• acute kidney injury
• nursing assessment
• signs and symptoms
• symptom assessment

• Humans
• Acute Kidney Injury/physiopathology
• Acute Kidney Injury/complications
• Dehydration/etiology
• Adult
• Hypovolemia/etiology
• Hypovolemia/diagnosis
• Water-Electrolyte Balance/physiology

• This research was supported by the National Institute for Health Research (NIHR).

• Aged
• Humans
• Aged, 80 and over
• Dehydration/diagnosis
• Dehydration/epidemiology
• Osmolar Concentration

• Acute care
• Bioelectrical impedance analysis
• Dehydration
• Older adults
• Systematic review

• Assessment
• Body composition
• Health
• Performance
• Physiology

Dehydration is common in the elderly, especially when hospitalised. This study investigated the impact of interventions to improve hydration in acutely unwell or institutionalised older adults for hydration and hydration linked events (constipation, falls, urinary tract infections) as well as patient satisfaction. Four databases were searched from inception to 13 May 2020 for studies of interventions to improve hydration. Nineteen studies (978 participants) were included and two studies (165 participants) were meta-analysed. Behavioural interventions were associated with a significant improvement in hydration. Environmental, multifaceted and nutritional interventions had mixed success. Meta-analysis indicated that groups receiving interventions to improve hydration consumed 300.93 mL more fluid per day than those in the usual care groups (95% CI: 289.27 mL, 312.59 mL; I² = 0%, p < 0.00001). Overall, there is limited evidence describing interventions to improve hydration in acutely unwell or institutionalised older adults. Behavioural interventions appear promising. High-quality studies using validated rather than subjective methods of assessing hydration are needed to determine effective interventions.

• beverages
• dehydration
• elderly
• fluid
• geriatric
• inpatient
• institutionalized
• meta-analysis
• systematic review

• Aged
• Aged, 80 and over
• Behavior
• Environment
• Female
• Humans
• Male
• Middle Aged
• Nutritional Physiological Phenomena
• Patient Satisfaction
• Publication Bias
• Risk
• Water-Electrolyte Balance/physiology

• Aged
• Dehydration/prevention & control
• Drinking
• Geriatric Nursing
• Humans
• Urinalysis
• Water-Electrolyte Balance

• biomarkers
• biomedical sensors
• electrolyte imbalance
• health performance
• hyperkalemia
• hypocalcemia
• hyponatremia
• proteomics and metabolomics
• wearables

• Electrolytes/analysis
• Humans
• Neoplasms/complications
• Water-Electrolyte Imbalance/diagnosis
• Water-Electrolyte Imbalance/etiology

• dehydration
• hypernatraemia
• management practices
• nursing home
• older person

• dehydration
• electrolytes
• enteral nutrition
• fluids
• older adult
• overhydration

Dehydration is prevalent in hospitalised patients and is associated with increased morbidity and mortality, particularly among the elderly (≥65 years). We aimed at comparing the performance of intracellular water to extracellular water ratio (ICW/ECW), calculated through a bioelectrical impedance analysis (BIA) of blood urea nitrogen, with the creatinine ratio (BUN/Cr) to predict poor outcomes in a cohort of prospectively identified patients. Data were combined from a cohort of elderly patients (≥65 years) admitted to hospital with fragility fracture (n = 125) and older adults aged ≥50 years admitted to hospital with stroke (n = 40). The association between hydration status and study outcomes (unfavourable discharge destination (rehabilitation, another ward, or death) and prolonged hospitalisation (>10 days)) was examined using logistic regression. The overall diagnostic accuracy of each hydration status measurement was assessed using the area under the receiver operating characteristic (ROC) curve. In 165 participants (mean age (SD) of 76.7 (9.2) years), an ICW/ECW ratio below the 25th percentile was associated with increased odds of poor discharge destination (OR (95% CI) = 4.25 (1.59–11.34)). Neither the relationship between the BUN/Cr ratio and prolonged stay nor discharge destination was significant. A BIA could be used utilised in conjunction with biochemical measurements to inform patient prognosis.

