Preventing and treating dehydration in the elderly during periods of illness and warm weather

Integration of a new technology into a work system: a case study of a smart drinking glass in French nursing homes

PURPOSE

To reduce the risk of dehydration in older adults, the French company Auxivia has developed a smart drinking glass (SDG) that can measure the amount of water drunk. The present study looked at the various work systems (WSs) designed for use of the SDG in a nursing home. The study's objectives were to (i) determine the WSs' impact on the staff's ability to comply with the device's prerequisites and ensure the device's effective use and (ii) draw up guidelines on designing work systems.

MATERIALS AND METHODS

At three nursing homes in France, two independent observers performed 9 h of observations at each site and a total of 29 interviews.

RESULTS

Decisions concerning implementation and the resulting WSs have an impact on the tasks to be performed, the tasks' inherent constraints and the use of the SDG. It is essential to take account of the sociotechnical system as a whole before integrating a technology. Ideally, the introduction of an SDG will go unnoticed by staff and residents; however, our results emphasize the value of highlighting work constraints via a human factors analysis.

CONCLUSIONS

It is essential to take account of sociotechnical WSs as a whole when integrating a technology.

An Audit on the Pre-operative Fasting Time of Trauma-List Orthopaedic Patients at a District General Hospital in Chichester, United Kingdom

INTRODUCTION

Pre-operative fasting of patients awaiting non-emergency surgeries has been a common practice to minimise the risk of vomiting and aspiration at the time of induction of anaesthesia. Current standard guidelines recommend that this fasting time be limited to two hours for clear fluids and six hours for solids and semi-solids, as prolonged fasting has been shown to be harmful to the patient.

METHODS

A descriptive cross-sectional study of the fasting times of all adult trauma orthopaedic patients who were operated on under anaesthesia between June 1 and 30, 2023. Fifty patients who met the inclusion criteria were included in the study.

RESULTS

The minimum and maximum fasting times observed for solids and semi-solids were 9 and 24 hours, respectively. The mean fasting time for solids and semi-solids was 15.8 hours. The minimum and maximum fasting times observed for clear fluids were 2 and 20 hours, respectively. The mean fasting time for clear fluids was 10.5 hours. Elderly patients accounted for a significant portion of the patients, with 64% (n=32) being above the age of 70 years.

CONCLUSION

A significant disparity was noted between the current fasting practices and the recommended standards set out by the Royal College of Nursing, the Association of Anaesthetists of Great Britain and Ireland, the European Society of Anaesthesiology, and the American Society of Anaesthesiologists. The knowledge of pre-operative fasting among the orthopaedic team doctors and the ward nursing staff was found to be inadequate.

[Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]

The scope of this study was to determine the percentage of elderly individuals receiving an adequate water intake and associated factors among non-institutionalized elderly individuals in the urban area of Pelotas, Rio Grande do Sul. It involved a cross-sectional, population-based study carried out in 2014 with elderly participants (≥ 60 years) of the "COMO VAI?" survey. The amount of water ingested per day of the interviewees was investigated, considering the intake of at least eight glasses per day to be adequate. The independent variables were sociodemographic, behavioral, and health characteristics, and Poisson Regression was used to investigate associations. A total of 1,451 elderly people were interviewed, with only 12.6% (95%CI 10.8; 14.7) drinking a sufficient amount. A higher percentage of the elderly with adequate water consumption was observed in younger elderly individuals, those overweight, those with five or more diseases, and those who were more impaired. A low percentage of the elderly with an adequate water intake was observed among the elderly adults in the study. The decreasing trend of water intake in relation to age highlights the importance of developing actions for the higher risk population to stress adequate water intake and the possible consequences of the lack of adequate consumption.

Effect of an Audible Alarm on the Fluid Consumption of Older Adults Living in a Nursing Home: A Randomized Controlled Trial

The aim of the current study was to investigate the effect of an audible alarm on fluid consumption among older adults living in a nursing home. This single-blind, randomized controlled, prospective experimental study was performed between July 27, 2017, and February 1, 2018. This study comprised 100 participants (intervention group, n = 50; control group, n = 50). The amount of fluid consumed by older adults in the intervention group in relation to the audible alarm increased significantly compared to the control group, and the deficiency of fluid consumption decreased. It was determined that the wristwatch with audible alarm was effective when used as a reminder to increase fluid consumption among older adults with fluid deficiency. [Journal of Gerontological Nursing, 48(9), 39-46.].

Prevention of pressure ulcers in older people with frailty

The incidence of pressure ulcers is highest among older people with frailty. The development of pressure ulcers is a common and challenging issue in this population, which can reduce people's quality of life and increase mortality risk. Multifactorial processes contribute to the development of pressure ulcers in older people with frailty, including age-related skin changes, comorbidities, polypharmacy, reduced mobility, inadequate nutrition and hydration, and continence issues. This article discusses the development and management of pressure ulcers in older people with frailty. It also outlines some of the measures that can be taken by nurses and other healthcare professionals to reduce the risk of pressure ulcers developing in this population.

Retrospective evaluation of planning margins for patients undergoing radical radiation therapy treatment for bladder cancer using volumetric modulated arc therapy and cone beam computed tomography

INTRODUCTION

Current contouring guidelines for curative radiation therapy for muscle-invasive bladder cancer (MIBC) recommend margins of 1.5-2.0 cm, applied to the clinical target volume (CTV). This study assessed whether the use of volumetric modulated arc therapy (VMAT), cone beam computed tomography (CBCT) and strict bladder preparation allowed for a reduced planning target volume (PTV) expansion, resulting in lower doses to surrounding organs at risk (OARs).

METHODS

Daily CBCT images for 12 patients (382 scans total) were retrospectively reviewed against four potential PTV margins created on and exported with the reference CT scan. To form the PTVs, three isotropic expansions of 0.5, 1.0 and 1.5 cm were applied to the CTV, as well as an anisotropic expansion of 1.5 cm superiorly and 1.0 cm in all other dimensions. Following treatment completion, the CBCTs were visually assessed to determine the margins encapsulating the bladder. For retrospective planning purposes, the 1.0-cm and anisotropic margins were compared with the previously recommended margins to determine differences in OAR doses.

