Dehydration
Evaluation and Management in Older Adults
- Andrew D. Weinberg, MD;
- Kenneth L. Minaker, MD;
- Council on Scientific Affairs, American Medical Association;
- Yank D. Coble, Jr, MD;
- Ronald M. Davis, MD;
- C. Alvin Head, MD;
- John P. Howe III, MD;
- Mitchell S. Karlan, MD;
- William R. Kennedy, MD;
- Patricia Joy Numann, MD;
- Monique A. Spillman;
- W. Douglas Skelton, MD;
- Richard M. Steinhilber, MD;
- Jack P. Strong, MD;
- Henry N. Wagner, Jr, MD;
- James R. Allen, MD, MPH;
- Robert C. Rinaldi, PhD
- Jacksonville, Fla (Chair); Lansing, Mich; (Resident Representative), Boston, Mass; San Antonio, Tex; Beverly Hills, Calif; Minneapolis, Minn; Syracuse, NY; (Medical Student Representative), Dallas, Tex; Macon, Ga; Cleveland, Ohio; New Orleans, La; Baltimore, Md. Council on Scientific Affairs staff
- From the Geriatrics and Extended Care Service, Brockton/West Roxbury Veterans Affairs Medical Center, Brockton, Mass (Drs Weinberg and Minaker); the Division on Aging, Harvard Medical School, Boston, Mass (Drs Weinberg and Minaker); and the Council on Scientific Affairs, American Medical Association, Chicago, Ill.
Abstract
Objective. —To review published literature regarding dehydration in older individuals and formulate a consensus on the evaluation and treatment of this unrecognized cause of hospitalizations, morbidity, and mortality.
Data Sources and Study Selection. —The literature concerning dehydration in the elderly population from MEDLINE was reviewed from 1976 through 1995. Search terms included dehydration, elderly, evaluation, hospitalization, and treatment. Particular emphasis was placed on articles describing original research leading to the development of new information on the evaluation and treatment of dehydration and review articles relating to the epidemiology, detection, treatment and health outcomes of this syndrome common in the geriatric population, including frail, institutionalized individuals.
Data Extraction. —Data contributing to a broad scientific understanding of dehydration were initially grouped according to topic areas of the physiology of normal aging, illness-associated clinical reports of dehydration in the elderly population, and diagnostic and therapeutic interventions. The authors developed a consensus based on the weight of evidence presented and the authors' experience in the field.
Conclusions. —Early diagnosis is sometimes difficult because the classical physical signs of dehydration may be absent or misleading in an older patient. Many different etiologies place the elderly at particular risk. In patients identified as being at risk for possible dehydration, an interdisciplinary care plan with regard to prevention of clinically significant dehydration is critical if maximum benefit is to result.
(JAMA. 1995;274:1552-1556)
Footnotes
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The recommendations of Report 1 of the Council on Scientific Affairs were adopted at the 1994 House of Delegates Annual Meeting and the remainder of the report was filed.
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This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the scientific literature as of April 1995.
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Reprint requests to Group on Science, Technology, and Public Health, Council on Scientific Affairs, American Medical Association, 515 N State St, Chicago, IL 60610 (James R. Allen, MD, MPH).
