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Aslan Kirazoglu D, Heybeli C, Atcıyurt K, Yigitalp V, Smith L, Veronese N, Rahmati M, Soysal P. The relationship between dehydration and etiologic subtypes of major neurocognitive disorder in older patients. Eur Geriatr Med 2024:10.1007/s41999-024-00986-z. [PMID: 38755401 DOI: 10.1007/s41999-024-00986-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/29/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Studies investigating associations between etiologic subtypes of major neurocognitive disorder (MND) and dehydration frequency are lacking. The aim of this study was to investigate the prevalence and risk factors of dehydration among older adults with and without MND (dementia), and across different etiologic subtypes of MND. METHODS This cross-sectional study included adults aged ≥ 65 years old from one geriatric outpatient clinic. Dehydration was defined as a calculated [1,86 × (Na + K) + 1,15 × glucose + urea + 14] plasma osmolarity of > 295 mOsm/L.Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. MND was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria. The underlying etiologic subtypes were determined by specific diagnostic criteria. RESULTS Of the 1377 patients 72% were female, the mean age was 80 ± 8 years, and 575 had dementia. Dehydration was more common in patients with dementia than those without dementia (58% vs. 53%, p = 0.044). The prevelance of dehydration was 57%, 62%, 54%, 57% and 68% in Alzheimer's disease, Parkinson's disease dementia, fronto-temporal dementia, dementia with Lewy bodies, and vascular dementia, respectively (p ≥ 0.05). MND was associated with dehydration (OR 1.26, 95% CI 1.01-1.57; p = 0.037) after adjustment for age and sex. In multivariable analysis, among patients with dementia, hypertension, DM, CKD, and dysphagia were more common while mean Mini-Mental State Examination score was lower in those who had dehydration versus no dehydration in older patients with dementia (p < 0.05). CONCLUSION Dehydration is slightly associated with the presence of MND independent of age and sex. However, dehydration is also quite common in older patients without cognitive disorders. Therefore, hydration status should be monitored in older adults irrespective of neurocognitive status. Hypertension, DM, CKD, dysphagia and severity of cognitive dysfunction were associated with dehydration in patients with dementia. The prevalence of dehydration is highest in patients with vascular dementia.
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Affiliation(s)
- Damla Aslan Kirazoglu
- Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Cihan Heybeli
- Division of Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Kübra Atcıyurt
- Department of Internal Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Veliye Yigitalp
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093, Fatih, Istanbul, Turkey
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human Sciences, Lorestan University, Khoramabad, Iran
- Department of Physical Education and Sport Sciences, Faculty of Literature and Humanities, Vali-E-Asr University of Rafsanjan, Rafsanjan, Iran
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), 34093, Fatih, Istanbul, Turkey.
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Souza CCD, Fernandes MP, Bertoldi AD, Demarco FF, Gonzalez MC, Bielemann RM. [Prevalence of water intake among non-institutionalized elderly individuals in Southern Brazil]. CIENCIA & SAUDE COLETIVA 2023; 28:1903-1914. [PMID: 37436305 DOI: 10.1590/1413-81232023287.14692022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/21/2022] [Indexed: 07/13/2023] Open
Abstract
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.
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Affiliation(s)
- Carolina Corrêa de Souza
- Faculdade de Nutrição, Universidade Federal de Pelotas. R. Gomes Carneiro 1, 2º andar, Prédio 1. 96010-610 Pelotas RS Brasil.