RESULTS

The 0.5-, 1.0- and 1.5-cm isotropic margins (IM) and the anisotropic margin (ANIM) covered the CTV in 46.1, 96.8, 100 and 100% of CBCTs retrospectively. Doses to OARs were significantly lower for the reduced margin plans for the small bowel, rectum and sigmoid.

CONCLUSION

Bladder planning target volumes may be safely reduced. We endorse a PTV margin of 1.0cm anteriorly, posteriorly and inferiorly with 1.0-1.5 cm superiorly for radical whole bladder cases using strict bladder preparation, VMAT and pretreatment CBCTs.

Nutrition and Healthy Aging: Prevention and Treatment of Gastrointestinal Diseases

Nutritional well-being is a fundamental aspect for the health, autonomy and, therefore, the quality of life of all people, but especially of the elderly. It is estimated that at least half of non-institutionalized elderly people need nutritional intervention to improve their health and that 85% have one or more chronic diseases that could improve with correct nutrition. Although prevalence estimates are highly variable, depending on the population considered and the tool used for its assessment, malnutrition in the elderly has been reported up to 50%. Older patients are particularly at risk of malnutrition, due to multiple etiopathogenetic factors which can lead to a reduction or utilization in the intake of nutrients, a progressive loss of functional autonomy with dependence on food, and psychological problems related to economic or social isolation, e.g., linked to poverty or loneliness. Changes in the aging gut involve the mechanical disintegration of food, gastrointestinal motor function, food transit, intestinal wall function, and chemical digestion of food. These alterations progressively lead to the reduced ability to supply the body with adequate levels of nutrients, with the consequent development of malnutrition. Furthermore, studies have shown that the quality of life is impaired both in gastrointestinal diseases, but especially in malnutrition. A better understanding of the pathophysiology of malnutrition in elderly people is necessary to promote the knowledge of age-related changes in appetite, food intake, homeostasis, and body composition in order to better develop effective prevention and intervention strategies to achieve healthy aging.

The Road to Healthy Ageing: What Has Indonesia Achieved So Far?

The World Health Organization (WHO) has projected that the world should prepare for an aging society. As the fourth most populous country in the world, the elderly population in Indonesia is also continuously growing. In 2010, the proportion of the elderly group was merely 5%, and it is expected to increase to 11% in 2035. Understanding the current situation of the adult population in Indonesia would be crucial to prepare for the future aging population. This article analyzed the current socio-demographic status, nutrition status, nutrient intake, and health profile of the current Indonesian adult population through a literature review. The key issues to prepare for healthy aging in Indonesia are summarized. Acknowledging the profile of the adult and senior adult population in Indonesia will provide beneficial information for all stakeholders in preparing Indonesia for a better healthy aging population with improved quality of life.

Albumin Infusion in Critically Ill COVID-19 Patients: Hemodilution and Anticoagulation

Hypercoagulation is one of the major risk factors for ICU treatment, mechanical ventilation, and death in critically ill patients infected with SARS-CoV-2. At the same time, hypoalbuminemia is one risk factor in such patients, independent of age and comorbidities. Especially in patients with severe SARS-CoV-2-infection, albumin infusion may be essential to improve hemodynamics and to reduce the plasma level of the main marker of thromboembolism, namely, the D-dimer plasma level, as suggested by a recent report. Albumin is responsible for 80% of the oncotic pressure in the vessels. This is necessary to keep enough water within the systemic circulatory system and for the maintenance of sufficient blood pressure, as well as for sufficient blood supply for vital organs like the brain, lungs, heart, and kidney. The liver reacts to a decrease in oncotic pressure with an increase in albumin synthesis. This is normally possible through the use of amino acids from the proteins introduced with the nutrients reaching the portal blood. If these are not sufficiently provided with the diet, amino acids are delivered to the liver from muscular proteins by systemic circulation. The liver is also the source of coagulation proteins, such as fibrinogen, fibronectin, and most of the v WF VIII, which are physiological components of the extracellular matrix of the vessel wall. While albumin is the main negative acute-phase protein, fibrinogen, fibronectin, and v WF VIII are positive acute-phase proteins. Acute illnesses cause the activation of defense mechanisms (acute-phase reaction) that may lead to an increase of fibrinolysis and an increase of plasma level of fibrinogen breakdown products, mainly fibrin and D-dimer. The measurement of the plasma level of the D-dimer has been used as a marker for venous thromboembolism, where a fourfold increase of the D-dimer plasma level was used as a negative prognostic marker in critically ill SARS-CoV-2 hospitalized patients. Increased fibrinolysis can take place in ischemic peripheral sites, where the mentioned coagulation proteins can become part of the provisional clot (e.g., in the lungs). Although critically ill SARS-CoV-2-infected patients are considered septic shock patients, albumin infusions have not been considered for hemodynamic resuscitation and as anticoagulants. The role of coagulation factors as provisional components of the extracellular matrix in case of generalized peripheral ischemia due to hypoalbuminemia and hypovolemia is discussed in this review.

Newly Developed COVID-19 Bundle Greatly Reduces the Infection Fatality Rate for a Highly Vulnerable Nursing Home Population

This performance improvement initiative used a bundle designed to reduce the COVID-19 infection fatality rate (IFR) by ≥33% and the new infection rate (IR) to <1% among nursing home (NH) residents over a 3-month period at a large public NH in New York City. Participants were all NH residents, newly testing COVID-19 PCR positive between March 1, 2020 and June 30, 2020. Key bundle components involved close observation of all residents with vital signs taken once/shift, including O2 saturation, frequent clinical team follow-up visits for those symptomatic, and ramped-up COVID-19 PCR testing. From April to June, average IFR was 12.3%, a 49.6% reduction from the March baseline (P < 0.05), and average new IR was 5.4%, a 29.9% reduction from baseline (P < 0.05). In the 2 follow-up months, no deaths occurred with a new IR < 1%, indicating sustained improvement. Because of its simplicity, this bundle or components of it could be readily applied elsewhere after appropriate assessment.

