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Recognizing the face of dehydration

26 l Nursing2011 l August
WATER IS ONE of the most impor-
tant nutrients for maintaining life
and ensuring healthy aging. Body
fluids move nutrients, gases, and
wastes throughout the body; are
essential in metabolizing food into
energy; and generally assist in the
body’s functions.1
Monitoring your patients’ fluid
status can prevent dehydration—a
potentially fatal condition—and its
complications.2 Dehydration is
defined as a rapid loss of more than
3% of body weight that’s associated
with water and electrolyte distur-
bance from either water or sodium
This article focuses on assessing
for and managing dehydration in
older adults.
Aging increases risk
Older adults, who are more likely to
have serious and chronic conditions
than their younger counterparts, are
at increased risk for dehydration, one
of the most frequent causes of hospi-
talization in adults ages 65 to 75.4
Age-related changes are another rea-
son for this preventable shift in water
balance.5 According to the Agency
for Healthcare Research and Quality
(AHRQ), the hospitalization rates for
dehydration increase substantially
with age.6
This problem is likely to grow,
too. By the year 2030, the number
of Americans age 65 and older is
expected to grow from 39 million
in 2008 to 72 million.7
According to AHRQ’s Guide to
Prevention Quality Indicators, hospi-
tal admission for dehydration is a
Prevention Quality Indicator (PQI).
This is a screening tool for potential
quality issues that may reflect the
quality of care provided in commu-
nity settings.2
By Magdalena Collins, BSN, RN, and Edith Claros, PhD, MSN, RN
Recognizing the face of
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. August l Nursing2011 l 27
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
28 l Nursing2011 l August
To fully understand the serious
implications of dehydration for older
adults, refresh your knowledge of
the pathophysiology underlying the
A delicate balance
Total body water (TBW), which
accounts for about 60% of a healthy
younger adult’s body weight, is
found in the intracellular (ICF) and
extracellular fluid (ECF) compart-
ments.8 The fluid in the ICF makes
up about 40% of adult body weight,
while fluid in the ECF makes up
about 20%. However, a particular
person’s water content depends on
the amount of adipose tissue or fat,
which is only about 10% water.
Compare this to skeletal muscle,
which is about 75% water. An adult
who’s obese may have TBW that’s
only 30% to 40% of body weight.1
(See Comparing TBW.)
TBW also declines with age, with
women having lower TBW than
men of the same age. In young men,
TBW is about 60% of body weight,
but in older men it’s about 50%; in
young women, it’s about 50%, and
in older women, about 40%.1
Hydration of the ICF and ECF
compartments is regulated separately.
Intracellular hydration is regulated
primarily by changes in osmolality,
which responds to osmoreceptors in
the thirst center in the hypothala-
mus. Extracellular hydration is
primarily regulated by blood vol-
ume, which responds to barore-
ceptors in the cardiac atria, large
pulmonary vessels, aortic arch, and
carotid sinus.1,9
Requirements for water intake
depend on many factors, including
the patient’s age and level of physical
activity. The main source of water gain
is through oral intake and metabolism
of nutrients.1 Healthy people of any
age need about 100 mL of water per
100 calories metabolized to dissolve
and eliminate metabolic wastes. For
example, someone who burns 1,800
calories needs about 1,800 mL of
water for metabolic purposes.1,8 Miller
suggests that consuming 1,500 to
2,000 mL of noncaffeinated fluid in
24 hours will maintain adequate
hydration in older adults.8
A healthy adult loses around
2,500 mL of body water daily. Usu-
ally most water is lost through the
kidneys, with smaller amounts lost
through the gastrointestinal tract,
skin, and lungs. Because water is
lost through the skin and lungs
without a person being aware of it,
these losses are called insensible
water losses.1 (See Sources of body
water gains and losses in the adult.)
The body attempts to conserve
water by concentrating urine via
feedback systems that produce an
increase in renal sodium and water
retention. Conversely, excess water
intake is excreted by the kidneys
as dilute urine, via feedback mecha-
nisms that decrease sodium and
water retention.1 A decrease in
blood volume or an increase in
ECF osmolarity stimulates the thirst
mechanism, leading the person to
increase fluid intake.
Considering the risks
Dehydration is a common cause of
morbidity and mortality in older
adults. Dehydration can be classified
as isotonic, hypertonic, or hypo-
tonic. (See Classifying dehydration.)
Risk factors for dehydration
age greater than 85
dependencies in feeding and eating
history of dehydration.5
Additional risk factors for dehydra-
tion include female gender, more than
four chronic conditions, more than
four medications, immobility, and lax-
ative use.10 Other risk factors include
dysphagia secondary to stroke; condi-
tions associated with an increased
demand for fluid, such as hypergly-
cemia, or an increased loss of fluids
such as diarrhea or vomiting; medica-
tions that increase fluid losses, such as
diuretics; sedating medications that
decrease the ability to obtain or desire
for fluid intake, such as antihista-
mines or antidepressants; environ-
mental conditions, such as extremes
in heat; and cognitive deficits such as
dementia or delirium. Delirium can
also be a sign of dehydration in older
Comparing TBW
Body composition of a lean and an obese person.