| | - Mayra Pacheco Fernandes
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Andréa Dâmaso Bertoldi
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Flávio Fernando Demarco
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
- Programa de Pós-Graduação em Odontologia, Universidade Federal de Pelotas. Pelotas RS Brasil
| | - Maria Cristina Gonzalez
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas. Pelotas RS Brasil
| | - Renata Moraes Bielemann
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas. Pelotas RS Brasil
- Programa de Pós-Graduação em Nutrição e Alimentos, Universidade Federal de Pelotas. Pelotas RS Brasil
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Atjo NM, Soraya GV, Natzir R, Kasyim H, Rasyid H, Chana G, Erlichster M, Skafidas E, Hardjo M. Point-of-Care Saliva Osmolarity Testing for the Screening of Hydration in Older Adults With Hypertension. J Am Med Dir Assoc 2022; 23:1984.e9-1984.e14. [PMID: 36174654 DOI: 10.1016/j.jamda.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 08/14/2022] [Accepted: 08/25/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Older adults have an elevated risk of dehydration, a state with proven detrimental cognitive and physical effects. Furthermore, the use of diuretics by hypertensive patients further compounds this risk. This prospective study investigated the diagnostic accuracy of point-of-care (POC) salivary osmolarity (SOSM) measurement for the detection of dehydration in hypertensive adults with and without diuretic pharmacotherapy. DESIGN Prospective diagnostic accuracy study. SETTING Home visits to patients recruited from 4 community health centers in West Sulawesi, Indonesia. PARTICIPANTS A total of 148 hypertensive older adults (57 men, 91 women). The mean ages of male and female patients were 69.4 ± 11.4 and 68.1 ± 7.8 years, respectively. METHODS Hypertensive adults were divided into 2 groups based on the presence of diuretics in their pharmacotherapeutic regimen. First-morning mid-stream urine samples were used to perform urine specific gravity (USG) testing. Same-day SOSM measurements were obtained using a POC saliva testing system. RESULTS Both USG (P = .0002) and SOSM (P < .0001) were significantly elevated in hypertensive patients with diuretic pharmacotherapy. At a USG threshold of ≥1.030, 86% of diuretic users were classified as dehydrated compared with 55% of non-using participants. A strong correlation was observed between USG and SOSM measurements (r = 0.78, P < .0001). Using a USG threshold of ≥1.030 as a hydration classifier, an SOSM threshold of ≥93 mOsm had a sensitivity of 78.6% and a specificity of 91.1% for detecting dehydration. CONCLUSIONS AND IMPLICATIONS Hypertensive patients on diuretics have significantly higher first-morning USG and SOSM values, indicating a higher likelihood of dehydration relative to those on other classes of antihypertensive medication. POC SOSM assessment correlates strongly with first-morning USG assessment, and represents a rapid and noninvasive alternative to urinary hydration assessment that may be applicable for routine use in populations with elevated risk of dehydration.
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Affiliation(s)
- Neng Mira Atjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Nursing, Faculty of Health Sciences, University of West Sulawesi, Majene, Indonesia
| | - Gita Vita Soraya
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Neurology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Rosdiana Natzir
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia; Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hasyim Kasyim
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Haerani Rasyid
- Division of Renal Diseases and Hypertension, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; Department of Clinical Nutrition, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Gursharan Chana
- MX3 Diagnostics Inc., VIC, Australia; Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, VIC, Australia
| | | | - Efstratios Skafidas
- MX3 Diagnostics Inc., VIC, Australia; Department of Electrical and Electronic Engineering, Melbourne School of Engineering, The University of Melbourne, VIC, Australia
| | - Marhaen Hardjo
- Department of Biomedicine, Graduate School Hasanuddin University, Makassar, Indonesia
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Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture. Nutrients 2022; 14:nu14040820. [PMID: 35215470 PMCID: PMC8880665 DOI: 10.3390/nu14040820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. METHODS We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). RESULTS The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. CONCLUSIONS Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.
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Buaprasert P, Piyapaisarn S, Vanichkulbodee A, Kamsom A, Sri-On J. Prevalence and risk factors of hypertonic dehydration among older patients admitted to the emergency department: A prospective cross-sectional study. Geriatr Gerontol Int 2021; 21:485-491. [PMID: 33847031 DOI: 10.1111/ggi.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/23/2021] [Accepted: 03/28/2021] [Indexed: 11/28/2022]
Abstract
AIM The prevalence of hypertonic dehydration (HD) among community-dwelling and hospitalized populations has been evaluated. However, to our knowledge, no study had previously focused on older patients admitted to the emergency department (ED). The present study aimed to evaluate the prevalence, risk factors and short-term outcomes of HD among Thai older patients admitted to the ED. METHODS This was a prospective cross-sectional study at one urban ED in Thailand. Patients aged ≥65 years who were admitted to the ED were enrolled into the study. Data including clinical hydration status, Charlson Comorbidity Index (CCI) score, activities of daily living score, current use of medications, laboratory examination results and serum osmolarity level were collected. HD was defined as a serum osmolarity level of >300 mOsm/kg. The short-term outcomes were a 30-day ED revisit, hospital readmission and mortality rates. RESULTS In total, 80 (21.6%) of 370 patients presented with HD. A CCI score of ≥5 was found associated with HD among older patients (adjusted odds ratio: 1.82; 95% confidence interval: 1.03-3.21). The ED revisit rates were 18.1% in the dehydrated group and 10.9% in the non-dehydrated group. The hospital readmission rates were 8.3% in the dehydrated group and 10.6% in the non-dehydrated group. Furthermore, the 30-day mortality rates were 6.9% and 5.3% in the dehydrated and non-dehydrated groups, respectively. CONCLUSIONS One-fifth of older patients admitted to the ED presented with HD. A CCI score of ≥5 was considered a risk factor of HD. Moreover, further studies should focus on the long-term outcomes of HD and risk reduction. Geriatr Gerontol Int 2021; 21: 485-491.