• bioelectrical impedance
• blood urea nitrogen
• creatinine
• dehydration
• extracellular
• intracellular

Dengue is a systemic and dynamic disease with symptoms ranging from undifferentiated fever to dengue shock syndrome. Assessment of patients’ severity of dehydration is integral to appropriate care and management. Urine colour has been shown to have a high correlation with overall assessment of hydration status. This study tests the feasibility of measuring dehydration severity in dengue fever patients by comparing urine colour captured by mobile phone cameras to established laboratory parameters.

Photos of urine samples were taken in a customized photo booth, then processed using Adobe Photoshop to index urine colour into the red, green, and blue (RGB) colour space and assigned a unique RGB value. The RGB values were then correlated with patients’ clinical and laboratory hydration indices using Pearson’s correlation and multiple linear regression. There were strong correlations between urine osmolality and the RGB of urine colour, with r = -0.701 (red), r = -0.741 (green), and r = -0.761 (blue) (all p-value <0.05). There were strong correlations between urine specific gravity and the RGB of urine colour, with r = -0.759 (red), r = -0.785 (green), and r = -0.820 (blue) (all p-value <0.05). The blue component had the highest correlations with urine specific gravity and urine osmolality. There were moderate correlations between RGB components and serum urea, at r = -0.338 (red), -0.329 (green), -0.360 (blue). In terms of urine biochemical parameters linked to dehydration, multiple linear regression studies showed that the green colourimetry code was predictive of urine osmolality (β coefficient -0.082, p-value <0.001) while the blue colourimetry code was predictive of urine specific gravity (β coefficient -2,946.255, p-value 0.007).

Urine colourimetry using mobile phones was highly correlated with the hydration status of dengue patients, making it a potentially useful hydration status tool.

The vast majority of symptomatic dengue infections will result in an uncomplicated disease course. A small proportion will develop severe dengue late in the course of disease, on about day 4 or 5 of illness. In the absence of early prognostic markers to triage dengue patients for early supportive intervention, all suspected dengue cases are followed up for daily assessment, which includes an assessment of dehydration. While the clinical assessment of dehydration is subjective, the passing of dark-coloured urine is an accepted indicator of dehydration. However, visual assessment of urine colour is limited by the varied perception of colour and ambient lighting. An objective method to assess urine colour is to encode it in the RGB model. We used a mobile phone to capture an image of urine samples under standardised conditions and computed the RGB value of each image. Our study demonstrated that RGB urine colourimetry using mobile phones is highly correlated with the hydration status of dengue patients, making it a hydration status tool of great potential.

• Adolescent
• Adult
• Cell Phone
• Child
• Color
• Colorimetry/instrumentation
• Colorimetry/methods
• Cross-Sectional Studies
• Dehydration/urine
• Dengue/pathology
• Dengue/urine
• Female
• Humans
• Male
• Middle Aged
• Urine/chemistry
• Young Adult

Background and Objectives: Dehydration might be an issue after hip fracture surgery, but the optimal tools to identify the dehydrated condition have not been determined. The aim of the present study was to compare the characteristics of elderly postoperative patients who were classified as dehydrated according to the methods used in the clinic. Materials and Methods: Thirty-eight patients aged between 65 and 97 (mean, 82) years were studied after being admitted to a geriatric department for rehabilitation after hip fracture surgery. Each patient underwent blood analyses, urine sampling, and clinical examinations. Results: Patients ingested a mean of 1,008 mL (standard deviation, 309 mL) of fluid during their first day at the clinic. Serum osmolality increased significantly with the plasma concentrations of sodium, creatinine, and urea. Seven patients had high serum osmolality (≥300 mosmol/kg) that correlated with the presence of tongue furrows (p < 0.04), poor skin turgor (p < 0.03), and pronounced albuminuria (p < 0.03). Eight patients had concentrated urine (urine-specific gravity ≥ 1.025) that correlated with a low intake of liquid and with a decrease in body weight during the past month of −3.0 kg (25–75 th percentiles, −5.1 to −0.9) versus +0.2 (−1.9 to +2.7) kg (p < 0.04). Conclusions: Renal fluid conservation of water, either in the form of hyperosmolality or concentrated urine, was found in 40% of the patients after hip fracture surgery. Hyperosmolality might not indicate a more severe fluid deficit than is indicated by concentrated urine but suggests an impaired ability to concentrate the urine.