Source: Porth CM. Essentials of Pathophysiology. 3rd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams &
Wilkins; 2011.
Total body
water = 60%
Total body
water = 30%
220 lbs 220 lbs
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. August l Nursing2011 l 29
Normal age-related physiologic
changes that contribute to dehydra-
tion, particularly in those age 85 and
older, include changes in body com-
position resulting in decreased TBW,
decreased renal function, and decreased
thirst.5,11,12 Age-related changes in
body composition include decreased
lean body mass. Decreased renal func-
tion results from decreased renal mass,
decreased renal blood flow, decreased
glomerular filtration rate (GFR), and
diminished creatinine clearance.1 The
ability of the kidneys to respond to
aldosterone and antidiuretic hormone
also decreases with age.13 Older adults
frequently experience decreased thirst
perception as well.12
Older adults with functional
decline and altered mobility are at
higher risk for dehydration because
they may not be able to indepen-
dently access fluids. Other causes of
dehydration include psychosocial
factors, such as inadequate patient
education about medications and
types and amount of fluids to drink;
lack of social support; and fear of
falling or of incontinence, which
may lead older adults to restrict
fluid intake.
Assessing your patient
Use a systematic approach to identify
risk factors to prevent dehydration or
to identify signs and symptoms con-
sistent with dehydration in your
older patients so you can quickly
intervene and help prevent compli-
cations. (See Look for these signs and
symptoms.) Obtain a comprehensive
health history for older adults in all
healthcare settings and update it reg-
ularly.14 The history should include:
diseases that put a patient at risk,
such as dementia, heart failure, chronic
kidney disease, malnutrition, and
mental health disorders such as
medications, including prescription
and over-the-counter drugs and
herbal and nutritional supplements.
any history of dehydration or
repeated infections.
a review of systems for possible
sources of fluid loss.5
When you perform medication
reconciliation, identify medications
that could alter fluid and electrolyte
balance. For example, dehydration
risk increases with the use of diuret-
ics, vasodilators, beta-blockers,
aldosterone inhibitors, angiotensin-
converting enzyme (ACE) inhibitors,
angiotensin receptor blockers, and
lithium.14 Some medications can
cause syndrome of inappropriate
secretion of antidiuretic hormone,
including tricyclic antidepressants,
selective serotonin reuptake inhibi-
tors, phenothiazines, vasopressin,
and some antineoplastic drugs.
Physical assessment should include
vital signs, height and weight, body
mass index, and major body systems
with special attention to any signs and
symptoms suggesting dehydration.
Although tachycardia is a compen-
satory mechanism to increase cardiac
output in younger, healthy adults
with dehydration, older adults may
not exhibit tachycardia, especially if
they’re taking medications such as
beta-blockers or calcium channel
blockers.14 In addition, many signs
and symptoms aren’t specific to
dehydration. For example, dry
mucous membranes can also be
caused by anticholinergic medica-
tions, and postural hypotension may
be an adverse reaction to antihyper-
tensive medication.
Besides delirium, other atypical
signs and symptoms of dehydration
in older adults include falls, muscle
weakness, changes in functional
status, fatigue, confusion, or changes
in level of consciousness.11 Don’t
assume that confusion is normal in
older adults. Instead, promptly assess
any change in mental status from
Diagnostic studies
Lab tests to help identify dehydration
include urinalysis, blood urea nitro-
gen (BUN), serum creatinine, serum
electrolytes, serum glucose, serum
osmolality, and hematocrit. Findings
consistent with dehydration include
dark amber, concentrated urine;
increased urine specific gravity
(>1.020); elevated BUN (>23 mg/dL);
elevated serum creatinine (>1.3 mg/dL);
BUN/creatinine ratio >25:1; hyperna-
tremia (>145 mEq/L); increased serum
osmolarity (>300 mOsm/kg H2O); and
increased hematocrit (>50%).15,16
Because creatinine is the byproduct
of muscle energy metabolism, produced
Classifying dehydration
Isotonic dehydration: a balanced
depletion of water and sodium that
causes ECF loss. Causes include
vomiting and diarrhea.
Hypertonic dehydration: depletion in
TBW content due to pathologic fluid
losses, diminished water intake, or
both. Because of the resulting hyper-
natremia in the ECF compartment,
water is drawn from the ICF com-
Hypotonic dehydration: depletion in
sodium and water in which sodium
loss predominates, resulting in ECF
loss. Causes include overuse of
diuretics, renal disease, and decreased
intake of sodium and water.
Source: Hartford Institute for Geriatric Nursing.
