benefits of switching to decaffeinated drinks for a healthier bladder.

Patients could opt-in to the trial, meaning they would be given decaffeinated hot drinks as the standard, with caffeinated drinks still available on request.

Ms Coombes and her team collated feedback from 699 patients and over 50% said they could not taste the difference.

Meanwhile, 76% reported that they would switch to decaffeinated drinks now that they knew the health benefits.

As such, a recommendation was made to UHL’s chief nurse and executive board to consider making decaffeinated tea and coffee the default across the trust, with caffeinated drinks remaining as an option should patients request it.

The trust made the switch and, since February 2022, decaffeinated drinks have been the standard.

Ms Coombes said: “That positive patient feedback really channelled and influenced out executive team to make the decision to switch to decaf as the default option.

"It’s such a simple thing that’s made a big difference. It’s relatively cost-effective and the benefits are huge.”

One of the most significant outcomes from the trial was that switching to decaffeinated drinks appeared to reduce the number of falls occurring among patients rushing to the toilet.

Prior to the trial, the trust was averaging around 17.4 falls per month related to toileting.

In the first year after the rollout of the decaffeinated drinks standard, there was a 30% reduction in falls related to toileting.

Ms Coombes noted that the most recent data from September 2023 showed that the trust was down to 6.75 falls per month – a 61% reduction.

Meanwhile, a survey of UHL’s outpatient continence clinic found that 63% of patients reported improvement in overactive bladder symptoms after switching to decaffeinated drinks.

Ms Coombes highlighted that cutting out caffeinated drinks did not just improve outcomes relating to falls, but also had other health benefits.

For example, she said that decaffeinated drinks could help reduce pad dependency use, which in turn could reduce moisture associated skin damage.

“There’s a lot of people that suffer in silence,” noted Ms Coombes.

“The public health message of the benefits of decaf really can make a difference.

"If you’ve got more control of your bladder, and you can get to the toilet in time, you don’t need to wear a pad.”

Further benefits from the switch that she flagged included reducing heart palpitations, reducing blood pressure and getting better quality sleep.

If decaffeinated drinks were to be rolled out at a national level, Ms Coombes said it would have a positive impact on patient wellbeing and health.

She said: “It would make such a big difference to patients’ quality of life. Just a simple switch to decaf could make a big difference – I think everywhere should do it.”

So far, Ms Coombes said she had received messages from over 30 trusts and health boards across the UK expressing interest in replicating her trial in their own organisation.

But it is not just NHS organisations that want to reap the benefits of trialling decaffeinated drinks, social care organisations have also caught on.

Having learnt of the success of Ms Coombes’ taste the difference challenge, Care England has looked at trialling the initiative in care home settings, to see if switching to decaffeinated drinks could decrease the chances of falls among residents.

Evidence suggests people living in care homes are three times more likely to fall than those living at home.

Care England and Ms Coombes have supported Stow Healthcare, which runs eight nursing and residential homes in East Anglia, to undertake its own trial.

Between June and November 2023, decaffeinated hot drinks were introduced as the default at its homes.

Decaffeination and falls prevention, a report published today on the findings of the trial, showed that 89% of Stow Healthcare’s 350 residents chose to be part of the trial from the outset, which rose to 92% by November 2023.

During the trial period, falls associated with care home residents rushing to the toilet dropped by 35%. The report noted that this was comparable to the 30% fall reduction that had been observed at the UHL trial.

Care home resident feedback to the trial was also “generally very positive”, the report noted.

One resident, Russell, said: “I’m drinking decaffeinated and haven’t noticed any difference at all in the taste – I’ve probably got used to it. I haven’t had a fall for two or three months and I’m happy to stay drinking decaf. I’d like to think it’s working.”

Operating director at Stow Healthcare, Ruth French, told Nursing Times that undertaking the trial had been “straightforward process” and that, in a short timeframe, it had wielded some “pretty significant results”.

“I loved the simplicity of the idea at its heart,” she said.

“Sarah [Coombes] had done such a good job in thinking about all of the steps that we needed to get ahead on this project. She was really handing it to people on a plate.”

Following completion of the trial, Stow said it would continue to offer decaffeinated drinks as standard, as well as providing residents with information about the possible health benefits of switching to decaffeinated products.

Ms French noted that falls contributed significantly to fragility fractures among older people.

According to the Office for Health Improvement and Disparities, the total annual cost of fragility fractures to the UK has been estimated at around £4.4bn, which includes £1.1bn for social care.

If Stow’s trial was scaled across the sector, the organisation said the results would mean thousands of falls could be prevented and, as a result of fewer admissions from social care, the NHS could also save an estimated £85m per year.

Ms French said: “Anything that we can do to reduce costs for the NHS, and overall improve health and wellbeing for our residents, is something that I think we all in social care need to stand up and take notice of.”

The collaboration between health and social care, as part of the taste the difference pilot, was something that Ms French said she was “really proud of”.

“This is a really good example of where NHS and social care have been able to work collaboratively together,” she said.

“There are going to be lots more opportunities for that moving forward,” she added.

Ms French urged other health and social care providers to consider running similar trials in their own organisations, and to look at promoting decaffeinated drinks.

She added: “It is a simple thing at heart to try out, and I think with the resources that Sarah has provided, we can really encourage people to just give it a go.

"Give it a go for six months in your service [and] see if it makes a difference, because what have you got to lose?”