The relation between stimulated salivary flow and the temporal consumption experience of a liquid oral nutritional supplement

Use of oral nutritional supplements (ONS) in undernourished patients has proven clinical benefits, but this can be hampered by low adherence due to poor experience of palatability. Many patients, particularly older patients, experience hyposalivation which can cause taste changes and reduce the enjoyment of foods. The aim of this study was to investigate differences in the temporal consumption experience (comprising sensory perception, in-mouth aroma release and subjective appetite) of a clinically relevant portion of ONS, for groups differing in saliva flow rates (SFR). The SFR (mL/min) of thirty healthy individuals was measured on three occasions. This data was used to categorise individuals into three groups using quartile analysis: low flow (LF) (0.3–0.6 mL/min, n = 5), medium flow (MF) (0.7–1.2 mL/min, n = 16) and high flow (HF) (1.3–1.8 mL/min, n = 9). Over the consumption of eight 15 mL sips of ONS, individuals rated their sensory perception and subjective appetite perception using line scales. Additionally, in-mouth aroma release was measured for each sip, using atmospheric pressure chemical ionisation (APCI). Compared with the MF and HF group, the LF group reported a significantly greater increase of mouth-drying over increased sips (p = 0.02). The LF group also experienced significantly higher aftertaste perception (p < 0.001), and more intense in-mouth aroma release (p = 0.015), compared with the HF group. These findings occurred concurrently with relatively lower hunger sensations in the LF and MF group. Many patients who are prescribed ONS likely experience reduced salivary flow rates. The unique sensory experiences of these individuals should be considered in order to optimise palatability and nutritional intake.

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A full portion of ONS was evaluated by three groups differing in saliva flow rates.

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A sensory profiling method captured perceptual differences over repeated sips.

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Mouth-drying built up most significantly for the low saliva flow group.

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Intensity of aftertaste and aroma release was highest in the low saliva flow group.

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Sensorial intensity of ONS may be associated with greater feelings of satiation.

The Role of Nutrition for Pressure Injury Prevention and Healing: The 2019 International Clinical Practice Guideline Recommendations

GENERAL PURPOSE

To review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline with further discussion of nutrition for pressure injury management in the context of the recommendations.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:1. Distinguish nutrition and malnutrition, especially as they relate to the development and healing of pressure injuries.2. Differentiate the tools and techniques that help clinicians assess nutrition status as well as the causes of pressure injuries in specific populations.3. Identify interventions for improving nutrition status and promoting pressure injury healing.

ABSTRACT

Macro- and micronutrients are required by each organ system in specific amounts to promote the growth, development, maintenance, and repair of body tissues. Specifically, nutrition plays an important role in the prevention and treatment of pressure injuries. The purpose of this manuscript is to review the nutrition-related recommendations presented in the 2019 European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacific Pressure Injury Alliance Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. Nutrition for pressure injury management is discussed in the context of the recommendations.

Real-World Evidence for Long-Term Safety and Effectiveness of Ipragliflozin in Japanese Patients with Type 2 Diabetes Mellitus: final Results of a 3-Year Post-Marketing Surveillance Study (STELLA-LONG TERM)

OBJECTIVE

To evaluate the long-term safety and effectiveness of ipragliflozin in real-world clinical practice in Japanese patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS

This post-marketing surveillance study (STELLA-LONG TERM) included Japanese patients newly initiated on ipragliflozin between 17 July 2014 and 16 October 2015 (data lock: 30 September 2019). Survey items included demographics, treatments, adverse drug reactions (ADRs), vital signs, and laboratory variables.

RESULTS

Of 11,424 registered patients, safety and efficacy analysis sets comprised of 11,051 and 8,763 patients, respectively. ADRs occurred in 2,129 patients (19.27%) and serious ADRs occurred in 210 patients (1.90%). Renal and urinary disorders (n = 739, 6.69%), particularly polyuria/pollakiuria (n = 612, 5.54%) and volume depletion-events, including dehydration (n = 243, 2.20%), comprised the most common ADRs. Mean (SD) change in hemoglobin A1c (─0.66 [1.25] %), fasting plasma glucose (─28.8 [50.1] mg/dL) and body weight (─3.33 [4.32] kg) from baseline to 36 months were statistically significant (P < 0.001).

CONCLUSIONS

The safety profile of long-term ipragliflozin treatment in routine clinical practice is consistent with previously reported interim data at 12 or 24 months and pre-approval clinical trials. Ipragliflozin treatment was also associated with sustained improvements in efficacy parameters for over 3 years.

Can the interRAI home care instrument be applied to the definition criteria of the Global Leadership Initiative on Malnutrition (GLIM)? A longitudinal study

BACKGROUND & AIMS

As malnutrition is an important modifiable risk factor for poor clinical outcomes, it is important to target malnourished older people and older people at risk of malnourishment. The Global Leadership Initiative on Malnutrition (GLIM) recently reached a consensus for a global definition of malnutrition. The primary aim of this study was to apply the interRAI Home Care (interRAI HC) instrument to fit the GLIM definition criteria of malnutrition to the closest. A second goal was to identify potential risk factors associated with malnutrition using this comprehensive assessment and to quantify their association.

METHODS

This is a case control study, which retrospectively determines the exposure to the risk of malnutrition and estimates its potential risk factors. The longitudinal data came from a larger study called Protocol 3. Eligibility criteria were a minimum age of 65 years old, a minimum score of 6 on the Edmonton Frail Scale or at least a moderate level of functional impairment measured by a Belgian version of the Katz scale. Older people with an official dementia diagnosis were also eligible. Bivariate analysis was performed and logistic regression models were developed in order to identify significant determinants of malnutrition.

RESULTS

The data consisted of 6334 frail older people (mean age: 80.6 ± 6.9, 70.6% female). About 2.4% became malnourished within a follow-up period of one year after baseline. The adjusted logistic regression yielded significant odds ratios for dysphagia (OR 2.2), loss of appetite (OR 1.8), bladder incontinence (OR 1.5) and low fluid intake (OR 1.5). Diabetes (OR 0.5) and visits to the physician (OR 0.5) had both a significant reverse effect.