Need Help Stat. Consider: Hydration Management.
Sources of body water gains and losses in the adult
Gains Losses
Oral intake Urine 1,500 mL
As water 1,000 mL Insensible losses
As food 1,300 mL Lungs 300 mL
Water of oxidation 200 mL Skin 500 mL
Feces 200 mL
Total 2,500 mL 2,500 mL
Source: Porth CM. Essentials of Pathophysiology. 3rd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams
& Wilkins; 2011.
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
30 l Nursing2011 l August
at a constant rate according to mus-
cle mass, and because older adults
lose muscle mass as they age, using
serum creatinine to assess renal
function in older adults will be mis-
leading.13 Use caution when assess-
ing older patients’ kidney function:
include GFR as well as creatinine
Nursing interventions
When your older patient is dehy-
drated, institute fall precautions.
Monitor vital signs, including ortho-
static BP, as well as intake and output
and daily weights. Administer I.V.
fluids as prescribed.11
Monitor the results of lab studies,
including the basic metabolic panel
and urinalysis. Assess your patient
for signs and symptoms of infection,
such as urinary tract infection, and
for changes in baseline mental status.
Try to determine and promptly treat
the cause of any diarrhea or vomiting.11
Assess for dysphagia and consider
requesting a speech therapy consul-
tation to evaluate swallowing. Offer
oral fluids on a schedule and make
sure fluids are placed within your
patient’s reach. Keep fasting required
for diagnostic and surgical proce-
dures to a minimum.11
Complications of dehydration
If dehydration is treated promptly, its
progression can be arrested and com-
plications avoided. But if dehydration
continues, compensatory mechanisms
begin to fail, resulting in decreased
tissue perfusion.14 Complications of
dehydration include shock, venous
thrombosis, intractable seizures, and
renal failure.17
According to Abdallah et al., hospi-
talization with dehydration has nearly
three times the mortality of hip frac-
ture at 30 days and twice the mortality
at 1 year. In their cross-sectional
descriptive study, the researchers sur-
veyed healthcare providers in the
northeast United States and found
that 89% identified dehydration as a
problem affecting older adults, and
94% noted the need for a public cam-
paign on dehydration awareness and
reduction. They also suggest promot-
ing hydration for older adults in the
community through mass outreach.3
Health-promotion strategies
Use a multidisciplinary approach to
prevent dehydration. I.V. therapy is
an alternative when oral hydration
isn’t an option.18
According to the Hartford Institute
for Geriatric Nursing, strategies for
hydration management include cal-
culating a daily fluid goal, then com-
paring your patient’s current intake to
this goal. Provide fluids consistently
all day, using a variety of fluids.5
For at-risk patients, institute fluid
rounds, including an 8-oz. glass of
fluid in the morning and another in
the evening. To encourage patients to
increase their intake, use strategies
such as happy hours and tea times.5
To help regulate and document
hydration status, teach patients to
use a urine color chart when possi-
ble. Document their intake and
usual hydration habits. Determine
the exact volume of beverage con-
tainers so you can calculate fluid
intake accurately.5
Any strategy preventing readmis-
sion benefits patients while reducing
department workload and length
of stay.19 Include medical, nursing,
occupational therapy, and dietary
staff. Appoint fluid and diet monitors
on each shift to assess and document
older patients’ hydration and eating
habits, fluid preference, and preferred
beverage temperature.14
Use assessment tools to identify
dehydration risk and nutritional
imbalance so you can implement pre-
ventive and therapeutic interventions.8
One such tool, the Dehydration Risk
Appraisal Checklist, can be down-
loaded from
Focus patient education on the
importance of hydration and of drink-
ing even when not thirsty. Aim for
early recognition of any decrease in
your patient’s usual fluid intake pat-
terns. Replenish and refresh fluids reg-
ularly. Frequently offer and encourage
your patient to drink preferred fluids
or eat fluid-rich foods, ensure access
to drinks, and position the patient
comfortably so drinking straws, feeder
cups, or special drinking apparatus
can be used. Incorporate swallowing
exercises, if needed. Use visual
reminders such as posters or notes.14
Besides assessing and monitoring
for dehydration in hospitalized
patients, emphasize preventive prac-
tices at home where recovery and
rehab often continue.20 Dehydration
may delay rehab or result in hospital
admission or readmission.
Patient teaching
As a nurse, you’re in an ideal posi-
tion to identify older adults at risk
for dehydration and to educate them
and their families. Inform them
about the benefits of hydration and
raise their awareness of the potential
risks associated with increasing age
and psychosocial factors.
