Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-25T22:57:33.508Z Has data issue: false hasContentIssue false
  • English
  • Français

Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years

Published online by Cambridge University Press:  02 January 2007

Jodi Dunmeyer Stookey ,
Carl F Pieper  and
Harvey Jay Cohen
Jodi Dunmeyer Stookey*
Affiliation:
Center for the Study of Aging and Human Development, Claude D Pepper Older Americans Independence Center, Duke University Medical Center, Box 3003, Durham, NC 27710, USA and the Geriatric Research, Education and Clinical Center (GRECC), Veterans Administration Medical Center, Durham,NC, USA
Carl F Pieper
Affiliation:
Center for the Study of Aging and Human Development, Claude D Pepper Older Americans Independence Center, Duke University Medical Center, Box 3003, Durham, NC 27710, USA and the Geriatric Research, Education and Clinical Center (GRECC), Veterans Administration Medical Center, Durham,NC, USA
Harvey Jay Cohen
Affiliation:
Center for the Study of Aging and Human Development, Claude D Pepper Older Americans Independence Center, Duke University Medical Center, Box 3003, Durham, NC 27710, USA and the Geriatric Research, Education and Clinical Center (GRECC), Veterans Administration Medical Center, Durham,NC, USA
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

The fluid recommendation for adults aged 70+ years has been criticised on the basis of a low prevalence of dehydration in community-dwelling older adults. This study explores whether the low prevalence might reflect limitations of individual dehydration indices.

Design

Cross-sectional data on plasma sodium, blood urea nitrogen (BUN), creatinine, glucose and potassium were used to classify 1737 participants of the 1992 Established Populations for Epidemiologic Studies of the Elderly (EPESE) (70+ years) according to multiple dehydration indices. Associations between dehydration indices, health and functional status were evaluated.

Results

Depending on the indicator used, the prevalence of dehydration ranged from 0.5% for hypotonic hypovolaemia only (plasma tonicity <285 mOsm l−1 with orthostatic hypotension) to 60% with dehydration defined as either plasma sodium ≥145 mEq l−1, BUN/creatinine ratio ≥20, tonicity ≥295 mOsm l−1, or hypotonic hypovolaemia. Elevated tonicity and BUN/creatinine ratio were respectively associated with chronic disease and functional impairment.

Conclusions

The true prevalence of dehydration among community-dwelling adults may be low or high, depending on the indicator(s) used to define dehydration. Before we can pinpoint a generalisable prevalence of dehydration for community-dwelling seniors and draw conclusions about fluid recommendations, validation studies of dehydration indices and longitudinal studies of dehydration, health and functional status are needed.

Keywords

AgedChronic diseaseDehydrationDietTonicityPrevalence
Type
Research Article
Information
Public Health Nutrition , Volume 8 , Issue 8 , December 2005 , pp. 1275 - 1285
Copyright
Copyright © The Authors 2005