• dehydration
• frail elderly patient
• urine color
• urine osmolality

• Aged
• Aged, 80 and over
• Analysis of Variance
• Creatinine/analysis
• Creatinine/blood
• Dehydration/diagnosis
• Dehydration/physiopathology
• Female
• Hip Fractures/complications
• Hip Fractures/physiopathology
• Humans
• Male
• Orthopedic Procedures/adverse effects
• Osmolar Concentration
• Sodium/analysis
• Sodium/blood
• Sweden
• Urea/analysis
• Urea/urine

• Bacillus coagulans GBI-30
• GanedenBC(30)®
• Gastrointestinal
• Immune system
• Probiotic
• Upper respiratory

• Aged
• dehydration
• diagnosis
• drinking
• osmolar concentration
• sensitivity and specificity

• Urine color
• dehydration
• frail elderly patients
• urine osmolality

• Dehydration
• Nursing homes
• Older people
• Risk factors

• Aged
• Dehydration/epidemiology
• Humans
• Nursing Homes
• Ontario
• Risk Factors

• Body fluids
• Body water
• Congestive heart failure
• Extracellular volume
• Hepatic cirrhosis
• Hypertonicity
• Hypotonicity
• Nephrotic syndrome
• Sepsis

• R01 HL105649 NHLBI NIH HHS
• U01 HL071556 NHLBI NIH HHS
• F32 DK009924 NIDDK NIH HHS
• R01 HL109015 NHLBI NIH HHS
• U01 DK099914 NIDDK NIH HHS
• R01 DK073665 NIDDK NIH HHS

• bowel preparation, dehydration, endoscopy, carbohydrate fluid, ASA guidelines, preoperative fasting

• Carbohydrates/administration & dosage
• Citrates/adverse effects
• Colonoscopy/methods
• Dehydration/prevention & control
• Drinking
• Humans
• Hypotension, Orthostatic/prevention & control
• Middle Aged
• Organometallic Compounds/adverse effects
• Picolines/adverse effects
• Preoperative Care
• Prospective Studies
• Single-Blind Method

• Dehydration
• Dementia
• Elderly
• Hypernatremia
• Hyponatremia
• Thirst
• Water

• Aging/metabolism
• Dehydration/metabolism
• Homeostasis/physiology
• Humans
• Hypernatremia/metabolism
• Hyponatremia/metabolism
• Kidney Diseases/metabolism

• Dehydration
• Drinking
• Fluid therapy
• Nursing care
• Risk assessment

• aged
• dehydration
• osmolar concentration
• sensitivity and specificity
• specific gravity
• urinalysis

• Aged
• Aged, 80 and over
• Dehydration/complications
• Female
• Frail Elderly
• Humans
• Male
• Memory Disorders/complications

• Aged
• Dehydration/blood
• Dehydration/diagnosis
• Drinking Water/administration & dosage
• Electric Impedance
• Female
• Humans
• Male
• Mouth Diseases/diagnosis
• Osmolar Concentration
• Sensitivity and Specificity
• Skin Physiological Phenomena
• Symptom Assessment/methods
• Urine

• CDF-2011-04-025 Department of Health

Dehydration is common among elderly people. The aim of this study was to perform validation analysis of a geriatric dehydration-screening tool (DST) in the assessment of hydration status in elderly people. This tool was based on the DST proposed by Vivanti et al., which is composed by 11 items (four physical signs of dehydration and seven questions about thirst sensation, pain and mobility), with four questions extra about drinking habits. The resulting questionnaire was evaluated in a convenience sample comprising institutionalized (n = 29) and community-dwelling (n = 74) elderly people. Urinary parameters were assessed (24-h urine osmolality and volume) and free water reserve (FWR) was calculated. Exploratory factor analysis was used to evaluate the scale’s dimensionality and Cronbach’s alpha was used to measure the reliability of each subscale. Construct’s validity was tested using linear regression to estimate the association between scores in each dimension and urinary parameters. Two factors emerged from factor analysis, which were named “Hydration Score” and “Pain Score”, and both subscales showed acceptable reliabilities. The “Hydration Score” was negatively associated with 24-h urine osmolality in community-dwelling; and the “Pain Score” was negatively associated with 24-h urine osmolality, and positively associated with 24-h urine volume and FWR in institutionalized elderly people.

