Physical signs of dehydration in the elderly

It is widely recognised that dehydration is a common condition in the elderly and that it is a frequent cause of hospitalization among older people, in spite of efforts by caregivers to prevent its development. Successful prevention strategies will require early identification of individuals at increased risk, which in turn means that knowledge of simple but reliable signs of mild dehydration is required. In this study, various physical signs were examined as clinical signs of dehydration in elderly. In this study, 27 consecutive elderly patients who were admitted to the Department of Medicine were evaluated. Based on a definition of dehydration as a calculated serum osmolality of more than 295 mOsm/kg, 9 patients were classified as dehydrated (mean osmolality of 310 mOsmol/kg) and 18 as non-dehydrated (mean osmolality of 279 mOsmol/kg). All patients were observed for physical signs of dehydration: decreased consciousness level; dry axilla; dry mouth; sunken eyes; decreased skin turgor; delayed capillary refill time. Blood and urine chemistry analyses were also compared between the two groups. For the physical signs, dry axilla had moderate sensitivity (44%) and good specificity (89%) to detect dehydration. Sunken eyes and delayed capillary refill time also showed relatively good specificity (83%). As expected, the mean serum sodium concentration in the dehydrated group (146 mmol/l) was higher (p<0.01) than that in the non-dehydrated group (134 mmol/l). During the hospitalization, 44% of patients in the dehydrated group died, while 17% in the non-dehydrated group died. The authors concluded that physical signs of dehydration in elderly showed relatively good specificity but poor sensitivity. They suggested that evaluation of the axillary moisture could help assess dehydration in situations where laboratory analysis was not available. Although the number of subjects in the study was small, these preliminary results help raise the awareness of the need for careful observation of vulnerable elderly individuals.

 

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Abstract   [button text=”View at PubMed” url=”http://www.ncbi.nlm.nih.gov/pubmed/22687791″ target=”_blank” color=”blue”][/button]

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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.

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By | 2017-05-21T03:07:10+00:00 diciembre 4th, 2012|Artículos seleccionados|Comentarios desactivados en Physical signs of dehydration in the elderly