Interventions to promote hydra-
tion include encouraging family and
visitors to provide fluids and remind-
ing older adults about drinking flu-
ids.3 You can ease older adults’ fears
Look for these signs and
Signs and symptoms of dehydration in
older adults include the following:
altered mental status
increased capillary refill time
dry skin and mucous membranes
decreased salivation and longitudinal
tongue furrows
urinary tract infection
hypotension, orthostatic hypotension
lethargy, near-syncope
muscle weakness
decreased urine output
tenting of skin
sunken eyes
weight loss of 3% to 5% in less than
30 days or acute weight loss
increased BUN, hematocrit, or serum
Source: Hartford Institute for Geriatric Nursing.
Need Help Stat. Consider: Hydration Management.
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. August l Nursing2011 l 31
about incontinence and falls by pro-
viding education and connection
with state and federally funded
community resources such as all-
inclusive older adult centers. The
Program of All-Inclusive Care for
the Elderly (PACE) includes com-
prehensive services with an inter-
disciplinary team of professional
and paraprofessional staff to assess
participants’ needs and to develop
and implement individual care
Improving outcomes
Don’t just go with the flow: Take
dehydration seriously and imple-
ment proper strategies to prevent it
or reverse its course. Your astute
nursing care can prevent hospital
admissions and readmissions—so
turn on the taps for best practices.
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Philadelphia, PA: Wolter s Kluwer/Lippincott
Williams & Wilkins; 2011.
2. Agency for Healthcare R esearch and Qual ity.
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So ft wa r e/ SA S / V31 / pq i_ g ui de _v31 .pd f.
3. Abdallah L, Remington R, Houde S, Zhan L, Mellilo
KD. Dehydration reduction in community-dwelling
older adults: perspective s of community hea lth care
providers. R es Gerontol Nurs. 2009;2(1):49-57.
4. Russo A, Wier LM, Elix haus er A. Hospital Utili-
zation Among Near-Elderly A dults, Ages 55 to 64
Years. Health Cost and Utili zation Project (HCUP).
Stati stica l Brief #79. Rockville, MD: Agency for
Health Care Policy and Re search (U.S.); 2007.
5. Mentes JC . Hydrat ion Man agement: Want to
Know More: Hyd ration M anagement. Nursing
Standard of Practice Protocol: Or al Hydration
Management. H artford Inst itute for G eriatric
Nursi ng. 2008. http://cons ultger s/
hydration_ management/want_to_know_more.
6. Agency for Healthcare R esearch and Qual ity.
Preventable Hospitalizations. Part II. Detailed Statistics
by Health Condition.
7. Hartford In stitute for Ger iatr ic Nursing. htt p://
8. Miller CA. Nursing for Wellness in Older Adults.
6th ed. Ph iladelphia, PA: Wolter s Kluwer H ealth/
Lippincott Williams & Wilkins; 2012.
9. Begum MN, Johns on CS. A rev iew of the litera-
ture on dehydration in the instit utiona lize d elderly.
eSPEN: the European eJournal of Clinical Nutrition
and Metabolism. 2010;5(1):e47-e53.
10. Post TW, Rose BD. Clinical man ifestation s and
diagnosis of volume depletion in adults. 2011.
11. Hartford I nstitute for Geriatric Nursing. Ne ed
Help Stat. C onsider: Hydration Man agement. http:// /topics/hydration_management /
need_help_stat /.
12. Huether SE, McCance KL . Understanding Patho-
physiology. 4th ed. St. Louis, MO: Mosby Elsevier;
13. Maaravi Y, Burs zty n M., Hammerman-Roz enberg
R, Cohen A , Stessman J. Mo derate renal i nsuf fi-
ciency at 70 years pred icts mor tality. QJM. 2006;
99(2):97-102. [Epub 2006 Jan 11]
14. Wotton K, Crann itch K, Munt R. Prevalence,
risk factors and strateg ies to prevent dehydr ation in
older adults. Contemp Nurse. 200 8;31(1):44-56.
15. Fischb ach F. A Manual of Laboratory and Diag-
nostic Tests. 8th ed. Philadelphi a, PA: Lippincott
Williams & Wilkins; 2009.
16. Ali B, Gray-Vickrey P. Lim iting the damage
from acute kidney injur y. Nursing. 2011;41(3):
17. Hua ng LH. Dehydrat ion. 2009. http://emedic ine. /article/906999-overview.
18. Flynn G, O ’Keefe ST. Being alert to dehydra-
tion. WIN: World of Irish Nursing and Midwifer y.
19. Bryant H. D ehydrat ion in older people: ass ess-
ment and m anagement. Emerg Nurse. 2007;15(4):
20. Nationa l Inst itute of Nursing R esearch. Chang-
ing Practice, C hang ing Lives: 10 Land mark Nu rsing
Research Studies. http://w
rdonlyres/ 27F3FB10-FE62-4119-9FA9-1140B6950
Edith C laros is a n asso ciate p rofes sor of nursin g at
the Mas sachu set ts Col lege of P harmac y and Health
Sciences, an d Magdal ena Collins is a re gist ered nurse
at Spaulding Reha bilit ation H ospital, bo th in Bos ton,
The aut hors ha ve disc lose d that th ey have no sig-
nific ant rel ation ship wi th or fi nancia l interest in an y
commer cial co mpanies that p ert ain to this educ a-
tional activity.