References

1Lavizzo-Mourey, RJ. Dehydration in the elderly: a short review. Journal of the National Medical Association 1987; 79(10): 1033–8.Google ScholarPubMed
2Phillips, PA, Rolls, BJ, Ledingham, JGG, Forsling, ML, Morton, JJ, Crowe, MJ, et al. Reduced thirst after water deprivation in healthy elderly men. New England Journal of Medicine 1984; 311(12): 753–9.CrossRefGoogle ScholarPubMed
3Rowe, JW, Andres, R, Tobin, JD, Norris, AH, Shock, NW. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. Journal of Gerontology 1976; 31(2): 155–63.CrossRefGoogle Scholar
4Silver, AJ. Aging and risks for dehydration. Cleveland Clinic Journal of Medicine 1990; 57(4): 341–4.CrossRefGoogle ScholarPubMed
5Leaf, A. Dehydration in the elderly. New England Journal of Medicine 1984; 311(12): 791–2.CrossRefGoogle ScholarPubMed
6Hoffman, NB. Dehydration in the elderly: insidious and manageable. Geriatrics 1991; 46(6): 35–8.Google ScholarPubMed
7Lavizzo-Mourey, R, Johnson, J, Stolley, P. Risk factors for dehydration among elderly nursing home residents. Journal of the American Geriatrics Society 1988; 36(3): 213–8.CrossRefGoogle ScholarPubMed
8US Department of Agriculture (USDA). The Food Guide Pyramid. Home and Garden Bulletin No. 252. Washington, DC: USDA Human Nutrition Information Service, 1992.Google Scholar
9Russell, RM, Rasmussen, H, Lichtenstein, AH. Modified food guide pyramid for people over seventy years of age. Journal of Nutrition 1999; 129(3): 751–3.CrossRefGoogle ScholarPubMed
10O'Neill, PA, Davies, I, Wears, R, Barrett, JA. Elderly female patients in continuing care: why are they hyperosmolar? Gerontology 1989; 35(4): 205–9.CrossRefGoogle ScholarPubMed
11Weinberg, AD, Pals, JK, Levesque, PG, Beal, LF, Cunningham, TJ, Minaker, KL. Dehydration and death during febrile episodes in the nursing home. Journal of the American Geriatrics Society 1994; 42(9): 968–71.CrossRefGoogle ScholarPubMed
12Miller, D, Perry, HM, Morley, JE. Relationship of dehydration and chronic renal insufficiency with function and cognitive status in older US blacks. In: Vellas, B, Albarede, JL, Garry, PJ, eds. Hydration and Aging. New York: Springer Publishing Company, 1998; 149–59.Google Scholar
13Lindeman, RD, Romero, LJ, Liang, HC, Baumgartner, RN, Koehler, KM, Garry, PJ. Do elderly persons need to be encouraged to drink more fluids? Journals of Gerontology Series A, Biological Sciences and Medical Sciences 2000; 55(7): M361–5.CrossRefGoogle ScholarPubMed
14Caird, FI, Andrews, GR, Kennedy, RD. Effect of posture on blood pressure in the elderly. British Heart Journal 1973; 35(5): 527–30.CrossRefGoogle ScholarPubMed
15Rikkert, MO, Hoefnagels, W, Deurenberg, P. Age-related changes in body fluid compartments and the assessment of dehydration in old age. In: Vellas, B, Albarede, JL, Garry, PJ, eds. Hydration and Aging. New York: Springer Publishing Company, 1998; 9–32.Google Scholar
16Weinberg, AD, Minaker, KL. Council on Scientific Affairs, American Medical Association. Dehydration, evaluation and management in older adults. Journal of the American Medical Association 1995; 274(19): 1552–6.CrossRefGoogle ScholarPubMed
17Pieper, CF, Rao, KM, Currie, MS, Harris, TB, Chen, HJ. Age, functional status, and racial differences in plasma D-dimer levels in community-dwelling elderly persons. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 2000; 55(11): M649–57.CrossRefGoogle ScholarPubMed
18Cohen, HJ, Pieper, CF, Harris, T, Rao, KMK, Currie, MS. The association of plasma IL-6 levels with functional disability in community-dwelling elderly. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1997; 52(4): M201–8.CrossRefGoogle ScholarPubMed
19Matz, R. Dehydration in older adults. Journal of the American Medical Association 1996; 275(12): 911–2.CrossRefGoogle ScholarPubMed
20 American Diabetes Association. Diagnosis and lab tests [online]. Available at http://www.diabetes.org/main/type1/medical/lab/diagnosis.jsp. Accessed December 2002.Google Scholar
21World Health Organization (WHO) Expert Committee. Physical Status: The Use and Interpretation of Anthropometry. WHO Technical Report Series No. 854. Geneva: WHO, 1995.Google Scholar
22Rosow, I, Breslau, N. A Guttman health scale for the aged. Journal of Gerontology 1966; 21(4): 556–9.CrossRefGoogle ScholarPubMed
23StataCorp. Stata Statistical Software, Release 6.0. College Station TX: Stata Corporation, 1999.Google Scholar
24Gennari, FJ. Current concepts, serum osmolality, uses and limitations. New England Journal of Medicine 1984; 310(2): 102–5.CrossRefGoogle ScholarPubMed
25National Research Council. Recommended Dietary Allowances, 10th ed. Washington, DC: National Academy of Sciences, 1989; 249.Google Scholar
26Weinberg, AD, Pals, JK, McGlinchey-Berroth, R, Minaker, KL. Indices of dehydration among frail nursing home patients: highly variable but stable over time. Journal of the American Geriatrics Society 1994; 42(10): 1070–3.CrossRefGoogle ScholarPubMed
27Greenleaf, JE. Stress, aging and thirst. In: Vellas, B, Albarede, JL, Garry, PJ, eds. Hydration and Aging. New York: Springer Publishing Company, 1998; 47–57.Google Scholar
28O'Neill, PA, Davies, J, Morris, J, McLean, KA. Hypernatraemic dehydration in patients in a large hospital for the mentally handicapped. British Medical Journal 1990; 300(6721): 396–7.CrossRefGoogle Scholar
29Halperin, ML, Goldstein, MB. Fluid, Electrolyte, and Acid–Base Physiology. Philadelphia, PA: WB Saunders Company, 1999.Google Scholar
30Vokes, TP, Aycinena, PR, Robertson, GL. Effect of insulin on osmoregulation of vasopressin. American Journal of Physiology 1987; 252(4 Pt 1): E538–48.Google ScholarPubMed
31Star, RA. Southwestern internal medicine conference: hyperosmolar states. American Journal of Medical Science 1990; 300(6): 402–12.CrossRefGoogle Scholar
32Pozefsky, T, Colker, JL, Langs, HM, Andres, R. The cortisone–glucose tolerance test: the influence of age on performance. Annals of Internal Medicine 1965; 63(6): 988–1000.CrossRefGoogle ScholarPubMed
33Teuscher, AU, Reinli, K, Teuscher, A. The SENECA Investigators (Survey in Europe on Nutrition and the Elderly, a Concerted Action). Glycaemia and insulinaemia in elderly European subjects (70–75 years). Diabetic Medicine 2001; 18(2): 150–3.CrossRefGoogle ScholarPubMed
34Choi, KM, Lee, J, Kim, DR, Kim, SK, Shin, DH, Kim, NH, et al. Comparison of ADA and WHO criteria for the diagnosis of diabetes in elderly Koreans. Diabetic Medicine 2002; 19(10): 853–7.CrossRefGoogle Scholar
35Resnick, HE, Shorr, RI, Kuller, L, Franse, L, Harris, TB. Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults: the health, aging and body composition study. Journal of Clinical Epidemiology 2001; 54(9): 869–76.CrossRefGoogle ScholarPubMed
36Fried, LP, Walston, J. Frailty and failure to thrive. In: Hazzard, WR, Blass, JP, Ettinger, WH, et al. , eds. Principles of Geriatric Medicine and Gerontology, 4th ed. New York: McGraw-Hill, 1999; 1387–402.Google Scholar