The burden and outcomes associated with dehydration among US elderly, 1991.

Warren, Jessica; Bacon, W. Edward; Harris, Tamara B.; McBean, A. Marshall; Foley, Daniel J.; Phillips, Carolyn

doi:10.2105/ajph.84.8.1265

Cited by 209 publications

(141 citation statements)

References 12 publications

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“…Dehydration in older adults has been shown to be a reliable predictor of increasing frailty, progressive deterioration in cognitive function and an overall reduction in quality of life (Warren et al, 1994;Miller et al, 1998). These adverse long-term outcomes of dehydration in the elderly mandate further research into the pathophysiology and manifestations of mild dehydration in order to facilitate early recognition and prompt intervention.…”

Section: Introductionmentioning

confidence: 99%

Impaired cognitive function and mental performance in mild dehydration

2003

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Dehydration is a reliable predictor of impaired cognitive status. Objective data, using tests of cortical function, support the deterioration of mental performance in mildly dehydrated younger adults. Dehydration frequently results in delirium as a manifestation of cognitive dysfunction. Although, the occurrence of delirium suggests transient acute global cerebral dysfunction, cognitive impairment may not be completely reversible. Animal studies have identified neuronal mitochondrial damage and glutamate hypertransmission in dehydrated rats. Additional studies have identified an increase in cerebral nicotinamide adenine dinucleotide phosphate-diaphorase activity (nitric oxide synthase, NOS) with dehydration. Available evidence also implicates NOS as a neurotransmitter in long-term potentiation, rendering this a critical enzyme in facilitating learning and memory. With ageing, a reduction of NOS activity has been identified in the cortex and striatum of rats. The reduction of NOs synthase activity that occurs with ageing may blunt the rise that occurs with dehydration, and possibly interfere with memory processing and cognitive function. Dehydration has been shown to be a reliable predictor of increasing frailty, deteriorating mental performance and poor quality of life. Intervention models directed toward improving outcomes in dehydration must incorporate strategies to enhance prompt recognition of cognitive dysfunction.

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Section: Introductionmentioning

confidence: 99%

Impaired cognitive function and mental performance in mild dehydration

2003

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“…This population is at risk for dehydration because the elderly have a diminished sensation of thirst and are less able to regulate their¯uid balance (Crowe et al, 1987;Phillips et al, 1991). If left untreated, dehydration can result in death in many cases (Mahowald & Himmelstein, 1981;Warren et al, 1994). Dehydration is poorly de®ned and its clinical signs can be vague, especially in the elderly (Chernoff, 1994;Weinberg & Minaker, 1995).…”

Section: Introductionmentioning

confidence: 99%

Validation of a dietary record routine in geriatric patients using doubly labelled water

2000

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Objective: To validate a 7-day estimated dietary record routine with standardized portion sizes and household measuring in a clinical setting with the doubly labelled water (DLW) method as the reference method. Design: Energy expenditure was measured with deuterium ( 2 H) and oxygen-18 ( 18 O), and water loss was estimated by 2 H dilution as part of the DLW measurements. Energy and water intake was measured with a 7 day dietary record. Setting: Five nursing home wards in Sweden. Subjects: Thirty-one geriatric patients with a mean age of 86 y. Inclusion criteria were stable body weight, de®ned as a maximum change of + 4% during the last 4 months of + 2% during the last 2 months and without any acute illness. Results: The mean daily energy intake was 7.2 MJ (1727 kcal) and the mean daily energy expenditure was 6.7 MJ (1595 kcal). The mean daily water intake was 1787 ml and mean daily water loss assessed by labelled water was 1774 ml. Using the dietary record routine, the staff overestimated the patients' energy intake by 8% and water intake from food and beverages by`1% compared to DLW. Conclusion: The 7 day dietary record routine based on standardized portion sizes and household measuring seems to be a valid method for assessing the intake of energy and¯uids by geriatric patients.