Recognizing the face of dehydration
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... Dehydration is generally used to describe a deficit in the total volume of body fluid and is also known as intravascular volume depletion or water-and-solute dehydration. Dehydration can be further classified as hypertonic, isotonic and hypotonic dehydration depending on its cause (Collins & Claros, 2011;Mentes, 2013). Hypertonic dehydration is the depletion of total body water caused by inadequate fluid intake or excessive fluid losses that subsequently cause intracellular fluid deficits. ...
... Dehydration in the older population may not only be an acute problem due to illness but also can be a chronic problem due to protracted inadequate care (Bennett et al., 2004;Wakefield et al., 2008). Common causes of chronic underhydration in the older population include but not limited to physical disabilities that impede the access to drinks, fear of incontinence or fluid overload, and cognitive impairments that affect the sense of thirst or the ability to communicate (Campbell, 2016;Collins & Claros, 2011;El-Sharkawy et al., 2014;Mentes, 2013;Wakefield et al., 2008). ...
... Clinical signs, such as dry or furry tongue, dry oral mucous membranes, poor skin turgor and sunken eyes, are common in dehydration (Bennett et al., 2004;Campbell, 2011). However, Collins and Claros (2011) argued that it is hard to determine the hydration status of s individuals simply based on these physical manifestations owing to age-related changes. For example, skin elasticity decreases with ageing that affects skin turgor. ...
Aim and objectives To examine the prevalence of dehydration upon hospital admission and its association with postoperative complications in older persons undergoing orthopaedic surgery. Background Ageing‐related physiological and pathological changes, as well as suboptimal care quality, can render older persons vulnerable to dehydration. However, few empirical studies have been conducted to examine the association between dehydration and care outcomes in this population. Design Retrospective documentary review. Methods The medical records of patients who were aged 65 years or above and admitted for orthopaedic surgery at an acute hospital in Hong Kong over the period of January 2013 to June 2013 were reviewed. The sociodemographic characteristics, health conditions, laboratory results during index hospitalisation, postoperative care and 1‐month survival were analysed. Dehydration status was defined on the basis of the ratio of blood urea nitrogen to creatinine upon admission. Results Of 310 reviewed records, 216 records were included in the analysis. A total of 21.8% of the patients in the included cases were defined as dehydrated and 35.2% were defined as at risk of dehydration. There were significantly more patients in the dehydrated group were female, having diuretic medication, swallowing difficulty, oedema, tube feeding, diaper or urinary catheter use, with postoperative complications in respiratory, gastrointestinal and haematological systems, and died within 30 days than those in the euhydrated group. Conclusions The findings of this study reveal that dehydration is highly prevalent among older persons on admission. Female gender and swallowing difficulty were found to be significantly associated with dehydration, although causal inference could not be delineated through this retrospective study. Relevance to clinical practice Given its significant influence on care outcomes and postoperative recovery, hydration care that promotes early recognition and timely management of dehydration is an integral part of fundamental care for older persons.
... Water regulates body temperature, protects body organs and tissues, helps dissolve minerals and nutrients to make them accessible and helps regulate acid-base balance. In a healthy adult, with an average 70 kg, water accounts for 60 % of body weight and the body requires 2-3⋅5 l per day of total water intake (2) . Water inputs composed of three major sources: major one result when drinking water and liquid with high water contents, second the water we eat come various food with a large amount of water content and the third source produce from the oxidation of macronutrients (endogenous or metabolic water) (3) . ...
... Water inputs composed of three major sources: major one result when drinking water and liquid with high water contents, second the water we eat come various food with a large amount of water content and the third source produce from the oxidation of macronutrients (endogenous or metabolic water) (3) . A person is considered dehydrated if they lose as little as 3 % of their body weight from water depletion (2) . Insufficient water intake with loss of body mass is associated with poor memory and attention (4) . ...