CONCLUSIONS

This study was the first large longitudinal research to explore the risk factors of malnutrition with a comprehensive assessment instrument as the interRAI HC, applying it to the recent GLIM definition criteria. The worldwide use of the interRAI instruments makes these findings relevant for global clinical practice and research. Adapting the interRAI instruments to the GLIM definition improves accurate detection, prevention and early treatment of malnourishment, avoiding further health deterioration in older people.

Analysis of quality of life, sociodemographic variables and self-reported diseases among working older adults

Background

Aging should not be seen as a hindrance to the continuity of work, while including older adults in the labor market contributes to national economies.

Objective

To analyze the association between subjective quality of life (QoL) assessment, sociodemographic variables and self-reported morbidity among working older adults.

Methods

The present study was conducted at farmers' markets in Presidente Prudente, Sao Paulo, Brazil. Participants were 24 older adults aged 68.69±6.5 years old. We administered the World Health Organization Quality of Life (WHOQOL-bref) questionnaire, a sociodemographic questionnaire including working conditions and a questionnaire to survey the participants' medical history. The normality assumption was assessed with the Shapiro-Wilk test. Pearson's and Spearman's tests were used for correlation analysis.

Results

The sample exhibited average QoL. Most participants were female, with 1 to 8 years of formal schooling, married, with family income 1 to 3 times the equivalent of the minimum wage and sought healthcare within the national health system. All the participants lived in their own house. Hypertension was the most prevalent disease.

Conclusion

QoL and morbidity exhibited moderate negative correlation. There was negative correlation between the QoL physical and psychological domains and variables years in the job, daily working hours, meal/rest breaks and number of meals/day. There was moderate negative correlation between the QoL environment domain and meal/rest breaks.

Diagnosing dehydration in the nursing home: international consensus based on a modified Delphi study

Aim

To assess which method (or combination of methods) are relevant and feasible to diagnose dehydration in nursing home residents.

Findings

International experts agreed on the relevance and feasibility of 9 anamnestic items, 8 physical symptoms and 3 blood tests to diagnose dehydration. This resulted in a diagnostic strategy consisting of a suspicion phase (including anamnestic items and physical symptoms) and a confirmation phase (including blood tests).

Message

This is the first study reaching international consensus about a strategy to diagnose dehydration in the nursing home.

Electronic supplementary material

The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users.

Purpose

Even though dehydration is a big problem among nursing home residents, a universally agreed method to diagnose dehydration among nursing home residents is missing. Therefore, this study aimed to establish consensus on a method to diagnose dehydration in this population.

Methods

Using an international Delphi study, 53 experts (physicians and advanced nurse practitioners) were asked to judge various methods to diagnose dehydration on relevance and feasibility in the nursing home. Based on the methods that gained consensus in the first and second round (≥ 75% consensus), a step-by-step diagnostic strategy was developed which was presented to, and judged by, the experts in round three.

Results

After the first and second round, consensus was reached on nine anamnestic items, eight physical symptoms and three blood tests. In the third round, 24 experts agreed with the developed step-by-step diagnostic strategy as a standard to diagnose dehydration in nursing home residents.

Conclusion

This is the first study reaching international consensus on a strategy to diagnose dehydration in the nursing home. This strategy comprehends a presumption phase, where anamnestic items and physical symptoms are examined, followed by a confirmation phase with blood tests to confirm the diagnosis of dehydration. Using this strategy, it is important to take the individual characteristics (e.g. co-morbidity) of the resident and its care environment (e.g. ambient temperature) into account.

Electronic supplementary material

The online version of this article (10.1007/s41999-020-00304-3) contains supplementary material, which is available to authorized users.

Efficacy and safety of empagliflozin in older patients in the EMPA-REG OUTCOME® trial

OBJECTIVE

The risks of cardio-renal complications of diabetes increase with age. In the EMPA-REG OUTCOME® trial, empagliflozin reduced cardiovascular (CV) mortality by 38% in patients with type 2 diabetes (T2D) and CV disease. Here we compare outcomes with empagliflozin in older patients in EMPA-REG OUTCOME.

METHODS

Patients with T2D and CV disease were randomised to empagliflozin 10 or 25 mg, or placebo plus standard of care. In post hoc analyses, risks of 3-point major adverse CV events (3P-MACE: composite of CV death, non-fatal myocardial infarction (MI) or non-fatal stroke), CV death, hospitalisation for heart failure, all-cause mortality, all-cause hospitalisation and incident/worsening nephropathy were evaluated for empagliflozin versus placebo by baseline age (<65, 65 to <75, ≥75 years). Adverse events (AEs) were analysed descriptively.

RESULTS

Effect of empagliflozin on all outcomes was consistent across age categories (P ≥ 0.05 for interactions) except 3P-MACE. The 3P-MACE hazard ratios (HRs) were 1.04 (95% confidence interval [CI] 0.84, 1.29), 0.74 (0.58, 0.93) and 0.68 (0.46, 1.00) in patients aged <65, 65 to <75, and ≥75 years, respectively (P = 0.047 for treatment-by-age group interaction). Corresponding CV death HRs were 0.72 (95% CI 0.52, 1.01), 0.54 (0.37, 0.79) and 0.55 (0.32, 0.94), respectively (P = 0.484 for treatment-by-age group interaction). Across age categories, empagliflozin AEs reflected its known safety profile. Rates of bone fractures, renal AEs and diabetic ketoacidosis were similar between empagliflozin and placebo across age categories.

CONCLUSIONS

In the EMPA-REG OUTCOME trial, empagliflozin reduced risks of CV mortality, heart failure and renal outcomes, supporting its cardio-renal benefits in older patients.

