The Prevalence, Risk Factors and Clinical Implications of Dehydration in Older Patients: A Cross-Sectional Study

Objectives: Adequate hydration is essential for the maintenance of physiological functions. Older adults may not be able to maintain adequate hydration, which is often not recognized. Our aim was to investigate the prevalence, risk factors and clinical implications of dehydration in older adults. Methods: This cross-sectional study included 964 older adults in one geriatric outpatient clinic in Turkey. Dehydration was defined as a calculated [1,86 x (Na+K)+1,15xglucose+urea+14] plasma osmolarity of ≥295 mOsm/L. Clinical characteristics and measures of comperehensive geriatric assessments of patients with dehydration and normohydration were compared. Predictors of dehydration were assessed using logistic regression analysis. Results: Mean age was 79.9±7.7 years, (71.7% female). The prevalence of dehydration was 31%. Female patients, diabetes mellitus (DM), chronic renal failure (CKD), a higher risk of falling (based on Timed Up and Go test), probable sarcopenia, dependence based on basic and instrumental daily living activities (BADL and IADL) were more common in the dehydrated group (p<0.05). After adjusting for age and gender, dependency on BADL and IADL, the risk of falling were still higher in the dehydrated group (p<0.05). There were significant relationships between dehydration and risk of falling (OR 1.38, 95% CI 1.00-1.90; p<0.05), after adjustment for age, gender, DM, CKD. Conclusion: Dehydration is common among older adults and is associated with a dependency, probable sarcopenia, and an increased risk of falling. Screening for dehydration and taking preventive measures may be beneficial in avoiding the negative consequences associated with dehydration.</p

Frequency and Clinical Impact of Anticholinergic Burden in older patients: Comparing older patients with and without chronic kidney disease

Aim: This study aimed to determine the frequency and impact of anticholinergic burden in older adults with chronic kidney disease (CKD) and compare the results to older adults without CKD. Method: Age- and sex-matched older adults (age ≥60) were selected from a total cohort of 1557 subjects, and grouped as CKD (n=589) and Non-CKD (n=589). Groups were compared for the frequency, type of anticholinergic agents, and their effects on comprehensive geriatric assessment parameters. The anticholinergic burden was assessed using the anticholinergic burden (ACB) scale. An ACB of ≥2 was categorized as high anticholinergic burden. Results: The mean age of the partients was 81±6, and 66% were female. More patients in the CKD group experienced a high anticholinergic burden (45%, versus 38%, p=0.015). Patients with CKD were more likely to receive beta blocker (25% versus 19%, p=0.018), diuretic (19% versus 6%, p<0.001), while those who did not have CKD were more likely to be treated with dopaminergic agents (8% versus 12%, p=0.039). A high anticholinergic burden was associated with sarcopenia (OR 1.62, 95% CI 1.10-2.38, p=0.015), geriatric depression scale (OR 1.50, 95% CI 1.02-2.20, p=0.037), and polypharmacy (OR 4.05, 95% CI 2.38-6.90, p<0.001), after adjustment for age, sex and comorbidities in the CKD group (p<0.05). Conclusion: Older patients with CKD are more likely to be exposed to drugs with anticholinergic effects, but have less clinical implications than those without CKD. A high anticholinergic burden is associated with polypharmacy, depression and sarcopenia in CKD