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Affiliation(s)
- Phudit Buaprasert
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Sawangwarach Piyapaisarn
- Department of Emergency Medicine, Srinagarind Hospital, Khon Kaen University, Khonkaen, Thailand
| | - Alissara Vanichkulbodee
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Anucha Kamsom
- The Department of Biostatistic, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Jiraporn Sri-On
- The Department of Emergency Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Białecka-Dębek A, Pietruszka B. The association between hydration status and cognitive function among free-living elderly volunteers. Aging Clin Exp Res 2019; 31:695-703. [PMID: 30128663 PMCID: PMC6491399 DOI: 10.1007/s40520-018-1019-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/03/2018] [Indexed: 11/25/2022]
Abstract
Background Ageing is inevitably associated with a progressive cognitive decline. With the rising percentage of the elderly in society, the number of people with dementia and cognitive impairment increases. Water is a vital ingredient that must be included in the diet. The impact of hydration status on cognitive performance has been studied only a little so far. Aims The objective of the study was to investigate the relation between the hydration status and the cognitive function. Methods The study was conducted among 60 free-living volunteers, aged 60–93 years. Data on water consumption were gathered based on 3-day records. The hydration status was assessed in morning urine samples by evaluating urine specific gravity. The cognitive function was tested using the Mini Mental State Examination (MMSE), the Babcock Story Recall Test and the Trail Making Test. Information about depression was gathered by the Geriatric Depression Scale. Results The mean daily total water intake was 2441 ± 622 ml, and 70% of respondents met the reference values for an adequate intake. The mean urine specific gravity (1.013 g/cm3, range of 1.004–1.025 g/cm3) indicated that most of the individuals were in a good hydration state. The average result of MMSE was 27.8, which is connected with mild cognitive impairment. There was no significant relationship between the hydration status and the results of the cognitive function test in the studied population. Discussion/conclusion As the elderly volunteers had a good hydration status, there was no significant relationship between cognitive performance and urine specific gravity. It is necessary to replicate the findings of this study with a larger and more diverse sample of older adults.
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Affiliation(s)
- Agata Białecka-Dębek
- Department of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776, Warsaw, Poland.
| | - Barbara Pietruszka
- Department of Human Nutrition, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776, Warsaw, Poland
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Mentes JC, DeVost MA, Nandy K. Salivary Osmolality, Function, and Hydration Habits in Community-Dwelling Older Adults. SAGE Open Nurs 2019; 5:2377960819826253. [PMID: 33415218 PMCID: PMC7774490 DOI: 10.1177/2377960819826253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/06/2018] [Accepted: 12/23/2018] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to examine the relationship between hydration status as
measured by salivary osmolality and personal hydration habits, selected demographic
characteristics, and performance on a walking and balance test in older community-dwelling
adults. This study used a descriptive observational design in a convenience sample of
multiethnic, community-dwelling older adults (N = 53). We collected
saliva for analysis on 3 days both in the morning and early afternoon, along with a
hydration habit questionnaire, get up and go test and demographic information. An
exploratory factor analysis of the hydration habit questionnaire revealed a two-factor
solution including physical barriers and psychological barriers to drinking fluids. A
linear mixed-model approach revealed that time of day (p < .01), race
(p = .015), mobility (p < .01), and cognitive
barriers (p = .023) are all significant predictors of salivary osmolality
among noninstitutionalized seniors. There is also a significant interaction between
psychological barriers to drinking fluids and time of day (p < .01).
Average salivary osmolality was higher in this group of older adults than has been
reported in younger adults. Controlling for all other variables, salivary osmolality is
higher in the morning than in the afternoon, lower among Black or African American seniors
than among White or Caucasian seniors, and higher among seniors with decreased mobility.
An interaction between psychological barriers and salivary osmolality showed that those
participants with more psychological barriers to drinking had higher salivary osmolality
in the morning and an inverse relationship in the afternoon.