Seasonal Variation in the Frequency of Presentation with Acute Ureteral Colic and Its Association with Meteorologic Factors

Introduction: A seasonal variation in the frequency of acute stone presentations has been observed in studies from the United States, Africa, and Asia. The increased incidence of acute stone presentations during periods of warm weather has been attributed to both the dehydrating effect of elevated temperatures and the vitamin D related increase in calciuria during periods of increased sunshine. The aim of this study is to establish whether the association between various meteorologic parameters and the frequency of acute stone presentations also exists in a European climate. Methods: All computed tomography kidneys, ureters and bladder scans performed by Emergency Departments within the Dublin Midland Hospital Group between June 2017 and September 2018 were identified from the national radiologic database. The date of scan in addition to stone parameters (site, size, and side) was recorded. These data were then correlated with weather recordings obtained from the Irish meteorologic office. Results: A total of 2441 patients were investigated for suspected renal colic during the study period of which 781 were confirmed to have ureteral stones. An increased frequency of acute stone presentations was observed during the summer months of both years (June, July, and August). Unexpectedly, the heat wave of summer 2018 was not associated with an increased frequency of nephrolithiasis compared with summer 2017. Conclusion: There is an increased frequency of acute nephrolithiasis during the summer months in Ireland. Health care services should be tailored to expect an increase in service needs during these periods of increased activity.

Bioimpedance-Guided Hydration for the Prevention of Contrast-Induced Kidney Injury: The HYDRA Study

BACKGROUND

Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status.

OBJECTIVES

The goal of this study was to compare the effect of standard and double intravenous (IV) infusion volumes in patients with low body fluid level, assessed by using bioimpedance vector analysis (BIVA), on the incidence of CI-AKI after elective coronary angiographic procedures.

METHODS

A total of 303 patients with low BIVA level on admission were randomized to receive standard volume saline (1 ml/kg/h for 12 h before and after the procedure) or double volume saline (2 ml/kg/h). Patients (n = 715) with an optimal BIVA level received standard volume saline and were included in a prospective registry. The saline infusion was halved in all patients with an ejection fraction <40%. BIVA was repeated immediately before the angiographic procedure in all patients. CI-AKI was defined as an increase in levels of cystatin C ≥10% above baseline at 24 h after contrast administration.

RESULTS

The incidence of CI-AKI was significantly lower (11.5% vs. 22.3%; p = 0.015) in patients receiving double volume saline than in those receiving standard volume saline, respectively. Before the angiographic procedure, 50% of the double volume patients achieved the optimal BIVA level compared with only 27.7% in the standard group (p = 0.0001). The findings were consistent in all the pre-specified subgroups excluding patients with a left ventricular ejection fraction <40% (p for interaction = 0.01).

CONCLUSIONS

Evaluation of BIVA levels on admission in patients with stable coronary artery disease allows adjustment of intravascular volume expansion, resulting in lower CI-AKI occurrence after angiographic procedures. (Personalized Versus Standard Hydration for Prevention of CI-AKI: A Randomized Trial With Bioimpedance Analysis; NCT02225431).

Reducing urinary tract infections in care homes by improving hydration

Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. We aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58% and UTIs requiring hospital admissions reduced by 36%, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds were a low-cost intervention for preventing UTIs and implemented easily by care staff.

Effects of Drugs and Excipients on Hydration Status

Despite being the most essential nutrient, water is commonly forgotten in the fields of pharmacy and nutrition. Hydration status is determined by water balance (the difference between water input and output). Hypohydration or negative water balance is affected by numerous factors, either internal (i.e., a lack of thirst sensation) or external (e.g., polypharmacy or chronic consumption of certain drugs). However, to date, research on the interaction between hydration status and drugs/excipients has been scarce. Drugs may trigger the appearance of hypohydration by means of the increase of water elimination through either diarrhea, urine or sweat; a decrease in thirst sensation or appetite; or the alteration of central thermoregulation. On the other hand, pharmaceutical excipients induce alterations in hydration status by decreasing the gastrointestinal transit time or increasing the gastrointestinal tract rate or intestinal permeability. In the present review, we evaluate studies that focus on the effects of drugs/excipients on hydration status. These studies support the aim of monitoring the hydration status in patients, mainly in those population segments with a higher risk, to avoid complications and associated pathologies, which are key axes in both pharmaceutical care and the field of nutrition.

Hydration practices in residential and nursing care homes for older people

AIM

To scope and explore hydration practices in care homes.

BACKGROUND

Older residents do not regularly consume adequate fluids to support health. Achieving this is difficult with residents who have coexisting health, sensory and functional problems, as well as challenging hydration habits.

DESIGN

This project used a sequential exploratory mixed method design to scope and explore existing hydration practices.

METHODS

Data were collected via two stages. First was a survey of hydration practices. Twenty-nine responses were received from 81 care homes (response rate: 35.8%). Second was the exploration of practitioners' experiences and perceptions of hydration practice via semi-structured interviews (54 staff: 43 interviews). Descriptive statistics summarised the survey findings. Open coding and thematic analysis were applied to the qualitative data, and details of the methods are reported in adherence to COREQ criteria.

RESULTS

It is important to provide hydration support in addition to regularly offering drinks to residents. Hydration practices include the following: use of social interaction to encourage drinking; verbal and nonverbal prompts to drink; giving fluids with routine practices and social activities; providing drinks-related activity, use of aids and equipment to support drinking; and creating a drink-friendly environment. Practices are implemented in care homes; however, no one care home implements all these hydration strategies at any one time.

CONCLUSIONS

Older care home residents need support and encouragement to drink adequate fluids which can be difficult to achieve with residents who have complex needs and challenging drinking habits. In addition to the routine offer of drinks, hydration support should be used to facilitate residents to drink sufficient amounts of fluid.

RELEVANCE TO CLINICAL PRACTICE

Staff working in care homes have an important role in assessing the hydration needs of residents and using multiple hydration practices to support residents to achieve their hydration requirements.

Improving hydration of care home residents by increasing choice and opportunity to drink: A quality improvement study

BACKGROUND & AIMS

Dehydration is recognised as an important problem among care home residents and can be associated with severe consequences. Insufficient provision of fluids to meet resident preferences and lack of assistance to drink have been identified as key factors driving under-hydration of care home residents. Using targeted interventions, this study aimed to optimise hydration care for frail older people in a care home setting.