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“…A recent study from 50 sites in Europe [7] found that 75% of study participants with mild COPD (GOLD stage II) were already taking inhaled corticosteroids, despite the fact that no inhaled medication has been found to improve clinical outcomes in patients with an FEV1 .50% pred [8].…”

Section: To the Editorsmentioning

confidence: 99%

“…This may be due to the fact that chronic renal impairment is more prevalent in the older population, and dehydration, which is common in acutely unwell older patients, may also contribute to a higher urea level [8]. With this background, we set out to assess whether raising the cut-off point of urea, while keeping the other criteria in CURB-65 as they are, would improve the specificity and positive predictive value (PPV) of the criteria in predicting mortality.…”

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confidence: 99%

Is it time to rethink the urea criterion in CURB-65?: Table 1—

Kamath¹

2006

Eur Respir J

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We read the article by CAPELASTEGUI et al.[1] on the validation of the severity assessment rules for the management of community-acquired pneumonia (CAP) with interest. The authors concluded that CURB-65 (confusion, urea .7 mmol? L -1 , respiratory rate o30?min -1 , low systolic (,90 mmHg) or diastolic (f60 mmHg) blood pressure, and aged o65 yrs) and CRB-65 indices recommended by the British Thoracic Society are indeed useful and easy to apply in day-to-day clinical practice, thereby helping in risk stratification and management as demonstrated by LIM et al. [2].With the current demographic trends, the proportion of the older population is set to rise. Globally, the projected number of people aged o65 yrs will double between 2000 and 2030 [3]. Moreover, CAP is common in older people and is associated with high mortality [4]. We note that the mean ages of patients reported in CAPELASTEGUI et al. [1] and LIM et al.[2] were 64.1 and 61.8 yrs, respectively. In a prospective study of elderly patients aged o65 yrs with CAP (mean¡SD age 81.1¡7.9 yrs), we reported that the sensitivity and specificity of CURB in predicting death were 81 and 52%, respectively [5]. The specificity figure of this elderly cohort was much lower than in other studies of younger patients [2,6,7]. Due to this low specificity, the CURB-65 criteria in their current form are not ideal for assessing older CAP patients.In the same study, we found that the urea criterion was only of borderline significance and cautioned that the urea cut-off point of .7 mmol?L -1 in the CURB criteria may not be a sufficiently specific parameter [5]. This may be due to the fact that chronic renal impairment is more prevalent in the older population, and dehydration, which is common in acutely unwell older patients, may also contribute to a higher urea level [8]. With this background, we set out to assess whether raising the cut-off point of urea, while keeping the other criteria in CURB-65 as they are, would improve the specificity and positive predictive value (PPV) of the criteria in predicting mortality.Analyses were conducted based on data from two prospective cohort studies [5,7], which were carried out in a single institute in UK using similar inclusion and exclusion criteria. Although all ages were included in the first study [7], in the second study only those who were aged o65 yrs were included [5]. Therefore, the compilation cohort consisted of a higher number of older patients with CAP and a higher mean age (mean¡SD age 70.3¡18.2 yrs) compared with previously reported studies.A total of 193 patients were included in the currently reported analysis. It was hypothesised that increasing the urea cut-off level in older people would improve the specificity of CURB-65. This hypothesis was tested by increasing the urea cutoff point by 2 mmol?L -1 each time from the currently recommended urea cut-off level of .7 mmol?L -1 (i.e. CU9RB-65 with urea cut-off .9 mmol?L -1 , CU11RB-65 using urea cutoff .11 mmol?L -1 and CU13RB-65 using urea cut-off .13 mmol?L -1 ), and th...

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The burden and outcomes associated with dehydration among US elderly, 1991.

Cited by 209 publications

References 12 publications

Impaired cognitive function and mental performance in mild dehydration

Impaired cognitive function and mental performance in mild dehydration

Validation of a dietary record routine in geriatric patients using doubly labelled water

Is it time to rethink the urea criterion in CURB-65?: Table 1—

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