title: Is the prevalence of dehydration among community-dwelling older adults really low? Informing current debate over the fluid recommendation for adults aged 70+years.
abstract: OBJECTIVE
  The fluid recommendation for adults aged 70+ years has been criticised on the basis of a low prevalence of dehydration in community-dwelling older adults. This study explores whether the low prevalence might reflect limitations of individual dehydration indices.
  
  
  METHODS
  Cross-sectional data on plasma sodium, blood urea nitrogen (BUN), creatinine, glucose and potassium were used to classify 1,737 participants of the 1992 Established Populations for Epidemiologic Studies of the Elderly (EPESE) (70+ years) according to multiple dehydration indices. Associations between dehydration indices, health and functional status were evaluated.
  
  
  RESULTS
  Depending on the indicator used, the prevalence of dehydration ranged from 0.5% for hypotonic hypovolaemia only (plasma tonicity < 285 mOsm l(-1) with orthostatic hypotension) to 60% with dehydration defined as either plasma sodium >or=145 mEq l(-1), BUN/creatinine ratio >or=20, tonicity >or=295 mOsm l(-1), or hypotonic hypovolaemia. Elevated tonicity and BUN/creatinine ratio were respectively associated with chronic disease and functional impairment.
  
  
  CONCLUSIONS
  The true prevalence of dehydration among community-dwelling adults may be low or high, depending on the indicator(s) used to define dehydration. Before we can pinpoint a generalisable prevalence of dehydration for community-dwelling seniors and draw conclusions about fluid recommendations, validation studies of dehydration indices and longitudinal studies of dehydration, health and functional status are needed.
authors.affiliation: Center for the Study of Aging and Human Development, Claude D Pepper Older Americans Independence Center, Duke University Medical Center, Box 3003, Durham, NC 27710, USA. jstookey@stanford.edu
authors.forename: Jodi Dunmeyer
authors.initials: JD
authors.lastname: Stookey
authors.forename: Carl F
authors.initials: CF
authors.lastname: Pieper
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001786:Blood Glucose; D001806:Blood Urea Nitrogen; D001834:Body Water / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000175:diagnosis / Q000453:epidemiology*; D004326:Drinking; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006306:Health Surveys; D006801:Humans; D008297:Male; D018673:Nutrition Policy; D009751:Nutritional Requirements; D011188:Potassium / Q000097:blood; D015995:Prevalence; D012964:Sodium / Q000097:blood; D014481:United States / Q000453:epidemiology; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D012964:Sodium; D003404:Creatinine; D011188:Potassium