METHODS

The study used quality improvement methods to develop and test interventions to extend drinking opportunities and choice in two care homes. Changes were made and evaluated using Plan-Do-Study-Act (PDSA) cycles. Data were captured on the amount of fluids served and consumed, and staff and resident feedback. The long-term impact of the interventions was assessed by measuring daily laxative and antibiotic consumption, weekly incidence of adverse health events, and average fluid intake of a random sample of six residents captured monthly.

RESULTS

The interventions were associated with an increase in the amount and range of fluids consumed, in one home mean fluid intakes exceeded 1500 ml for three consecutive months. Laxative use decreased significantly in both homes. A number of practical and organisational barriers affected the sustainability of interventions.

CONCLUSIONS

Interventions to optimise the hydration of care home residents can be effective. Plan-Do-Study-Act cycles provide an effective methodology to implement new interventions into existing practice in care homes. Sustainable change requires strong leadership, organisational support and teamwork.

Risk factors associated with dehydration in older people living in nursing homes: Scoping review

BACKGROUND

Dehydration in the older people is a prevalent problem that is often associated with physiological changes, physical limitations and environmental conditions.

OBJECTIVES

The scoping review was carried out to identify risk factors associated with dehydration in older people living in nursing homes.

DESIGN

The revised scoping methodology framework of Arksey and O'Malley (2005) was applied. Study selection was carried out in accordance with Davis et al. (2009) and focused on the inclusion criteria (people over 65 years old and living in nursing homes). Risk factors were classified using the geriatric assessment.

DATA SOURCES

An electronic database search was performed in PubMed, Scopus and CINAHL. The literature search was carried out between October 2016 and January 2017.

REVIEW METHODS

Thematic reporting was performed and study findings were validated through interdisciplinary meetings of experts. The quality of the papers consulted was also evaluated using the Newcastle-Ottawa Scale adapted for cross-sectional, cohort and case-control studies.

RESULTS

In all, 16 papers were analysed, all of which were observational studies. The risk of bias ranged from very low (n = 1), to medium (n = 13) and high (n = 2). The risk factors were classified in line with the different components of the geriatric assessment. In the socio-demographic characteristics age and gender were identified. In the clinical component, infections, renal and cardiovascular diseases and end-of-life situations were the most common factors highlighted in the papers analysed. With reference to the functional component, its limitation was associated with dehydration, while for factors of mental origin, it was related to dementia and behavioural disorders. Finally, the factors relating to the social component were institutionalisation, requiring a skilled level of care and it being winter.

CONCLUSIONS

The most commonly repeated factors highlighted in the review were age, gender, infections, end of life and dementia, with it being important to highlight the large number of factors in the clinical component. Even so, the great majority of the factors were unmodifiable conditions associated typically associated with the physiology of ageing.

Hydration health literacy in the elderly

BACKGROUND

Inadequate hydration in the elderly is associated with increased morbidity and mortality. However, few studies have addressed the knowledge of elderly individuals regarding hydration in health and disease. Gaps in health literacy have been identified as a critical component in health maintenance, and promoting health literacy should improve outcomes related to hydration associated illnesses in the elderly.

METHODS

We administered an anonymous survey to community-dwelling elderly (n = 170) to gauge their hydration knowledge.

RESULTS

About 56% of respondents reported consuming >6 glasses of fluid/day, whereas 9% reported drinking ≤3 glasses. About 60% of respondents overestimated the amount of fluid loss at which moderately severe dehydration symptoms occur, and 60% did not know fever can cause dehydration. Roughly 1/3 were not aware that fluid overload occurs in heart failure (35%) or kidney failure (32%). A majority of respondents were not aware that improper hydration or changes in hydration status can result in confusion, seizures, or death.

CONCLUSIONS

Overall, our study demonstrated that there were significant deficiencies in hydration health literacy among elderly. Appropriate education and attention to hydration may improve quality of life, reduce hospitalizations and the economic burden related to hydration-associated morbidity and mortality.

National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active

OBJECTIVE

  To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals.

BACKGROUND

  Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals.

RECOMMENDATIONS

  Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.

The Diuretic Action of Weak and Strong Alcoholic Beverages in Elderly Men: A Randomized Diet-Controlled Crossover Trial

With ageing, there is a greater risk of dehydration. This study investigated the diuretic effect of alcoholic beverages varying in alcohol concentration in elderly men. Three alcoholic beverages (beer (AB), wine (AW), and spirits (S)) and their non-alcoholic counterparts (non-alcoholic beer (NAB), non-alcoholic wine (NAW), and water (W)) were tested in a diet-controlled randomized crossover trial. For the alcoholic beverages, alcohol intake equaled a moderate amount of 30 g. An equal volume of beverage was given for the non-alcoholic counterpart. After consumption, the urine output was collected every hour for 4 h and the total 24 h urine output was measured. AW and S resulted in a higher cumulative urine output compared to NAW and W during the first 4 h (effect size: 0.25 mL p < 0.003, effect size: 0.18 mL, p < 0.001, respectively), but not after the 24h urine collection (p > 0.40, p > 0.10). AB and NAB did not differ at any time point (effect size: -0.02 mL p > 0.70). For urine osmolality, and the sodium and potassium concentration, the findings were in line. In conclusion, only moderate amounts of stronger alcoholic beverages, such as wine and spirits, resulted in a short and small diuretic effect in elderly men.

The Impact of Hyposalivation on Quality of Life (QoL) and Oral Health in the Aging Population of Al Madinah Al Munawarrah

Hyposalivation (HS) affects aging individuals by causing pain and discomfort in the oral cavity. The aim here was to determine the impact of hyposalivation and the saliva pH on the quality of life and caries status of geriatrics population. A total of 138 male outpatients attending the Taibah University College of Dentistry (TUCoD) dental clinic were included in the study. The saliva flow, pH, Quality of Life (QoL), and caries status were recorded. The QoL was measured using the Arabic version of the Oral Health Impact Profile-14 (OHIP-14), and the caries status was recorded using the Decayed, Missed, Filled Teeth (DMFT) index. The mean age was 67.5 years and 64% were classified as having hyposalivation. The older respondents tended to have a lower saliva flow and pH compared to their younger counterparts. There was a significant inverse association (p = 0.02) between the caries status and mean saliva flow rate. There was also a significant (p < 0.001) positive correlation between caries and the OHIP-14 scores (Spearman’s ρ = 0.293). The prevalence of hyposalivation was relatively high and there was an inverse relationship between the age, the saliva flow, and pH. Those with more caries reported significantly poor QoL.

