Dehydration in geriatrics: consequences and practical guidelines

Abstract

Purpose of reviewGeriatric dehydration is a widespread and under recognized problem. The purpose of this review was to examine the latest evidence regarding geriatric dehydration and provide practical guidance for health professionals. Recent findingsThis review covers evidence from the past 2 years and shows that geriatric dehydration is not benign and is associated with significant personal distress, as well as negative economic and health system consequences. New guidance on nutrition and hydration in the elderly recommend against the use of skin turgor, dry mouth, urine colour or specific gravity to determine hydration status in the elderly. Instead, serum osmolality is considered the gold standard. SummaryStrategies to prevent and manage geriatric dehydration should differ depending on aetiology (low intake, volume depletion or both). Widespread dissemination and implementation of innovative strategies that target improved access to fluids, and systems change to enable rapid and accurate identification and treatment are required.

Pharmacovigilance study of GLP-1 receptor agonists for metabolic and nutritional adverse events

“…It is apparent that the inhibition of fluid intake in the CNS produced by the administration of GLP-1 RAs and the loss of fluid induced by gastrointestinal adverse effects combine to contribute to the onset of dehydration. In elderly patients, who are at inherently higher risk of developing diabetes and dehydration ( Atciyurt et al, 2024 ), low fluid intake and hypovolemia are the main etiologic factors contributing to severe dehydration outcomes in elderly patients ( Lambert and Carey, 2023 ). Reduced fluid intake and gastrointestinal adverse effects due to GLP-1 RAs are potential triggers of acute kidney injury ( Filippatos et al, 2014 ; Long et al, 2024 ), all of which contribute to the significant number of severe outcomes of dehydration following GLP-1 RA use.…”

Hydration Status in Older Adults: Current Knowledge and Future Challenges

“…Age-related physiological factors contributing to dehydration include blunted thirst sensation and reduced urinary concentrating ability of the kidney in older people [51]. Besides physiological changes, cognitive impairment is one of the most common psychological factors that increases the risk of dehydration with age [52]. Many older adults often forget to drink sufficient water due to memory problems caused by normal aging or diseased state, such as dementia and delirium.…”

“…Impaired physical abilities, reduced mobility and inability to eat and drink also increase elderly people's risk of dehydration, especially those living at home and in institutions [53]. Furthermore, older patients with poorly controlled diabetes are more likely to be dehydrated because of the diuretic efficacy of hyperglycosuria [52]. Those suffering from urinary incontinence may also increase vulnerability to dehydration due to self-restriction of fluid intake.…”

“…Older patients with dysphagia are prone to dehydration due to poor oral intake to meet the requirements [54]. Finally, environmental factors should not to be neglected since older people have a poor capacity to adapt ambient environment [52].…”