Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study

Abstract

Background/Aim: Inadequate fluid intake is assumed to be a trigger of water-loss dehydration, which is a major health risk in aged and geriatric populations. Thus, there is a need to search for easy to use diagnostic tests to identify dehydration. Our overall aim was to investigate whether skin barrier parameters could be used for predicting fluid intake and/or hydration status in geriatric patients. Methods: An explorative observational comparative study was conducted in a geriatric hospital including patients aged 65 years and older. We measured 3-day fluid intake, skin barrier parameters, Overall Dry Skin Score, serum osmolality, cognitive and functional health, and medications. Results: Forty patients were included (mean age 78.45 years and 65% women) with a mean fluid intake of 1,747 mL/day. 20% of the patients were dehydrated and 22.5% had an impending dehydration according to serum osmolality. Multivariate analysis suggested that skin surface pH and epidermal hydration at the face were associated with fluid intake. Serum osmolality was associated with epidermal hydration at the leg and skin surface pH at the face. Fluid intake was not correlated with serum osmolality. Diuretics were associated with high serum osmolality. Conclusions: Approximately half of the patients were diagnosed as being dehydrated according to osmolality, which is the current reference standard. However, there was no association with fluid intake, questioning the clinical relevance of this measure. Results indicate that single skin barrier parameters are poor markers for fluid intake or osmolality. Epidermal hydration might play a role but most probably in combination with other tests.

Hydrogen bound water profiles in the skin influenced by optical clearing molecular agents—Quantitative analysis using confocal Raman microscopy

“…Also, OCA application can substantially influence the water content in the dermis . As the hydration state and water bounding in the skin is of major interest in cosmetology and dermatology , the search for the most effective, low‐cost, and at the same time, nondestructive and nontoxic OCAs with controllable influence on the skin water content for clinical application became a hot topic in the last few years . In this context, it is necessary to differentiate water control in skin layers on the short (minutes) and long (hours and days) time scales.…”

Dry skin and the use of leave‐on products in nursing care: A prevalence study in nursing homes and hospitals

“…There are numerous factors which may cause skin dryness like endocrine disorders, genetic predisposition, climate or medication (Paul et al, ; White‐Chu & Reddy, ). Fluid intake is believed to affect the skin hydration as well, but the empirical evidence supporting this association is week (Akdeniz, Tomova‐Simitchieva, Dobos, Blume‐Peytavi, & Kottner, ), especially in care‐dependent aged adults (Akdeniz, Boeing, et al, ).…”

Narrative Review of Low-Intake Dehydration in Older Adults

“…Despite the relatively high intake of fluids, 20% of the patients were dehydrated and 23% had an impending dehydration according to serum osmolality. As a result, the authors conclude by questioning the clinical relevance of the fluid intake measure [ 16 ] and hence lend support to the recommendation from ESPEN.…”

“…That the use of fluid intake as a clinical sign of low-intake dehydration is not related to serum osmolality was confirmed in another study: Akdeniz and co-authors [ 16 ] conducted an observational study in a geriatric hospital. They measured, among others, 3-day fluid intake and serum osmolality.…”