REPORT: January 2006

Research News You Can Use: Base Your Practice on Evidence

Can you recognize chronic dehydration in older adults?

by Nancy M. Watson, PhD, RN, director, Center for Clinical Research on Aging*, University of Rochester, School of Nursing, and chair, Council on Nursing Research

Chronic dehydration is a serious problem in older adults — with potentially life-threatening consequences. It differs from acute dehydration caused by a rapid loss of fluids. In contrast, chronic dehydration results from poor fluid intake over a long time and can result in chronic deterioration of the functioning of the kidneys, muscles, and mind. It may lead to seizures as well as infections. Older persons are more likely to experience chronic dehydration than younger persons. The commonly held belief is that hospitalized or elderly individuals in residential facilities are more vulnerable to chronic dehydration than are elderly people living in the community.

In a recent study of community-dwelling older persons seeking care at an emergency room (Bennett, Thomas and Riegel, 2004), researchers reviewed the records of 185 older adults visiting an emergency department over a one month period. Almost half (48%) had chronic dehydration – none had this potentially serious condition assessed or identified by a nurse based on the documentation of the visit. Physicians only assessed about a quarter of these patients (26%) for dehydration. Part of the problem may be that some of the key presenting signs and symptoms of dehydration may be different for those with chronic dehydration compared to acute dehydration. Usual indicators of dehydration, such as an elevated heart rate and high specific gravity of urine, were not present in these chronically dehydrated patients. Nevertheless, other common signs of dehydration were present such as “dry oral membranes and upper body weakness” (Bennett, et al, p. 27). Both of these are good assessment measures for dehydration in older adults; however, skin turgor - another symptom assessed - is unreliable.

Nurses working in almost all settings encounter older adults – many of whom may need to be assessed for chronic dehydration since serious preventable complications can result. These complications include “medication toxicity, loss of muscle function, depressed state of consciousness, renal failure and seizures, and hypo- or hyperthermia … [and] serious infections.” (Bennett et al, p. 22) Since typical signs of dehydration may not be useful, being aware of those older adults most likely to experience chronic dehydration is important. Older adults with multiple chronic medical diagnoses (i.e., four or more), those who are dependent in ambulation, living in a residential facility and/or with decreased cognitive functioning are at a higher risk of chronic dehydration. These risk factors should alert nurses to a significant need for an assessment for chronic dehydration in order to avoid serious preventable complications. However, assessment should not be limited to high-risk older adults alone.

Remember, in this study, elevated heart rate, high urinary specific gravity, and skin turgor were not reliable indicators of dehydration in chronically dehydrated older adults. In addition, living in a residential facility, having difficulty ambulating without assistance, and orientation to person, place, and time, were not significantly different in the dehydrated or the non-dehydrated individuals. Dry oral membranes and upper body weakness were more helpful symptoms and should be assessed within the context of the total picture for each elderly client.

Reference

Bennett, J.A., Thomas, V. & Riegel, B. (2004). Unrecognized chronic dehydration in older adults: Examining prevalence rate and risk factors. “Journal of Gerontological Nursing,” 30, 22-28.

*www.dementianursing.org