A non-invasive solution for monitoring of the activity and dehydration of organisms is proposed in the work. For this purpose, a wireless standalone chemical sensor platform using two separate measurement techniques has been developed. The first approach for activity monitoring is based on humidity measurement. Our solution uses new humidity sensor based on a nanostructured TiO₂ surface for sweat rate monitoring. The second technique is based on monitoring of potassium concentration in urine. High level of potassium concentration denotes clear occurrence of dehydration. Furthermore, a Wireless Body Area Network (WBAN) was developed for this sensor platform to manage data transfer among devices and the internet. The WBAN coordinator controls the sensor devices and collects and stores the measured data. The collected data is particular to individuals and can be shared with physicians, emergency systems or athletes' coaches. Long-time monitoring of activity and potassium concentration in urine can help maintain the appropriate water intake of elderly people or athletes and to send warning signals in the case of near dehydration. The created sensor system was calibrated and tested in laboratory and real conditions as well. The measurement results are discussed.

• Deep vein thrombosis
• Dehydration
• Déshydratation
• Elderly
• Personne âgée
• Thrombose veineuse profonde

• deglutition disorders
• hydration
• rehabilitation
• stroke
• water-electrolyte imbalance

• Adult
• Age Factors
• Aged
• Deglutition Disorders
• Dehydration/epidemiology
• Drinking
• Female
• Fluid Therapy
• Health Status
• Humans
• Hypernatremia/epidemiology
• Male
• Middle Aged
• Risk Factors
• Sex Factors
• Stroke/complications
• Stroke Rehabilitation
• Urinary Tract Infections/epidemiology

• Dehydration
• clinical
• diagnosis
• hypovolemia
• older
• osmolality

• data collection
• deglutition disorders
• dehydration
• drinking
• fluid balance
• thickened liquids

• Bioelectrical impedance analysis
• dehydration
• quality-of-life
• residential facilities

• Adiposity
• Age Factors
• Aged
• Aged, 80 and over
• Body Composition
• Body Water/metabolism
• Case-Control Studies
• Deglutition
• Deglutition Disorders/complications
• Deglutition Disorders/diagnosis
• Deglutition Disorders/physiopathology
• Dehydration/diagnosis
• Dehydration/etiology
• Dehydration/metabolism
• Dehydration/physiopathology
• Electric Impedance
• Female
• Homes for the Aged
• Humans
• Pilot Projects
• Predictive Value of Tests
• Residential Facilities
• Risk Factors
• Water-Electrolyte Balance

• Aged
• Dehydration
• Drinking
• Osmolar concentration

• Critical illness
• Enteral nutrition
• Hydration
• Nutrition assessment
• Older adults
• Parenteral nutrition

• assessment
• dehydration
• elderly
• hydration
• older
• weight

• Aged
• Aged, 80 and over
• Body Weight
• Dehydration/metabolism
• Feces
• Female
• Humans
• Inpatients/statistics & numerical data
• Linear Models
• Male
• Nutrition Assessment
• Reference Values

Adults with severe malaria frequently require intravenous fluid therapy to restore their circulating volume. However, fluid must be delivered judiciously as both under- and over-hydration increase the risk of complications and, potentially, death. As most patients will be cared for in a resource-poor setting, management guidelines necessarily recommend that physical examination should guide fluid resuscitation. However, the reliability of this strategy is uncertain.

To determine the ability of physical examination to identify hypovolaemia, volume responsiveness, and pulmonary oedema, clinical signs and invasive measures of volume status were collected independently during an observational study of 28 adults with severe malaria.