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Affiliation(s)
- Janet C Mentes
- School of Nursing, University of California, Los Angeles, CA, USA
| | | | - Karabi Nandy
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Akdeniz M, Boeing H, Müller-Werdan U, Aykac V, Steffen A, Schell M, Blume-Peytavi U, Kottner J. Effect of Fluid Intake on Hydration Status and Skin Barrier Characteristics in Geriatric Patients: An Explorative Study. Skin Pharmacol Physiol 2018; 31:155-162. [DOI: 10.1159/000487403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/02/2018] [Indexed: 12/28/2022]
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Garrett DC, Rae N, Fletcher JR, Zarnke S, Thorson S, Hogan DB, Fear EC. Engineering Approaches to Assessing Hydration Status. IEEE Rev Biomed Eng 2017; 11:233-248. [PMID: 29990109 DOI: 10.1109/rbme.2017.2776041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dehydration is a common condition characterized by a decrease in total body water. Acute dehydration can cause physical and cognitive impairment, heat stroke and exhaustion, and, if severe and uncorrected, even death. The health effects of chronic mild dehydration are less well studied with urolithiasis (kidney stones) the only condition consistently associated with it. Aside from infants and those with particular medical conditions, athletes, military personnel, manual workers, and older adults are at particular risk of dehydration due to their physical activity, environmental exposure, and/or challenges in maintaining fluid homeostasis. This review describes the different approaches that have been explored for hydration assessment in adults. These include clinical indicators perceived by the patient or detected by a practitioner and routine laboratory analyses of blood and urine. These techniques have variable accuracy and practicality outside of controlled environments, creating a need for simple, portable, and rapid hydration monitoring devices. We review the wide array of devices proposed for hydration assessment based on optical, electromagnetic, chemical, and acoustical properties of tissue and bodily fluids. However, none of these approaches has yet emerged as a reliable indicator in diverse populations across various settings, motivating efforts to develop new methods of hydration assessment.
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11
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Sagy I, Vodonos A, Novack V, Rogachev B, Haviv YS, Barski L. The Combined Effect of High Ambient Temperature and Antihypertensive Treatment on Renal Function in Hospitalized Elderly Patients. PLoS One 2016; 11:e0168504. [PMID: 27992525 PMCID: PMC5167394 DOI: 10.1371/journal.pone.0168504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/30/2016] [Indexed: 11/22/2022] Open
Abstract
Background The aging kidney manifests structural, functional as well as pharmacological changes, rendering elderly patients more susceptible to adverse environmental influences on their health, dehydration in particular. Hypothesis Higher temperature is associated with renal function impairment in patients 65 years and older who routinely take thiazide and/or ACE-inhibitors/ARBs. Methods We obtained health data of patients older than 65 who were admitted to a large tertiary center during the years 2006–2011, with a previous diagnosis of hypertension, and treated with thiazide, ACE-inhibitors/ARBs or both. We collected environmental data of daily temperature, available from collaborative public and governmental institutions. In order to estimate the effect of daily temperature on renal function we performed linear mixed models, separately for each treatment group and creatinine change during hospital admission. Results We identified 26,286 admissions for 14, 268 patients with a mean age of 75.6 (±6.9) years, of whom 53.6% were men. Increment in daily temperature on admission of 5°C had significant effect on creatinine increase in the no treatment (baseline creatinine adjusted 0.824 mg/dL, % change 1.212, % change 95% C.I 0.082–2.354) and dual treatment groups (baseline creatinine adjusted 1.032mg/dL, % change 3.440, % change 95% C.I 1.227–5.700). Sub-analysis stratified by advanced age, chronic kidney disease and primary diagnosis on hospital admission, revealed a significant association within patients admitted due to acute infection and treated with dual therapy. Conclusion Whereas previous studies analyzed sporadic climate effects during heat waves and/or excluded older population taking anti-hypertensive medications, the present study is novel by showing a durable association of temperature and decreased renal function specifically in elderly patients taking anti-hypertensive medications.