Full-text available
Despite the hot climate and high humidity in the Jazan Region of Saudi Arabia, which increases risk for dehydration, no previous studies have assessed awareness of dehydration and fluid intake practice among adults in this region. Therefore, the aim of this cross-sectional study was to determine awareness of the dehydration state and fluid intake practices among 440 adults in the Jazan Region of Saudi Arabia. Out of the total, 51⋅8 % were male and 48⋅2 % were females. Good knowledge of dehydration definition and prevention and recommended minimum water intake was observed in 98, 95 and 75 % of the participants, respectively. Fifty-nine percent of the participants met the minimum daily requirement of 3 l or more per day. The age (95 % CI 1⋅003, 1⋅017, P value = 0⋅006), diabetes (95 % CI 1⋅028, 1⋅459, P value = 0⋅023) and prior hospitalisation due to dehydration (95 % CI 1⋅010, 1⋅378, P value = 0⋅037) were associated with higher water intake. Additional glasses of coffee (95 % CI 1⋅02, 1⋅115, P value = 0⋅004) and juice (95 % CI 1⋅039, 1⋅098, P value < 0⋅001) were associated with more water intake. The participants exhibited good knowledge of dehydration definition, symptoms and consequences. Intake of fluids such as ‘juice and coffee’ enhances more water intake. Although two-thirds of the participants met the recommended daily water intake, still one-third of them did not meet this level. Innovative approaches to enhance healthy drinking are warranted and may include partnering with patients to take an active role in hydration monitoring and increasing communication with the different healthcare providers.
... In healthy adults with normal Body Mass Index (BMI), water accounts for 60% of body weight [1,6]. A person can become dehydrated if they lose as little as 3% of their body weight from water depletion [6]. ...
... In healthy adults with normal Body Mass Index (BMI), water accounts for 60% of body weight [1,6]. A person can become dehydrated if they lose as little as 3% of their body weight from water depletion [6]. The loss of body mass with no water intake is associated with poor memory and attention [7]. ...
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Background Dehydration results from a decrease in total body water content either due to less intake or more fluid loss. Common symptoms of dehydration are dry mouth/tongue, thirst, headache, and lethargy. The aim of this study was to assess knowledge of dehydration definition, symptoms, causes, prevention, water intake recommendations and water intake practices among people living in Riyadh, Saudi Arabia. Methods A cross-sectional study using self-reported questionnaire was employed. Participants were invited during their visit to shopping malls. The shopping malls were selected based on geographical location covering east, west, north and southern part of the city. Self-filled questionnaires were distributed to 393 participants, using systematic sampling technique. Variables recorded included demographics, past medical history, knowledge of dehydration definition, symptoms, causes, prevention and daily water intake practices. Descriptive statistics were summarised as mean, standard deviation and proportions. Negative binomial model was used to identify the predictors of water intake. Analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC, USA). Results Out of 393 participants, 273(70%) were Saudi, 209(53%) were female, average age was 32.32 ± 8.78 years. Majority 366(93%) had good knowledge of dehydration definition, 332(84%) for dehydration prevention, and 293(74%) of water intake recommendation. Top three recognized dehydration symptoms were: dry lips (87%), thirst (84%), dry tongue (76%) and recognized dehydration causes were: diarrhoea (81%), sweating (68%) and vomiting (62%). The less recognized symptoms were fatigue 176(44.78%), lack of focus 171(43.5%), headache/dizziness 160(40.71%), light headedness 117(29.7%), muscle weakness 98(24.94%), rapid breathing 90(22.9%), and muscle cramps 64(16.28%).The participants had reported an average of 5.39 ± 3.32 water glasses intake per day. The total volume of water intake was significantly different between males n = 184 (3.935 ± 2.10 l) and females n = 209 (3.461 ± 2.59 l) (p = 0.046). The participants’ weight status, intake of juice or tea were the significant predictors of more water intake. Conclusion The participants displayed good knowledge of dehydration definition, prevention, and water intake recommendation. The participants also displayed good knowledge of the common symptoms, however knowledge was lacking for uncommon symptoms. Moreover, participants had reported adequate water intake, meeting the daily water intake recommendation of ≥3.7 l for men and ≥ 2.7 l for women. Electronic supplementary material The online version of this article (10.1186/s12889-018-6252-5) contains supplementary material, which is available to authorized users.
... 75,78,79 Furthermore, age-related water consumption changes make elder adults vulnerable to dehydration, which is considered the most common fluid and electrolyte disorder in older adults. 75,80,81 Dehydration is a risk factor for clinical deterioration in patients with PD, as individuals with dysphagia drink only about 1 L of water daily. Thus, it is strongly recommended that patients with PD drink enough water to maintain appropriate hydration 75,[82][83][84] and that adequate hydration level is part of clinical practice guidelines for PD and future research on SUDPAR. ...
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Classified as the second most common neurodegenerative disorder associated with aging after Alzheimer's disease, Parkinson's disease (PD) is the most common movement disorder. In the last decade, despite advances in treatment, mortality rates linked with PD continued to reach significant figures. Available studies have shown that compared with healthy controls, patients with PD are accompanied by high rates of premature death. This is usually caused by factors such as pneumonia and cerebrovascular and cardiovascular diseases. Recently, it has been demonstrated that a significant proportion of patients with PD die suddenly. This is referred to as a sudden and unexpected death in PD (SUDPAR). Here, we focus on the magnitude of SUDPAR. Finally, it is important to learn more about SUDPAR for the implementation of effective prevention strategies.
