Narrative Review of Low-Intake Dehydration in Older Adults

Abstract

Low-intake dehydration is a common and often chronic condition in older adults. Adverse health outcomes associated with low-intake dehydration in older adults include poorer cognitive performance, reduced quality of life, worsened course of illness and recovery, and a high number of unplanned hospital admissions and increased mortality. The subjective methods to assess (risk of) dehydration are not reliable, and the evidence about preventive measures are also limited. So is the knowledge about the optimal intake of beverages per day. This narrative review presents the state of the science on the role of low intake hydration in older adults. Despite its simple cause—the inadequate intake of beverages—low-intake dehydration appears to be a very complex problem to address and much more research is needed in the area. Based on the existing evidence, it seems necessary to take setting specific differences and individual problems and needs into account to tackle dehydration in older adults. Further, it is necessary to increase awareness of the prevalence and severity of low-intake dehydration among older adults and in nursing staff in care homes and hospitals as well as among caregivers of older adults living at home.

Roles, mutual expectations and needs for improvement in the care of residents with (a risk of) dehydration: A qualitative study

“…Therefore, the question of whether the nursing staff can recognize dehydration on time arises. Recent literature confirms the existence of these challenges in awareness and monitoring, and stresses the importance of preventing dehydration (Beck et al, 2021;Lea et al, 2017;Levinson, 2014;Thomas, 2020).…”

Lower hydration status increased diabetic retinopathy among middle-aged adults and older adults: Results from NHANES 2005-2008

“…It seemed that in diabetic kidney disease patients with albuminuria, glomerular filtration rate and albumin excretion rate were independently associated with DR ( 37 ). Secondly, serum osmolality above 300 mOsm/kg was the diagnostic criteria of hypotonic dehydration ( 15 ). Salt and water balance should also be taken into account when serum osmolality was at a normal level, as isotonic or hypotonic dehydration might also be existed ( 38 , 39 ).…”

“…Considering the impaired pancreatic and renal function of diabetes, we also used calculated osmolarity to evaluate the hydration status of people aged 65 or older for wider application in clinical practice ( 15 , 21 – 23 ).…”

“…It's widely known that polyuria is a common symptom in people with diabetes. With age, the sensation of thirst blunts, primary urine concentration declines, muscle mass decreases, and total body water and fluid stores decrease, which may increase the risks of dehydration ( 15 – 18 ). Furthermore, age-related pathophysiological changes like the concentration change of Na + , K + , and Cl − and comorbidities such as hyperglycemia, nephrotic syndrome, and adrenal insufficiency may also result in dehydration ( 10 , 19 ).…”

Dehydration in geriatrics: consequences and practical guidelines

“…For those patients who are unwell or unable, or in severe cases unconscious, then treatment with subcutaneous or intravenous fluid should be considered. Details regarding the decision algorithm regarding choice of fluids are outlined in the guidelines [1 ▪▪ ] and a recent updated narrative review [22 ▪ ], but isotonic intravenous fluids appear to be sufficient for volume depletion in most cases of vomiting and diarrhoea.…”