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Affiliation(s)
- Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alina Vodonos
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel.,Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Rogachev
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yosef S Haviv
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Nephrology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Leonid Barski
- Internal Medicine Division, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hooper L, Bunn DK, Downing A, Jimoh FO, Groves J, Free C, Cowap V, Potter JF, Hunter PR, Shepstone L. Which Frail Older People Are Dehydrated? The UK DRIE Study. J Gerontol A Biol Sci Med Sci 2016; 71:1341-7. [PMID: 26553658 PMCID: PMC5018558 DOI: 10.1093/gerona/glv205] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Water-loss dehydration in older people is associated with increased mortality and disability. We aimed to assess the prevalence of dehydration in older people living in UK long-term care and associated cognitive, functional, and health characteristics. METHODS The Dehydration Recognition In our Elders (DRIE) cohort study included people aged 65 or older living in long-term care without heart or renal failure. In a cross-sectional baseline analysis, we assessed serum osmolality, previously suggested dehydration risk factors, general health, markers of continence, cognitive and functional health, nutrition status, and medications. Univariate linear regression was used to assess relationships between participant characteristics and serum osmolality, then associated characteristics entered into stepwise backwards multivariate linear regression. RESULTS DRIE included 188 residents (mean age 86 years, 66% women) of whom 20% were dehydrated (serum osmolality >300 mOsm/kg). Linear and logistic regression suggested that renal, cognitive, and diabetic status were consistently associated with serum osmolality and odds of dehydration, while potassium-sparing diuretics, sex, number of recent health contacts, and bladder incontinence were sometimes associated. Thirst was not associated with hydration status. CONCLUSIONS DRIE found high prevalence of dehydration in older people living in UK long-term care, reinforcing the proposed association between cognitive and renal function and hydration. Dehydration is associated with increased mortality and disability in older people, but trials to assess effects of interventions to support healthy fluid intakes in older people living in residential care are needed to enable us to formally assess causal direction and any health benefits of increasing fluid intakes.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norfolk, UK.
| | - Diane K Bunn
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | | | | | - Joyce Groves
- Public and Patient Involvement in Research (PPIRes) Norfolk, UK
| | - Carol Free
- Public and Patient Involvement in Research (PPIRes) Norfolk, UK
| | | | - John F Potter
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norfolk, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norfolk, UK
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Validation analysis of a geriatric dehydration screening tool in community-dwelling and institutionalized elderly people. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:2700-17. [PMID: 25739005 PMCID: PMC4377927 DOI: 10.3390/ijerph120302700] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/16/2015] [Indexed: 02/06/2023]
Abstract
Dehydration is common among elderly people. The aim of this study was to perform validation analysis of a geriatric dehydration-screening tool (DST) in the assessment of hydration status in elderly people. This tool was based on the DST proposed by Vivanti et al., which is composed by 11 items (four physical signs of dehydration and seven questions about thirst sensation, pain and mobility), with four questions extra about drinking habits. The resulting questionnaire was evaluated in a convenience sample comprising institutionalized (n = 29) and community-dwelling (n = 74) elderly people. Urinary parameters were assessed (24-h urine osmolality and volume) and free water reserve (FWR) was calculated. Exploratory factor analysis was used to evaluate the scale’s dimensionality and Cronbach’s alpha was used to measure the reliability of each subscale. Construct’s validity was tested using linear regression to estimate the association between scores in each dimension and urinary parameters. Two factors emerged from factor analysis, which were named “Hydration Score” and “Pain Score”, and both subscales showed acceptable reliabilities. The “Hydration Score” was negatively associated with 24-h urine osmolality in community-dwelling; and the “Pain Score” was negatively associated with 24-h urine osmolality, and positively associated with 24-h urine volume and FWR in institutionalized elderly people.
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Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Di Muzio M, Giunta S, Onder G, Di Iorio A, Volpato S, Corica F, Mussi C, Antonelli Incalzi R. Potentially inappropriate medications and functional decline in elderly hospitalized patients. J Am Geriatr Soc 2009; 57:1007-14. [PMID: 19467144 DOI: 10.1111/j.1532-5415.2009.02266.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To verify whether the use of potentially inappropriate medications (PIMs) is associated with loss of independence in elderly in-patients by promoting adverse drug reactions (ADRs). DESIGN Prospective observational study. PARTICIPANTS Five hundred six patients aged 65 and older admitted to 11 acute care medical wards. MEASUREMENTS In-hospital loss of one or more activities of daily living (ADLs) and three or more ADLs. PIMs were identified according to diagnosis-independent Beers criteria and ascertained by study physicians based on daily review of medical and nurse records. The relationship between risk factors and outcomes was assessed using logistic regression. RESULTS Overall, 104 patients (20.6%) were taking at least one PIM at the time of admission (baseline users), and 49 (9.7%) were newly prescribed at least one PIM during their hospital stay. The loss of one or more ADLs occurred in 9.6% of baseline users, 16.3% of new users, and 8.5% of nonusers (P=.21) and that of three or more ADLs in 7.7% of baseline users, 12.2% of new users, and 4.8% of nonusers (P=.10). The lack of association was confirmed after correction for potential confounders, including ADRs. The occurrence of ADRs was strongly associated with both outcomes (odds ratio (OR)=7.80, 95% confidence interval (CI)=3.53-17.3 for the loss of > or =1 ADLs; OR=3.98, 95% CI=1.50-10.5 for the loss of > or =3 ADLs), but PIMs caused only six of 106 ADRs. CONCLUSIONS ADRs to any drugs more than the use of PIMs might be associated with functional decline in elderly hospitalized patients, but because the power of this study was too limited to definitively exclude a direct relationship between PIMs and functional decline, this merits further investigation.
