Treating the Frail Older Adult
Frail older adults with high risk of dehydration should take water specifically in amounts prescribed by their physician. Rehydration methods depend on the severity and type (isotonic, hypotonic, or hypertonic) of dehydration, as well as the availability of facilities such as intravenous procedures or hypodermoclysis. In general, severe hypernatremic dehydration with decline in consciousness warrants hospitalization. Rate and amount of rehydration volume needed is beyond the scope of this paper. If rehydration can be restored more gradually, because of less alarming and only mild hemodynamic symptoms and signs, oral repletion is highly preferable. Coffee and alcoholic drinks as well as fluids with high protein intake should be avoided because of their diuretic effects. Enteral feeding tubes are sometimes needed if water and nutritional balance must be restored. Ethical considerations must take place before starting tube feeding in case of a severe chronic disease (i.e., dementia) at the end stage of life. Hypodermoclysis has been undervalued for a long time, but it is an evidence-based low cost therapy in geriatrics, with only small chances for adverse effects.[40] Approximately 3 litres of fluid can be given in a 24-hour period at two separate sites. Because of its safety and ease of administration, hypodermoclysis is a useful alternative to intravenous administration.[41] It is equally as well accepted by older adult patients as intravenous therapy. Additionally in confused patients and those in whom IV punctures are difficult to achieve, it represents the far superior method.[42] Hypodermoclysis can be set up and administered by nurses in almost any setting so that hospital admission may be avoided.[41] In periods of increasing risk for dehydration (starting a diuretic, diarrhea, vomiting, dependence by wrist fracture, or lithium therapy), physicians and other health professionals should take notice of water balance and prescribe and safeguard a minimum intake of 1.5 litres. In case of high body temperature (fever) or a hot climate with low humidity, fluid loss through sweat is increased. Apart from water replacement, it is essential to be aware of salt depletion.[43] In a recent randomized controlled trial we showed that in older men, the advice to increase fluid intake by 1.5 litres had no negative side-effects, but increased daily water turnover with approximately 1 litre.[44] Therefore the general advice to safeguard daily water intake in frail older adults at risk for dehydration by prescribing them an increased water intake especially in a period of increased water turnover can probably be carried out safely.
Geriatrics and Aging. 2007;10(9):590-596. © 2007 1453987 Ontario, Ltd.
Cite this: Dehydration in Geriatrics - Medscape - Oct 01, 2007.
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