Seasons and ALS time of death

INTRODUCTION

Respiratory complications are the main cause of death in amyotrophic lateral sclerosis (ALS). Season-associated-death risk was not addressed before.

OBJECTIVE

To assess month/season-associated death risk in ALS.

METHODS

We included all patients followed in our unit who died before 1 January 2016, excluding those with uncertain information. A χ² test assessed differences between months/seasons. A two-step cluster analysis explored the significant survival independent factors. Values of p < 0.05 or p < 0.01 (multiple comparisons) were considered significant.

RESULTS

From 778 patients, 543 had died at censor date. Absolute death number was 46,46,37,47,38,50,41,43,41,48,40,66, for each month from January to December. No significant difference existed when considering all months and seasons globally (p > 0.05). Significant differences were found comparing December (highest rate, 12.2%) with March, May, July, August, September, November (p < 0.05). Deaths were higher in winter than in spring (p = 0.031), but similar between winter and summer (p = 0.16), and winter and autumn (p = 0.087). Bulbar-onset patients had a relatively increased death rate in summer, while spinal-onset patients died more frequently in winter.

DISCUSSION

Death risk factors are probably dehydration for patients with dysphagia during summer and respiratory infections for patients with weak cough during winter. Flu vaccination, better ventilatory/cough assistance in winter and hydration in summer are recommended.

Review on Mechanisms, Importance of Homeostasis and Fluid Imbalances in the Elderly

Water is considered an essential nutrient, but very often is overlooked in favour of nutrition. Due to age related changes, older people are more vulnerable to both, dehydration and overhydration. This article describes the principles of water homeostasis and provides a description of common age-related physiological changes related to water balance. Fluid homeostasis largely depends on osmo- and baro-receptors that respectively react to changes in osmolality and blood pressure, water-regulating hormone release, the subsequent response of kidneys to the hormonal stimulation and activation of thirst. These mechanisms diminish with age and put elderly at risk of dehydration. All involved in a care for the elderly should be informed and become vigilant to prevent dehydration from occurring.

Acoustical Method of Whole-Body Hydration Status Monitoring

An acoustical handheld hydration monitor (HM) for assessing the water balance of the human body was developed. Dehydration is a critical public health problem. Many elderly over age of 65 are particularly vulnerable as are infants and young children. Given that dehydration is both preventable and reversible, the need for an easy-to-perform method for the detection of water imbalance is of the utmost clinical importance. The HM is based on an experimental fact that ultrasound velocity in muscle is a linear function of water content and can be referenced to the hydration status of the body. Studies on the validity of HM for the assessment of whole-body hydration status were conducted in the Appalachian State University, USA, on healthy young adults and on elderly subjects residing at an assisted living facility. The HM was able to track changes in total body water during periods of acute dehydration and rehydration in athletes and day-to-day and diurnal variability of hydration in elderly. Results of human studies indicate that HM has a potential to become an efficient tool for detecting abnormal changes in the body hydration status.

Safety of ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus (STELLA-ELDER): Interim results of a post-marketing surveillance study

OBJECTIVE

To determine the incidence of adverse drug reactions (ADRs) associated with ipragliflozin in elderly Japanese patients with type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

We report interim results of a postmarketing surveillance survey. Japanese physicians recorded ADRs in elderly patients (≥ 65 years old) who were first prescribed with ipragliflozin within 3 months of its launch (April 2014).

MAIN OUTCOME MEASURES

Incidence of ADRs within 1 year of starting treatment with ipragliflozin.

RESULTS

898 ADRs occurred in 721/7,170 patients (10.06%). Skin complication-, volume depletion-, genital infection-, polyuria/pollakiuria-, urinary tract infection-, and hypoglycemia-related ADRs occurred in 2.23%, 1.90%, 1.45%, 1.32%, 0.77%, and 0.32%, respectively. ADRs were classified as serious in 44 (0.61%) patients. Half of the ADRs occurred within 30 days of starting treatment. There were no cases of Stevens-Johnson syndrome or toxic epidermal necrolysis. Most (92.1%) of the ADRs resolved or improved. Glycated hemoglobin, fasting blood glucose, body weight, and systolic blood pressure decreased by 0.6% (baseline 7.8%), 22.7 mg/dL (baseline 163.0 mg/dL), 2.3 kg (baseline 67.4 kg), and 3.1 mmHg (baseline 133.2 mmHg), respectively, from baseline to treatment discontinuation/last visit.

CONCLUSIONS

Ipragliflozin is well tolerated and reduced surrogate endpoints in elderly Japanese patients with type 2 diabetes mellitus. Clinicaltrials.gov identifier: NCT02297620.

Prevention of Dehydration in Independently Living Elderly People at Risk: A Study Protocol of a Randomized Controlled Trial

Background:

Dehydration of elderly people living independently is a very important public health issue. This study compares two interventions to prevent dehydration in elderly people at risk: an educational intervention and an educational intervention in combination with a drink reminder device.

Methods:

This is an experimental two-armed parallel study. A Public Health Service develops the interventions and will be partnering with a general practice and a university to evaluate the effects. Two groups – all people aged 80 years and older, and people of 65 years and older who have cardiovascular disease – receive a letter from the general practice in which they are asked whether they want to participate in the study and if so to return the form. People who want to participate and whose daily fluid intake is insufficient are randomized to receive either the educational intervention or the educational intervention in combination with a drink reminder device. The participants are asked to fill in a questionnaire before the intervention, 6 weeks after the start of the intervention and 6 months after the start (or after the end) of the intervention. Changes between the two groups in fluid intake, knowledge, awareness of the risks of dehydration, and quality-of-life will be tested by Linear Mixed Model analyses.

Conclusions:

This study will improve the knowledge of the effectiveness of interventions designed to prevent dehydration in elderly people.