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Affiliation(s)
- Andrea Corsonello
- Italian National Research Centers on Aging, Ancona and Cosenza, Italy.
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Position of the New Zealand Dietetic Association (Inc): Nutrition for exercise and sport in New Zealand. Nutr Diet 2008. [DOI: 10.1111/j.1747-0080.2008.00305.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Telmisartan blocks the detrimental actions of angiotensin II mediated via the angiotensin type 1 receptor. Unique features of telmisartan are high lipophilicity and a long terminal elimination half-life (~ 24 h). Telmisartan/hydrochlorothiazide is indicated for hypertensive patients unable to achieve target blood pressure with either monotherapy. Fixed-dose combination tablets containing telmisartan 40 or 80 mg and hydrochlorothiazide 12.5 mg are widely available; in addition, telmisartan/hydrochlorothiazide 80/25 mg is available in the USA. Telmisartan/hydrochlorothiazide is superior to losartan/hydrochlorothiazide and valsartan/hydrochlorothiazide in maintaining blood pressure control in the risky early morning hours at the end of the dosing interval. Furthermore, telmisartan/ hydrochlorothiazide provides superior 24-h mean blood pressure reduction and is better tolerated than amlodipine/hydrochlorothiazide in elderly patients with predominantly systolic hypertension. Telmisartan has the potential to confer additional reno- and cardioprotection to that due to blood pressure control. The cardioprotective activity of renin–angiotensin system blockade with telmisartan alone and in combination with ramipril is currently being evaluated in the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial (ONTARGET) and the Telmisartan Randomized AssessmeNt Study in aCE iNtolerant subjects with cardiovascular Disease (TRANSCEND). In total, 31,546 patients have been enrolled worldwide and are being followed for up to 5.5 years.
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Abstract
Maintaining adequate fluid balance is an essential component of health at every stage of life. Age-related changes make older adults more vulnerable to shifts in water balance that can result in overhydration or, more frequently, dehydration. This article reviews age-related changes, risk factors, assessment measures, and nursing interventions for dehydration.
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Affiliation(s)
- Janet Mentes
- University of California, Los Angeles School of Nursing, USA.
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Ritchie JD, Miller CK, Smiciklas-Wright H. Tanita Foot-to-Foot Bioelectrical Impedance Analysis System Validated in Older Adults. ACTA ACUST UNITED AC 2005; 105:1617-9. [PMID: 16183365 DOI: 10.1016/j.jada.2005.07.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Indexed: 11/16/2022]
Abstract
Simple, accurate, and noninvasive methods for assessing body composition are needed in many clinical, community, and research settings. The foot-to-foot bioelectrical impedance analysis (BIA) system may be one method of addressing those needs. The objective of this study was to determine the validity of a foot-to-foot BIA system for body-composition assessment of older adults. Subjects 55 years of age or older without functional limitations or cognitive impairments (N=50) were measured using both the Tanita foot-to-foot system (Tanita Corporation of America, Inc, Arlington Heights, IL) and traditional hand-to-foot BIA. The correlation for percent body fat measurements between the Tanita and traditional BIA was r=0.84 (P<.001). Percent body fat estimates from both BIA measures were significantly correlated with waist circumference, body mass index, and age (all P<.01). The Tanita BIA system provides a valid measure of percent body fat in older adults, and could be a convenient and practical approach for assessment in public health settings.
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Affiliation(s)
- Julie D Ritchie
- Department of Nutritional Sciences, The Pennsylvania State University, University Park 16802, USA
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TSUCHIDA M, NAGURA T, BAI X, LI C, TOMIYAMA-MIYAJI C, KAWAMURA T, UCHIYAMA M, ABO T. Granulocytic activation and reciprocal immunosuppression induced by dehydration: relationship with renal failure. Biomed Res 2004. [DOI: 10.2220/biomedres.25.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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