title: Hyponatremia: incidence, risk factors, and consequences in the elderly in a home-based primary care program.
abstract: OBJECTIVE
  To determine the incidence, risk factors, etiology, and associations of hyponatremia in community-dwelling elderly with geriatric morbidity and mortality.
  
  
  METHODS
  Elderly participants of a single center home-based primary care program were included.
  
  
  METHODS
  Retrospective chart review was conducted on demographic and clinical variables, comorbid diseases, frailty by Fried criteria and biochemical tests over a 1-year period. Primary outcome measure was a composite of falls, fractures due to falls, and hospitalization witnessed within the first year of enrollment into the program. Secondary outcome was all-cause mortality.
  
  
  RESULTS
  The study population (n = 608) had a mean age of 84.3 ± 9.3 years and was largely female (77.1%) and African-American (89.5%). Mean follow-up was 41.5 months. Frailty was seen in 44.4%. Incidence of allcause mortality was 26.9%. Initial hyponatremia occurred in 8.71% (n = 53), and persistent hyponatremia (> 6 months of low serum sodium) in 4.1% (n = 25) of the study population. The major causes of hyponatremia included multiple potential causes, idiopathic syndrome of inappropriate antidiuretic hormone (SIADH) and medications (thiazides and selective serotonin reuptake inhibitor (SSRI)). Primary outcome was independently associated with frailty (Odds ratio (OR) of 2.33) and persistent but not initial hyponatremia (OR 3.52). Secondary outcome was independently associated with age > 75 years (OR 2.88) and Afro-American race (OR 2.09) only but not to frailty or hyponatremia.
  
  
  CONCLUSIONS
  Hyponatremia is common in home-bound elderly patients and its persistence independently contributes to falls, fractures, and hospitalization but not mortality. Our study highlights a new association of hyponatremia with frailty and underscores the need to study time-dependent association of hyponatremia with epidemiological outcomes.
authors.forename: Anirban
authors.initials: A
authors.lastname: Ganguli
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Mascarenhas
authors.forename: Namirah
authors.initials: N
authors.lastname: Jamshed
authors.forename: Eshetu
authors.initials: E
authors.lastname: Tefera
authors.forename: Judith H
authors.initials: JH
authors.lastname: Veis
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016021:Epidemiologic Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology; D016330:Frail Elderly / Q000706:statistics & numerical data; D006699:Home Care Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007010:Hyponatremia / Q000453:epidemiology*; D007177:Inappropriate ADH Syndrome / Q000453:epidemiology; D015994:Incidence; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D049971:Thiazides / Q000627:therapeutic use
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D049971:Thiazides