title: Hyponatremia: Special Considerations in Older Patients.
abstract: Hyponatremia is especially common in older people. Recent evidence highlights that even mild, chronic hyponatremia can lead to cognitive impairment, falls and fractures, the latter being in part due to bone demineralization and reduced bone quality. Hyponatremia is therefore of special significance in frail older people. Management of hyponatremia in elderly individuals is particularly challenging. The underlying cause is often multi-factorial, a clear history may be difficult to obtain and clinical examination is unreliable. Established treatment modalities are often ineffective and carry considerable risks, especially if the diagnosis of underlying causes is incorrect. Nevertheless, there is some evidence that correction of hyponatremia can improve cognitive performance and postural balance, potentially minimizing the risk of falls and fractures. Oral vasopressin receptor antagonists (vaptans) are a promising innovation, but evidence of their safety and effect on important clinical outcomes in frail elderly individuals is limited.
authors.affiliation: Department of Medicine for the Elderly, NHS Grampian, c/o Wards 303/4, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK. roy.soiza@nhs.net.
authors.forename: Roy L
authors.initials: RL
authors.lastname: Soiza
authors.affiliation: School of Medicine & Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK. kirsten.cumming.09@aberdeen.ac.uk.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Cumming
authors.affiliation: School of Medicine & Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK. jennifer.clarke.10@aberdeen.ac.uk.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Clarke
authors.affiliation: School of Medicine & Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK. karen.wood.10@aberdeen.ac.uk.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wood
authors.affiliation: Department of Medicine for the Elderly, NHS Grampian, c/o Wards 303/4, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK. phyo.myint@abdn.ac.uk.|School of Medicine & Dentistry, University of Aberdeen, Aberdeen AB25 2ZD, UK. phyo.myint@abdn.ac.uk.
authors.forename: Phyo K
authors.initials: PK
authors.lastname: Myint
keywords: aging; arginine vasopressin; geriatrics; hyponatremia; old; salt; sodium