Dehydration in Frail, Older Residents in Long-Term Care Facilities

An Investigation into Equations for Estimating Water Requirements and the Development of New Equations for Predicting Total Water Intake

“…Typically the distribution of body water is compared to a reference 70 kg man (Feinsod et al, 2004;Sawka et al, 2005). Using the common percentages to describe water distribution in the body, the reference 70 kg man has 42 liters of TBW, 28 liters of ICF (66%), and 14 liters of ECF (33%).…”

“…Some investigators consider any loss of total body water as dehydration (Feinsod et al, 2004;Gross et al, 1992;Kavouras, 2002;Robinson & Weber, 2004;Shireffs, 2003;Thomas et al, 2008). Others consider dehydration as a loss of body water from the intracellular and interstitial compartments (Mange et al, 1997;Thomas, Tariq, Makhdomm, Haddad, & Moinuddin, 2004).…”

“…Unlike other nutrients, water is unique in that there is day-to-day variation within an individual due to changes in PA and environmental conditions (IOM, 2005a). There are also variations between individuals; changes that occur in aging (Feinsod et al, 2004) and in body weight or body composition differences (Lee & Gallagher, 2008;Wang et al, 1999) between individuals may affect the requirements. Thus, in the assessment of water requirements these factors must be taken into consideration.…”

“…There is a reduction in the glomerular filtration rate (GFR) and free water clearance due to a diminished ability to maximally concentrate the urine (Feinsod et al, 2004;Hodak, & Verbalis, 2005;Luckey & Parsa, 2003;Schlanger et al, 2010). Other kidney factors that can specifically affect older adults are the decreased activity of renin and the decreased secretion of aldosterone (Feinsod et al, 2004;Ferry, 2005) which can directly impact water balance and urine output. However, Bossingham et al (2005) did not find any differences in urine output between older and younger men and women in a water balance study conducted on 46 individuals.…”

“…The Evidence Library committee concluded that there was insufficient evidence to discern the best equation for estimating water requirements and noted that none of the water requirement equations commonly applied in clinical practice and cited extensively in research studies (Chidester & Spangler, 1997;Holben, Hassell, Williams & Helle, 1999;Feinsod, Levenson, Rapp, Beechinor, & Liebmann, 2004) had been validated (ADA, 2007).…”