... Adequate hydration is fundamental to health. Dehydration, the acute or chronic deprivation of water (Collins & Claros, 2011), has signifi cant detrimental outcomes, including falls, impaired cognition, and delirium (Gaspar & Mentes, 2020;Grabowski et al., 2007). Consequently, dehydration is a common underlying factor in avoidable resident hospital transfers (Gaspar & Mentes, 2020), resulting in unnecessary and signifi cant costs to the health care system, including extended lengths of hospital stay (Grabowski et al., 2007;Pash et al., 2014). ...
The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].
... Although the recommendation for sedentary adults is to drink approximately 2 L daily, water is frequently neglected as a dietary constituent (29)(30)(31). However, age-related water consumption changes make older people vulnerable to dehydration, which is considered the most common fluid and electrolyte disorder in older adults (29,32,33). Thus, as dehydration is a risk factor for the deterioration of PD, it is strongly recommended that patients with PD drink sufficient water to maintain hydration (29). ...
... A desidratação abrange parte significativa desta população, onde segundo Collins et al. (8) e Vivanti et al. (9) é uma das causas mais frequentes de hospitalização entre os indivíduos de 65 a 75 anos. Rosler et al. (10) Avaliando a desidratação em idosos de uma estratégia de saúde da família de acordo com Lopes (11) A população da pesquisa foram os idosos frequentadores da ESF que se enquadravam nos critérios de inclusão da pesquisa, os quais foram: ser idoso e estar na faixa etária de 60 a 80 anos, ser morador do município de Tucuruí e possuir cadastro no programa de saúde do idoso da ESF. ...
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Objetivo: Verificar possíveis sinais de desidratação e avaliar hábitos de ingestão hídrica de idosos frequentadores de uma Estratégia Saúde da Família (ESF) do município de Tucuruí, Pará. Método: Trata-se de uma pesquisa de campo, de caráter descritivo, com abordagem quantitativa baseada na análise de questionários respondidos pelos participantes da pesquisa. Resultados: A amostra foi composta por 40 idosos, sendo em sua maioria mulheres. Identificou-se que 85% possuem boa sensação de sede, 47,5% admitem sentir a boca seca, 7,5% sentem as axilas secas e 47,5% sentem a pele seca. Sobre a frequência de defecação, 97,5% defecam diariamente. Sobre o consumo de bebidas e alimentos, verificou-se que a água é a mais consumida, onde 75% admitem beber de 1 a 2 litros por dia, 12,5% bebem de 2 a 3 litros e os outros 12,5% ingerem menos de 1 litro. Conclusão: Felizmente, foi possível verificar que os indivíduos pesquisados possuem bons hábitos, tais como alimentação saudável e uma boa ingesta hídrica, o que contribui para que não apresentem sinais de desidratação.
... Undoubtedly, water in all its forms is necessary for life (Collins and Claros 2011;Gandy 2015). For example, Ewaid (2017) views water as "the liquid of life". ...
Full-text available ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ The superficial water of Djedra wadi was the subject of a feasibility study relating to a dam under construction to store water to meet the increasing needs imposed by various uses. This water, however, is loaded with minerals resulting from the leaching of rocks composed essentially of outcropped carbonates and evaporates. Therefore, the aim of this study was to interpret and evaluate the mineralization of this water and to characterize its suitability for agricultural use. To this end, we measured some physicochemical parameters. Electrical conductivity and salinity were measured in situ using a commercial multi-parameter portable meter. Some water samples were then analyzed in the laboratory to determine the following chemical parameters: calcium, magnesium, sodium, potassium, bicarbonates, chlorides, and sulfates. These data were used to construct a repartition map of the electrical conductivity and salinity, to determine the hydrochemical facies using Piper and Stiff diagrams, and to identify the (un)suitability of water for irrigation using Richard and Wilcox representations. The results show that the electrical conductivity and salinity increase downstream of the watershed. The conductivity values do not exceed 990 µS/cm for the El Hammam watercourse but they exceed 2200 µS/cm for the El Akiba watercourse. With regard to the hydrochemical facies, the water upstream indicates a sodium chloride facies, whereas downstream it indicates a calcium bicarbonate facies for El Hammam and calcium sulfate facies for El Akiba and Djedra. The results also show that the downstream water is considered unsuitable for irrigation in most crops and most soils. However, monitoring of the water mineralization allows one to use them for the irrigation of salt-tolerant and resistant plants on well-drained soils, but this requires the installation of a unit to record salt concentrations daily. The implementation of an ecological purification system appropriate to the climate of the region studied, by afforestation of reeds on the slopes downstream, allows the absorption of mineral salts contained in the water.
... Dehydration is defined as 1% or greater loss of bodyweight as a result of fluid loss [35,36] and may result from decreased thirst sensation and fluid intake or excessive excretion [35,37]. Importantly, dehydration is the most common fluid and electrolyte disorder in older adults [38,39] and one of the most common causes of hospitalization in adults aged 65-75 years [35,40]. In fact, it has been shown that depending on the type of dehydration and its treatment, the mortality in the elderly population associated with abnormalities of water balance may be higher than 40% [35,41]. ...