Ugotavljanje dehidracije pri starostnikih, ki so bili obravnavani na nujni medicinski pomoči: akcijska raziskava

Uvod: Skrb za zadostno hidracijo starostnikov je pogosto izražena, vendar v praksi velikokrat pozabljena. Z raziskavo smo želeli ugotoviti stanje hidracije pri starostnikih, starejših od 65 let, ki živijo v socialnovarstvenih institucijah v Mariboru in okolici. Metode: V retrospektivni raziskavi smo ugotavljali vrednosti označevalcev dehidracije pri 107 starostnikih, starejših od 65 let. Med njimi je bilo 70 (65 %) žensk, povprečne starosti 84,1 let, in 37 (35 %) moških, povprečne starosti 80,4 let. Vzorec je zajemal starostnike, napotene v ambulanto za Internistično nujno pomoč Univerzitetnega kliničnega centra Maribor v obdobju od 1. 11. 2013 do 24. 1. 2014. Analizirali smo laboratorijske rezultate, zbrane v medicinsko-informacijskem sistemu. Kriterije dehidracije so predstavljali: natrij v serumu nad 145 mmol/L, sečnina nad 20 mg/ml oz. razmerje sečnina/kreatinin nad 20 : 1. Rezultati: Raziskava je potrdila prisotnost povišanih vrednosti označevalcev dehidracije pri 73,8 % obravnavanih starostnikov. En kriterij dehidracije je dosegalo 35 starostnikov, dva kriterija 39 in tri kriterije 5 starostnikov. Diskusija in zaključek: Ugotovili smo, da povišane vrednosti označevalcev dehidracije ne dajo zanesljivega odgovora o stanju hidracije starostnikov, saj se le-ta lahko glede na uporabljene kriterije preceni ali podceni. Za boljšo oceno hidracije je v nadaljnjih raziskavah potrebno uporabiti natančnejše označevalce v kombinaciji s starostnikovimi kliničnimi znaki in anamnestičnimi podatki.

Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition

Although the prevalence of malnutrition in the old age is increasing worldwide a synthetic understanding of the impact of aging on the intake, digestion, and absorption of nutrients is still lacking. This review article aims at filling the gap in knowledge between the functional decline of the aging gastrointestinal tract (GIT) and the consequences of malnutrition on the health status of elderly. Changes in the aging GIT include the mechanical disintegration of food, gastrointestinal motor function, food transit, chemical food digestion, and functionality of the intestinal wall. These alterations progressively decrease the ability of the GIT to provide the aging organism with adequate levels of nutrients, what contributes to the development of malnutrition. Malnutrition, in turn, increases the risks for the development of a range of pathologies associated with most organ systems, in particular the nervous-, muscoskeletal-, cardiovascular-, immune-, and skin systems. In addition to psychological, economics, and societal factors, dietary solutions preventing malnutrition should thus propose dietary guidelines and food products that integrate knowledge on the functionality of the aging GIT and the nutritional status of the elderly. Achieving this goal will request the identification, validation, and correlative analysis of biomarkers of food intake, nutrient bioavailability, and malnutrition.

The pathophysiology of fluid and electrolyte balance in the older adult surgical patient

BACKGROUND & AIMS

Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period.

METHODS

The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studies were used when these were not available. The bibliographies of extracted papers were also searched for relevant articles.

RESULTS

Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury.

CONCLUSIONS

Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult.

Elderly subjects with type 2 diabetes show altered tissue electrical properties

OBJECTIVE

The aim of the present research was to show the characteristics of body composition in a sample of elderly subjects with type 2 diabetes compared with healthy controls matched by age and body mass index (BMI) by bioelectrical impedance vector analysis.

METHODS

The sample consisted of 144 free-living patients (84 women and 60 men) with type 2 diabetes 60 to 84 y old and 209 age-matched controls (116 women and 93 men). Anthropometric measurements (weight; height; upper arm, hip, waist, and calf circumferences; biceps; triceps; and subscapular and suprailiac skinfolds) were taken. Blood samples for the assessment of plasma glucose and glycated hemoglobin were collected. The BMI, upper arm muscular area, and waist-to-hip ratio were calculated. Bioelectrical impedance vector analysis was applied. The analysis was performed in the entire diabetic sample and the healthy BMI-matched groups.

RESULTS

Compared with healthy subjects, patients had greater weight (P < 0.01 in women), higher BMI (P < 0.01 in women), smaller muscular area (P < 0.01 in men), and thicker skinfolds (P < 0.01 in women and men). Female and male patients showed larger phase angles (P < 0.01). Moreover, female patients showed a shorter vector length and lower resistance (P < 0.01) and male patients showed a higher reactance (P < 0.01). The BMI-matched analysis confirmed that patients were characterized by larger phase angles.

CONCLUSIONS

Older patients with type 2 diabetes were characterized by peculiar anthropometric and bioelectrical patterns, which can be related to their smaller appendicular muscular area and lower extracellular/intracellular water ratio.

Investigating structural brain changes of dehydration using voxel-based morphometry

Dehydration can affect the volume of brain structures, which might imply a confound in volumetric and morphometric studies of normal or diseased brain. Six young, healthy volunteers were repeatedly investigated using three-dimensional T₁-weighted magnetic resonance imaging during states of normal hydration, hyperhydration, and dehydration to assess volume changes in gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF). The datasets were analyzed using voxel-based morphometry (VBM), a widely used voxel-wise statistical analysis tool, FreeSurfer, a fully automated volumetric segmentation measure, and SIENAr a longitudinal brain-change detection algorithm. A significant decrease of GM and WM volume associated with dehydration was found in various brain regions, most prominently, in temporal and sub-gyral parietal areas, in the left inferior orbito-frontal region, and in the extra-nuclear region. Moreover, we found consistent increases in CSF, that is, an expansion of the ventricular system affecting both lateral ventricles, the third, and the fourth ventricle. Similar degrees of shrinkage in WM volume and increase of the ventricular system have been reported in studies of mild cognitive impairment or Alzheime s disease during disease progression. Based on these findings, a potential confound in GM and WM or ventricular volume studies due to the subjects’ hydration state cannot be excluded and should be appropriately addressed in morphometric studies of the brain.