Physical Signs of Dehydration in the Elderly

Abstract

Objective Dehydration is a common condition and frequent cause of hospitalization in older people, despite the caregiver's high attention in attempt to avoid its occurrence. In this study, various physical signs were examined as clinical signs of dehydration in elderly. Methods A prospective observational study was conducted in an acute care teaching hospital. Consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Dehydration was defined as a calculated serum osmolality above 295 mOsm/L. The patients diagnosed as dehydrated or not dehydrated were observed for physical signs of dehydration. Data of blood and urine chemistry analysis were also compared between the two groups. Results A total of 27 elderly patients admitted with acute medical conditions were included in this study. For the physical signs, dry axilla had moderate sensitivity (44%) and excellent specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). For laboratory data, the mean concentrations of serum sodium of the dehydrated group (146 mEq/L) was significantly higher (p<0.01) than those of the non-dehydrated group (134 mEq/L). Conclusion Physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. The evaluation of the axillary moisture could help assess dehydration as well as laboratory data analysis such as serum sodium concentration.

Impending Low Intake Dehydration at Admission to A Geriatric Ward- Prevalence and Correlates in a Cross-Sectional Study

“…Despite the general awareness of the importance of this problem among medical staff, very often, older patients who are dehydrated are not being identified, or their hydration status is misdiagnosed [13,14]. Making a proper diagnosis is often a challenge, mainly because signs and symptoms that are usually ascribed to dehydration have debatable diagnostic value in the older population [15,16]. Untreated dehydration negatively affects health and wellbeing, and significantly increases mortality rates of hospitalized older patients [2].…”

What Serum Sodium Concentration Is Suggestive for Underhydration in Geriatric Patients?

“…Physical signs of dehydration in this population show poor sensitivity. In the case of patients aged 65 years or older, admitted to the teaching hospital in Japan due to an acute medical condition, the sensitivity of physical signs of dehydration-such as dry mouth; sunken eyes; decreased skin turgor; dry axilla; decreased consciousness level; and delayed capillary refill time-was equal to 56% (for dry axilla) or lower [9]. The diagnostic accuracy of commonly used signs and symptoms of dehydration (such as self-reported feelings of thirst and well-being; mouth, skin, and axillary dryness; skin turgor; sunken eyes; capillary refill; blood pressure upon resting and after standing; body temperature; and pulse rate) was also low in the study performed in care home residents aged ≥ 65 years in the United Kingdom [10].…”

Association between dehydration on admission and postoperative complications in older persons undergoing orthopaedic surgery

“…For example, skin elasticity decreases with ageing that affects skin turgor. In their prospective observational studies, Fortes et al (2015) and Shimizu et al (2012) also found that physical signs and symptoms, including low systolic blood pressure, tachycardia, dry mucous membranes or axilla, sunken eyes, and poor skin turgor and capillary refill time, have poor sensitivity as indicators of dehydration in older persons. Hoyle, Chua, and Soiza (2011) questioned the clinical utility of physical assessment in identifying dehydration due to fair interobserver agreement.…”