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ABSTRACT
Dehydration has serious consequences for older adults, including increased risk of illness or death. This retrospective review of medical records describes the prevalence, assessment, and risk factors for chronic dehydration in 185 older adults who visited an emergency department in June 2000. Results showed chronic dehydration was present in 89 (48%) patients. Physicians documented assessment for signs of dehydration in 23 (26%) of the dehydrated older adults, but no independent assessments for dehydration were recorded by nurses. These findings indicate many older adults may suffer from unrecognized dehydration, and nurses should be alert to the possibility that dehydration may be present in community-dwelling older adults as well as those who live in residential facilities.
Chronic dehydration is a common but preventable condition with serious consequences for older adults, including medication toxicity (Chernoff, 1994), loss of muscle function (Askew, 1 996), depressed state of consciousness (Snyder, Feigal, & Arieff, 1987), renal failure and seizures (Lavizzo-Mourey, 1987), and hypo- or hyperthermia (Chernoff, 1994). Serious infections also are especially common in dehydrated older adults (Warren et al., 1994).
Acute dehydration may be experienced by individuals of all ages during illness. Acute dehydration is a loss of water and sodium, often caused by vomiting, diarrhea, sweating, blood loss, or fluid accumulation in body spaces where it cannot be drawn back into circulation.
On the other hand, chronic dehydration is a fluid imbalance of longer duration that in older adults is usually caused by insufficient fluid intake (Armstrong-Esther, Browne, Armstrong-Esther, & Sander, 1996; Chidester & Spangler, 1997; Kay serJones, Schell, Porter, Barbaccia, & Shaw, 1999; Weinberg, Minaker, & Council on Scientific Affairs, American Medical Association, 1995). Chronic dehydration causes fluid deficits within the cells, leading to altered absorption of medications, delirium, weakness, fatigue, exacerbation of medical conditions, and increased risk of death. Reported death rates for older adults admitted to the hospital for acute and chronic dehydration range from 18% to 71% (Molaschi et al., 1997; Warren et al., 1994), and mortality may be seven times higher than for patients who are not dehydrated (Snyder et al., 1987).
Dehydration in elderly patients is common and costly. The annual cost of care for older adults with a primary diagnosis of dehydration has been estimated at more than $1 billion...