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Cited by 117Geriatric Care and Nursing HomesNutrition and Health in AgingElectrolyte and hormonal disorders

Which Frail Older People Are Dehydrated? The UK DRIE Study

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Hooper, Lee, Bunn, Diane K., Downing, Alice, Jimoh, Florence O., Groves, Joyce, Free, Carol, Cowap, Vicky, Potter, John F. +2 more·2016·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
DOI 10.1093/gerona/glv205PMC PMC5018558
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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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  • Prevalence rates of dehydration are low in independent, community-dwelling older persons but increase to more than one third in more frail and vulnerable older adults and those in need of care.

    “Prevalence rates are also low in independent, community-dwelling older persons but increase to more than one third in more frail and vulnerable older adults and those in need of care (9).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [9]

    The Abstract reports that 20% of the 188 UK long-term-care residents were dehydrated, contrary to the claim that prevalence in older adults needing care exceeds one third. Figure 2 in the Discussion separately reports 28% with impending dehydration; it does not classify them as currently dehydrated. The study does not establish a prevalence rate for independent, community-dwelling older people. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

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  • Reduced thirst and reduced urine concentration by the kidney increase dehydration risk in older adults.

    “Among age-related physiological changes, reduced thirst and reduced urine concentration by the kidney increase dehydration risk (9,(243)(244)(245)(246).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [9]

    The paper’s introductory passage says older people are thought to face greater dehydration risk because thirst sensation and urinary concentrating ability frequently decline with age. The Discussion cautions that DRIE was cross-sectional and could not establish whether poor renal function causes dehydration or the reverse. The citing sentence presents the risk increase as established rather than qualified. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Memory problems may cause older adults to forget to drink and forget that they haven't drunk.

    “Memory problems may cause older adults to forget to drink and forget that they haven't drunk (7)(8)(9)252).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [9]

    The paper’s introductory passage says people with dementia may forget to drink when daily routines are lost, and the Discussion says dementia can disrupt drinking habits. It does not say they forget that they have not drunk; the study also cautions that its cross-sectional findings cannot establish causation. No page numbers are available in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Fluid intake may be reduced voluntarily because of issues about getting to the toilet and continence.

    “Fluid intake may also be reduced voluntarily, e.g. because of issues about getting to the toilet and continence (8,226,253).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [226]

  • In older adults, renal function is often poor so that renal parameters no longer accurately signal low-intake dehydration.

    “In older adults, renal function is often poor so that renal parameters no longer accurately signal low-intake dehydration (7,225,226).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [226]

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Cited by

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Authors
Hooper, L., Bunn, D. K., Downing, A., Jimoh, F. O., Groves, J., Free, C., Cowap, V., Potter, J. F., Hunter, P. R., & Shepstone, L.
Affiliations
  • University of East Anglia (GB)
  • University of Canberra (AU)
ORCID
Venue
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Publisher
Oxford University Press (OUP)
Published
2015-11-09
Volume
71
Issue
10
Pages
1341-1347
ISSN
  • 1079-5006 (ISSN-L)
  • 1758-535X
DOI
10.1093/gerona/glv205
PMC
PMC5018558
OpenAlex
W2194650851
Cited by
117
References
6
Citations by year
2026: 2 · 2025: 14 · 2024: 11 · 2023: 13 · 2022: 12 · 2021: 11 · 2020: 14 · 2019: 15 · 2018: 11 · 2017: 6 · 2016: 7 · 2012: 1
FWCI
14.63
Type
journal article
Language
en
Open access
Locations
  • The Journals of Gerontology Series A (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institute for Health and Care Research (CDF-2011-04-025)
  • Age UK
Topics
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
Keywords
dehydration, older adults, long-term care, residential care, serum osmolality, frailty, cognitive function, renal function, diabetes mellitus, potassium-sparing diuretics, urinary incontinence, thirst, fluid intake, prevalence
MeSH terms
Aged, Aged, 80 and over, Cross-Sectional Studies, Dehydration, Female, United Kingdom, Humans, Long-Term Care, Male, Risk Factors, Biomarkers, Geriatric Assessment, Prevalence, Frail Elderly

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