Parkinson’s disease (PD) is one of the most common age-related neurodegenerative disorders. Several studies over the last few years have shown that PD is accompanied by high rates of premature death compared with healthy controls. Death in PD patients is usually caused by determinant factors such as pneumonia, and cerebrovascular and cardiovascular diseases. During recent years it has emerged that dehydration may also contribute to mortality in PD. Interestingly, it has been documented that a substantial proportion of patients with PD die suddenly (known as sudden and unexpected death in PD). In this article, we focus on the magnitude of the problem of sudden and unexpected death in PD, with special reference to the daily water consumption of PD patients.
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Background & aims Dehydration is the most common fluid and electrolyte problem among the elderly. The purpose of this review is to summarize the literature on dehydration in the institutionalized elderly. Methods To find relevant literature for this narrative review, a computerized search of articles published until June 2009 was performed in three databases: PubMed, Medline, and the Cochrane Library. Results Dehydration is conceptualized and operationalized in many different ways in the literature. Yet, dehydration is reported to be widely prevalent and costly to individuals and to the health care system. It affects large numbers, contributes to or exacerbates other severe medical conditions, may cause acute confusion and disorientation, and severely impairs the elderly individual's quality of life. Various strategies to detect and address dehydration are reported in the literature and these are primarily based on practice, or small scale research projects. Conclusions Detection and prevention of dehydration is critically important among the frail, institutionalized elderly. In the future, the efficacy, effectiveness and economics of these strategies need to be further evaluated through research.
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The treatment of dehydration in older adults admitted from residential care to an acute hospital setting may lead to haemodynamic stability. There is however an increased risk for short or long term alterations in physiological, cognitive and psychological status and ultimately, decreased quality of life. Such acute care admissions could be decreased where preventative strategies tailored to address individual risk factors are combined with more frequent assessment of the degree of hydration. The questionable reliability of assessment criteria in older adults increases the need to use multiple signs and symptoms in the identification and differentiation of early and late stages of dehydration. This article reviews various risk factors, explores the reliability of clinical signs and symptoms and reinforces the need to use multiple patient assessment cues if nurses are to differentiate between, and accurately respond to, the various causes of dehydration. Specific strategies to maintain hydration in older adults are also identified.
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Glomerular filtration rate (GFR) diminishes with age. Kidney function in the elderly is often assessed by serum creatinine alone, although it is insensitive in this age group. Formulae for predicting GFR are not widely used. To study the effect of low predicted GFR on mortality. Longitudinal cohort study. Setting: The community-based Jerusalem Seventy Year Olds Longitudinal Study. We studied 445 subjects, all aged 70 years, using questionnaires, a medical examination with history-taking, and standard laboratory tests. Moderate renal insufficiency was defined as a predicted GFR of <60 ml/min, based on the Cockcroft-Gault (CG) and the Modification of Diet in Renal Disease (MDRD) equations. Predicted GFR was normally distributed, with a mean +/- SD of 62.4 +/- 15.27 ml/min. Predicted GFR was <60 ml/min in 221 (46%), most of whom had normal serum creatinine. Twelve-year mortality was 38.7% in these 221 vs. 27% in the other 204. The survival advantage was already evident after 3 years. Under Cox proportional hazard analysis using numerous common risk factors as independent variables, lower predicted GFR had a significant mortality risk (hazard ratio 2.108, 95%CI 1.43-3.12, p = 0.0002). In community-dwelling elderly people, moderate renal insufficiency as assessed using the CG equation is a strong and independent predictor of mortality. Most of these at-risk patients have 'normal' serum creatinine.
Dehydration is a common problem among older adults and can negatively affect their health. This cross-sectional descriptive study used survey findings and focus group interviews to investigate dehydration problems among community-dwelling older adults and to identify strategies perceived to be helpful in preventing dehydration in this population. The survey sample (n = 18) and four focus groups (n = 36) included health care providers in the northeast United States from provider agencies representing emergency care, home care, primary care, and community health care. Survey findings indicated that 89% of participants identify dehydration as a problem affecting older adults, and 94% noted the need for a public campaign on dehydration awareness and reduction. Four major themes emerged: Intentional Avoidance and Caution, Lack of Awareness/Education/Understanding, Poor Access to Fluids, and Social and Environmental Influences. Strategies identified to promote hydration in community-dwelling older adults included community partnerships, community education, community engagement, and interdisciplinary approaches. This study provides useful information and detailed strategies recommended by health care providers for designing interventions to promote hydration for community-dwelling older adults.
Essentials of Pathophysiology
  • Cm Porth
Porth CM. Essentials of Pathophysiology. 3rd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2011.