The physical examination defined volume status poorly. Jugular venous pressure (JVP) did not correlate with intravascular volume as determined by global end diastolic volume index (GEDVI; r_s = 0.07, p = 0.19), neither did dry mucous membranes (p = 0.85), or dry axillae (p = 0.09). GEDVI was actually higher in patients with decreased tissue turgor (p < 0.001). Poor capillary return correlated with GEDVI, but was present infrequently (7% of observations) and, therefore, insensitive. Mean arterial pressure (MAP) correlated with GEDVI (r_s = 0.16, p = 0.002), but even before resuscitation patients with a low GEDVI had a preserved MAP. Anuria on admission was unrelated to GEDVI and although liberal fluid resuscitation led to a median hourly urine output of 100 ml in 19 patients who were not anuric on admission, four (21%) developed clinical pulmonary oedema subsequently. MAP was unrelated to volume responsiveness (p = 0.71), while a low JVP, dry mucous membranes, dry axillae, increased tissue turgor, prolonged capillary refill, and tachycardia all had a positive predictive value for volume responsiveness of ≤50%. Extravascular lung water ≥11 ml/kg indicating pulmonary oedema was present on 99 of the 353 times that it was assessed during the study, but was identified on less than half these occasions by tachypnoea, chest auscultation, or an elevated JVP. A clear chest on auscultation and a respiratory rate <30 breaths/minute could exclude pulmonary oedema on 82% and 72% of occasions respectively.

Findings on physical examination correlate poorly with true volume status in adults with severe malaria and must be used with caution to guide fluid therapy.

Clinicaltrials.gov identifier: NCT00692627

• Palliative care
• bioelectrical impedance analysis
• cancer
• clinically assisted hydration
• dehydration
• hydration

• Cardiography, Impedance/methods
• Cardiography, Impedance/statistics & numerical data
• Causality
• Comorbidity
• Dehydration/epidemiology
• Dehydration/nursing
• Evidence-Based Medicine
• Fluid Therapy/statistics & numerical data
• Humans
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Neoplasms/nursing
• Outcome Assessment, Health Care/methods
• Outcome Assessment, Health Care/statistics & numerical data
• Reproducibility of Results
• Sensitivity and Specificity
• Treatment Outcome

Non-invasive methods for detecting water-loss dehydration following acute stroke would be clinically useful. We evaluated the diagnostic accuracy of multi-frequency bioelectrical impedance analysis (MF-BIA) against reference standards serum osmolality and osmolarity.

Patients admitted to an acute stroke unit were recruited. Blood samples for electrolytes and osmolality were taken within 20 minutes of MF-BIA. Total body water (TBW%), intracellular (ICW%) and extracellular water (ECW%), as percentages of total body weight, were calculated by MF-BIA equipment and from impedance measures using published equations for older people. These were compared to hydration status (based on serum osmolality and calculated osmolarity). The most promising Receiver Operating Characteristics curves were plotted.

27 stroke patients were recruited (mean age 71.3, SD10.7). Only a TBW% cut-off at 46% was consistent with current dehydration (serum osmolality >300 mOsm/kg) and TBW% at 47% impending dehydration (calculated osmolarity ≥295–300 mOsm/L) with sensitivity and specificity both >60%. Even here diagnostic accuracy of MF-BIA was poor, a third of those with dehydration were wrongly classified as hydrated and a third classified as dehydrated were well hydrated. Secondary analyses assessing diagnostic accuracy of TBW% for men and women separately, and using TBW as a percentage of lean body mass showed some promise, but did not provide diagnostically accurate measures across the population.

MF-BIA appears ineffective at diagnosing water-loss dehydration after stroke and cannot be recommended as a test for dehydration, but separating assessment by sex, and using TBW as a percentage of lean body weight may warrant further investigation.

• Cost of Illness
• Dehydration/nursing
• Dehydration/physiopathology
• Dehydration/psychology
• Evidence-Based Nursing
• Fluid Therapy
• Geriatric Nursing
• Humans
• Risk Factors
• United States